HomeMy WebLinkAboutPermit Building 1993-8-16
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Ollice: 726,3759
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LOCATiON OF PROPOSED WORK: ~ \ ~
\t1n~~V\ In
BLOCK'
OWNER: Q0\\Q.rt-~()~ ~)\\\ \Q r
ADDRESS: ' '\ c) YM... ~() Il\~ \\ t 0t ) ~ t )
\t\ '\' (\-\(\0_) STATE: \_Q <D_,
C2j~ (irUl UC1Y1-i
DEMOLISH OT~ER
ASSESSORS MAP'
LOT:
C'TY:
DESCRIBE ~K!
NEW
REMODEL
TAX LOT:
,
~:
SUBDIVISION'
PHONF'
~ ~L.V-~ ~-
*
~irrrA L.~ :1
S!!J$ltJ1I9iI-779" '
ZIP:
CONTRACT09]SNAME~ ' ~ ADD8ESS
GENERAL: -, (Y11 0 (\ ~\ ~~ ')
PLUMBING: jh.')jJ AI\ , \ \\ J\ ~ ~,
CONST,
tQr6Wr
l o({ A\ f\ .
MECHANICAL: - ~ -----"
ELECTRICAl" _ ~D. \L\l~ ~\C'1 L'Y\. , ~
\ QJ\ )\0 - OFFICE USE -
QUAD AREA: LAND USE: \\~) FLOOD PLAIN:
. OF BLDGS: \ . OF UNITS: \ - ZONING CODE: u\~
OCCY GROUP: \c\'-l\\- ~ CONSTR, TYPE: vrJ . OF BDRMS: - ~
. OF STORIES: I HEAT SOURr'~' F E-./ SECONDARY HEAT:
WATER HEATER: ~ RANGE: b SQUARE FOOTAGE:_I~
To request an inspection, you must call 726.3769. This 15 a 24 hour recordIng. AI/Inspections requested before 7:00 a,m. will be
made the same working day, Inspections requested after 7:00 a.m. will be made the followIng work day.
D Temporary Electric
D Site Inspection - To be made
after excavation, but pdo to
settl~rm,
-V
~nder a u~n ji"EleetrioalV
l Meeha leal - Prio~
D Footing - After trenches are
excavated.
D
Masonry - Steel location, bond
beams, grouting.
D
Foundation - After forms are
erected but prior to concrete
placement.
D
Underground Plumbing - Prior
to filling trench.
D
Underlloor PlumblnglMechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
insulation or decking.
D Floor Insulation - Prior to
decking.
~anltary Sewer - Prior to fillIng
trench.
Storm Sewer - Prior to flll1ng
trench.
~ater Line - Prior to filling
I trench. .
P. Rough Plumbing - Prior to
cover. .
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
.; '~}1.\,
W~~~hn;:t~If)OVF '0.
(~,~vr '> ;,
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
D WalllCelling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stove - After Installation.
D Insert - After fireplace approval
and Installation of unit. .
,'i!
D Curbcut & Approach - After
forms are erected but prIor to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material in place.
D Fence - When completed.
D Streot Trees - When all required
trees are planted.
D
Final Plumbing - When all
plumbing work Is.complet.e.
D Final Electrical - When all
electrical work is complete.
D Final Mechanical - When all
mechanical work Is complete.
~Flnal Building - When all
required Inspections have been
approved and building is
oompleled. ~ bv1:-
DOther
MOBILE HOME INSPECTIONS
locking and Set-Up - When all
locking Is complete.
umbing Connections - When
home has been connected to
water and sewer.
f'. ~Iectrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home is connected to
the service pa~et.
~Inal - After all required
inspections are approved and
porches, skirting, decks, and
venting have been Installed.
. . ~ -~
Lot taces Lot Type Setbacks IS THE PROPOSED WORK IN'THE _"
I PL. HSEIGAR ACC I , -.
Lot sq, flg, Interior HISTORICAL DISTRICT, OR ON
IN I I THE HISTORICAL REGISTER?
Lot coverage Corner If yes, this application must be signed
Is I I and approved by the Historical
Topography Panhandle Iw I' I Coordinator prior to permit Issuance.
Total height Cul,de,sac IE I I
APPROVED:
BUILDING PERMIT
ITEM SQ, FT, X $ISQ, FT, ~ VALUE
Main
Garage
lcaCDdJ
}
Carport
Total Val ue
Building Permit Fee
~~.co
T,~S
alP .~~
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARG_E iSDC) '"
(B) ~lQ...,.4(
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
ASgS
AS.
IS.W
Sanitary Sewer
FT.,
FT.,
Water
Slorm Sewer
FT.
Mobile Home
Plumbing Permit
Lo5~
~,~
Lf)R./~5
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Fu mace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
CZf
rO'5,CO
dnCf:)
~ill
Total Permit
(D)
MISCELLANEOUS PERMITS
,
Mobile Home
State Issuance
State Surcharge
Sidewalk
fl
,
I
Curbcut
fl
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrlc~ c9&'1--fl'S
(A, B, C, D, and E Combined) <-jq[O ~L)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction st:lall, in all respects, conform to th~ Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee'
Date Paid:
Receipt Number-
Received By:
Plans Reviewed By
Date
Systems Devolopment Charge is due on a,ll undeveloped
properties within the City limits which are being improved.
.lWRIT~O~.~ O~~~NTS-
jl,tLI1J' J.~~I~J~rfU{.or
\ l,nJ9W_ ~- ,'f\\if\~-,\'{\l9A,IIT 2 ^ I
~-'Jl\l'1 ~ ') \ en 'N. ('~ ;zQC:)--U.J6.j)
~9{) f\A \) t+ T ~)\ ,\t\[iJ .)
- "I(\,PfW-4Pl~
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I furthor certify
that any and all work performed sharr be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work descrlbod
herein, and thal NO OCCUPANCY will be made of any
structure without permission of the Building Safety 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 inspections 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.
Signature 9J~ ~_
Oatp
VALIDATION: rvfl'/\ (\
RECEIPT NU~ER '-\,-'\\:" I
DATE PAIr> ?6)> \ \ Q - ?-:J,
AMOUNT R'f..E~ED 6Qll\ E\)( YY I 0 :'if)
RECEIVED ~'" ( _ .. - .
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DEVELOPMENT SERVICES
ADMINISTRATION
PLANNING / BUILDING
PUBLIC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET '
SPRINGFIELD, OR 97477
(503) 726-3753
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PLACED IN A PARK
As required by the City of Springfield Development Code and/or the State of
Oregon, I understand and agree, as shovn by my signature on this form, that vith
th~ a~v~l)bt the ~ttach7P Hermits for a home to be located at
rVl::Sl,)c:7)~c5J17 , Springfield, Oregon, City Job Number
_4..> 1~(.1:r I vill 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 in terior space line
5 feet from the edge of a park street
2 feet from the interior edge of a park side"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 sidevalk
3 feet from an interior space line or rear space line
I further state, by my signature belov, that I have been provided vith the
folloving information:
Manufactured Home Blocking Requirements
Minimum Requirements for Permanent Steps
- Electrical Connection
(" ~+-
_ ~M/UA.I' ~
Sifure
Date
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CITY OF
.IIlCr[ELO SYSTU1S DEVELOPljiWT
WORKSHEET ·
(COliI1ERCIAL t. RESIDENTIAL)
Clltd\GE QJ\\
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11M-IE Olt COIWAHY: _l':J_o.~Ti)__,bQ,0" r-^.IlJ'O:> L '--\"-- \401J1 I::. '0.0:-
LOCATIOll: SD(_ -r;; '2;::' 6:'cl~lHvtJ Mor::.>'L-~ UoMt:.. I':> Mo\Ji<':-::>\r--I.
O[VELOP1-!G1T TYPE:
OUILOWG SIZE:
.LOT SIZE
,SQ. Ft.
1. STORI,! ORA IllAG~
Il-!PERVIOUS SQ. rT, X $O.l0G PER SQ_ Fr.
(See Reverse for Runoff Coefficients If Actual Imperv. t,rea
Is e-
Is Unknmm)
2, SM: IT ARY S [\oiFlt -( r 1"
1:0. 0:: prU'S I Lj. X $38.55 PER P:-U
(See Reverse To O,~ten;linc Total prU'S)
Is 7,?Q l~ I
~;. JJ~~~L~!~.Q?Tr<TJ.l};:.
l:!'J Or: Ui:!TS X TE~-:l !~J\TE X COST PER. TRII)
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l - 0 ~ I
S 7--1--;' -!
v
'!. ~:~~.Gl
:-;
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.,
x S2:3~Gl
- ,
l~'?.'~
(See ^tt~Cli;:C:1~ C To Ut!terr::ine Trip RJ.~c=)
SUOTOT^L -(^DD ITEI'~S 1,2, & 3) S
4. ^OlHlHSTRAT!VE FEES
'01\SE, CHARGE (SUBTOTAL ABOVE) X ;05
Is -;'0 '::!- I
TOT:\~_ -C 11\' S0;:
, C ,-/' 9 0
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5. SANITMY SE\.IER-H',11-lC
-. .~-,'.: :'..:
,110. OF PFU'S
.,..{-
x 513.25 PER PFU .+ S10 1-\WHC ADKIN. FEE s 1"1 C; ~
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,........__ . .......:..'...~~_.. ._....J' "__~ ........~:~~.:....~-.'.~.:_..::.. ;'.: :'
.>:, ~lWI1C CR[DIT IF ^PPLICABlE (SEE REVERSE)
<..>:.::.:..:-'..... ...........-..-.( ,<~"::....: ."':".. ..,,' ........... .., .'. .
-" ~' ,,,' ''-f1'J,1/<f'V
".;;/' '" . ",.(\ Kip Burdick I
, ,SDC Coordinator
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TOTAl-MWMC sac: Is 1'7'J~ I
TOTAL SDCS qq ~ ~.
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