HomeMy WebLinkAboutPermit Building 1993-5-19
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORI<:~ lor)
ASSESSORS MAP: I f"}() ~ /1')
OWNER: '- )P_OJ') j Q J~~ 1 ~
'''::'''15IIJ/)' (}.{j I),OJ ;",
CITY: . j ( 7 STATE: ~ 0 ~frrt
DESCRIBE wOi\!st\'\,Yf\ 11.1 CUN"f\Q C\ (\d) l\ I\fYYt ~
NEW ~ REMODEL ~~ITION DEMOLISH -\ OTHER
LOT'
BLOCK:
.
JOB NUMBER -(].gO-lclLo
225 Fifth Slreel
Springfield, Oregon 97477
TAX LOT:
r )44-{ Y )
SUBDIVISION:
PHONE: ~4f\ -p,q~ 1
)
ZIP:
CONST.
CONTRACTsm'~ NA~r..~ ADDRESS )...\, _ CONTRACTOR HI _I k^~XPIRES I'HONE_
GENERAL:\"l(YfH ~nlNlY\ \44\ ~Aqqt\)JL lV~! 6/1ft1l}fl~?1/t;L')
PLUMBING(~QJ1 , ru~ \\ \~ II l \-
~::c::~~:~'~ci 0 {1l-~~1t5U)[) ) (j/SI'~1 J~/f)?/l3
\ R-\\JlU - OFFICE USE -
QUAD AREA: LAND USE: \\Rl FLOOD PLAIN:
H OF BLDGS' \ H OF UNITS: \ ZONING CODE:---lD~
OCCY GROUP: \~?J-\ \-v\. CONSTR. TYPE: \/.0 . OF BDRMS: ,~
H OF STORIES: \ HEAT SOURCE: I='v SECONDARY HEAT:
WATER HEATER' V RANGE: U SQUARE FOOTAGE: 15l.oh
To request an InspectIon, you must call 726-3769. This Is a 24 hour recording. All inspections requested before 7:00 a.m. will bc
made the same working day, Inspection.s reques.ted after 7:00 ~.r:n.!~}1l be made ,the. following work day.
o Temporary Electric
o
Masonry - Steel location, bond
beams, grouting.
o
Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/ Mechanical
- Prior to insulation or decking.
o
Post and Beam - Prior to floor
Insulation or d~cking.
o Floor Insulation - Prior to
decking.
rt:t5{ Sanitary Sewer - Prior to fillrng
L...f-l trench.
O Storm Sewer - Prior to filling
trench. .
rcB Water Line - Prior to filling.
L+J trench.
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
m Rough Electrical -
T cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - After installation.
o Insert - After fireplace approval
and installatIon of unit.
o Curbcut & Approach - After
(orms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In prace.
o Fence - When completed.
o Street Trees - When all required
trees are planted.
o Final Plumbing - When all
plumbing work is complete.
rt-Ainal Electrical - When all
7electric I ork's c plele.
o Final Mechani al - When all
mechanical work Is completc.
~7Final Building - When all
required Inspections hnve been
approved and buildin, ~r
compleled. 01JJL JUr v
o Other
MOBILE HOME INSPECfIONS
d Blocking and Set-Up - Wtlcn all
( blocking is complete:
rPIUmblng Connections - When
home has been connected to
water and sewer.
~Iectrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
FFinal - After all reQu;led
inspections are approved and
porches, skirting, decks. and
venting have been installed.
Setbacks
~:;::-r;:;SE-'-GAR . ACC I
I N I
I I
S I
I
I
Lot laces
Lot Type
.
Lot sq. Itg.
Interior
Lot coverage
Corner
Topograph'l
Panhandle
Tolal height
Cul.de.sac
W
'/
LE
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT. VALUE
Main
Garage
CarDort
d/I ~ 5-
Tottd Va UI~
Building Permit Fee ' ~.50
State ~lircharge ~
Total Fce (A)
SYSTEMS DEVELOPMENT CHARZ1qSD%
'(B) '(.0.
PLUMBING PERMIT
ITEM
FEE
Fixtures
Resldenti,d Bath(s)
N"
Sanitary Sewer
FT.
_._---
rIJr:=;cD
<A ~ ,CO
Water
FT.
Storm SevIer
FT.
Mobile Home
l~a>
Plumbing Permit
I rD ,CD
~ :).C)
~.ff)
State Surcharge
Tot;1I Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vcn t Fan
N"
Wood Sto'/e/lnsertlFireplace Unit
Dryer VCnl
Mechanic;il Pcrmit
Issuance
StC'ltc Surcharge
G"
lD5~
~n.W
~,d:=S
Total Permit
(D)
MISCELLANEOUS PERMITS
MOIJilc Home
Stale Issuance
State Surcharge
Sidewalk
ft
Curbcut ___ ft
Demolition
State Surcharge
Total Miscellaneous Permits
(E)
--r~
TOTAL AMOUNT DUE (excluding electrical). L~.:S~i,~3
(A, 8, C, D~1cl E Corllbinccl~. _(~3fjfl~)
IS 'i.PROPOSED WORK It-!THE .....
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is grantee on the express condition Ih e said
construction 5hall, in all respects, conform to t Ordinance
adopted by Ihe Cily of Springfield, . cluding the
Development Code, regulating the cons cHon and use of
buildings, and may be suspended revoked at any time
upon violation of any provisfns said ordinances,
Plan Check Fee: -:-\W
Date Paid: C)>\'
/fans Reviewed By
Date
,
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
. (In fI./'f5)7{J mud--l tku.1-'. <^
l f1\ill1mud\GY;Wj~
'A1~C\'Jh.l hL:u .=tED_t-wt\ '
_1)TrS0~u~~
By signature, I state and agree, that I have carefully examined
the completed appt:cation and do hereby certify that all
Information hereon is true and correct, and I further certify
that any and a!1 work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
str'Jcture without permission of the Building Safely Division.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
I further agree to ensure .that all required inspectlons are
requested at the proper time, that each address is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans will remain
on the site at all times during construction.
SignatuO.~ .~
Date I ~ - I q -13
VALIDATION:, &-
RECEIPT NUMBER~;-~ +-AS0-/--
DATE PAID ~ ,/q?/--<\
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DEVELOPMENT SERVICES
PUBLIC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726,3753
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PL-"-CED IN A PARK
,l,s required by the Ci ty of Springfield Development Code and/or the State of
Oregon, I understand and agree, as sho.n by my signature on this form, that .ith
th~aP2;~al nthe attac~rdrP~~s for a home to be located at
rv I c-t. '\ 1J f/f\ J:rr<--VU) , Springfield, Oregon, Ci ty Job Number
. I viii meet or exceed the belov listed minimum setbacks.
Home Setbacks
10 feet from a park building
20 feet from any public street
5 feet from any rear space line or interior space line
5 feet from the edge of a park street
2 feet from the interior edge of a park side1,alk
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public street
5 feet from the edge of a park street
2 feet from the interior edge of a park side\o'alk
3 feet from an interior space line or rear space line
I further state, by my signature below; that I have been provided vith the
follo~ing information:
Manufactured Home Blocking Requirements
~inimum Requirements for Permanent Steps
- Electrical Connection
.0/J/I/I/lA.A-J -"' ~
?J~ure
5-ICf- 13
Date
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CITY O.PHlr,GFIELD SYSTG1S OEVEL.ErH CIli\\('GE
WORKSHEET
(cOt111mClAL t, RES!OENTlAL)
~DlJJ.o
!
r~M-1E' Oft COIWAN'!':
LOCA nor:: SDC. -r;;l?~,-6-::r.l.l~..:.Y.:l!:\v.tJ Mop..>\ 1.-E--W-orvlS I":> M,:,\J tG~\ k.\ .
DEVELOPI'IElIT TYPE:
JJ"<J"~'~~b9N'.~'~F' ,,,,c. I'l"" ~ Ru A \\1) \ C\ IJ. n rr1bRt[)
i,
[JUILDING SIZE:
,LOT SIzE
SQ_ Ft.
1. STORl.1 ORA WAGE.
II-lPERVIOUS SQ. n. . x SO.ll3G rER SQ_ Fr.
(See Reverse For Runoff Coefficients If f\ctual Imperv. t,rea
Is 0-
Is UnknO\m)
2. SANITARY SEWER-CITY
1:0. or rFU'S 1'-1. . X $38.55 rER rr:u
(See Reverse 1'0 Octeluine Total rrU'S)
Is ??"\ I~I
:; . I:3fd L~J2.D HT i\TJJ}; 1.
r~o 0:- UUITS X T!\i;l RI\TE X COST PER TRIP
I .., ~ - 0'- 1
S. t/!.-';'-'
i. .l:::,-rl..; X S3SS.GI
:;
x
" ..."~C' (,1
.'. .)""u,.-,,~.
------
---
v
x S:CS.Gl
llderoinc Trip Rate::)
SUBTOTAL '(ADD
ITEI',S 1,2, l, 3) S
- ,
If.?'1.'~
(Sce Attachmc:lt C To
4. ADMINISTRATIVE FEE~
'[JASE CHARGE' (SUBTOTAL MlDVE) X ;05 Is "7'OIj. I
TOTi\L-CtIY SOC. .:; ceo ~.
5. SANITARY SEWER-H'..!I1C
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SOC Coord1nator
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