HomeMy WebLinkAboutPermit Mechanical 1993-7-21
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORi'" ---
ASSESSORS MAP- /7/J_<
LOT'
OWNER'
ADDRESS:
CITY'
DESCRIBE WORK:
NEW
"^
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERA' .
PLUMBING'
.
SPRINGFIELD
BLOCK'
STATE:
/JI(
.
JOB NUMBER C(":j / ~ '3'7
225 Fifth Street
Springfield, Oregon 97477
#2.2..'2....
TAX LOT:
SUBDIVISION'
.AI' / A->'"1
'-1 l'~ (/
PHONE:
7,:M, - 93/g
ZIP:
;~
V~
.... d6
~
,/.."b~r I~~
OTHER
DEMOLISH
ADDRESS
CONST.
CONTRACTOR'
EXPIRES
PHONE
MECHANICAL'
otvl /6t #'~J'
tv. S-fl /J -<.L fh-.J
P'
ELECTRICA' '
10 SVs-
;;;;-<73
3(;{( -~ (,I./'(
- OFFICE USE -
QUAD AREA: LAND USF' FLOOD PLAIN:
. OF BLDGS' . OF UNITS' ZQNING CODE:
OCCY GROUP' CONSTR. TYPE: # QF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT'
WATER HEATER: RANGE: SQUARE FOOTAGE:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All 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.
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab PlumbingJ ElectricalJ
Mechanical - Prior to cover.
o
Footing - After trenches are
excavated.
o
Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to fitling trench.
o
Underfloor Plumbing/Mechanical
_ Prior to insulation or decking.
o
Post and Beam - Prior to floor
Insulation or deckIng.
o Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water LIne - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
~ Rough Mechanical - Prior to
~ver.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/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
forms Bre erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material in place.
o Fence - When completed.
o Street Trees - \'\Ihcn all required
trees' are plantect.
o
Final Plumbing - When ali
plumbing work Is complet.e.
o Final Electrical - When all
electrical work Is complete.
,
1><1 Final Mechanical - When all
, "'jechanlcal work Is complete.
o Final Building - When ali
required Inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the servIce panel.
o Final - After all required
Inspections are approved end
porches, skIrting, decks, and
venting have been installed.
.
lot faces lot Type
lot sq. flg. Interior I PL.
IN
lot coverage Corner Is
Topography Panhandle Iw
Total height CuI-dc-sac IE
I
\1
.
. is THE PROPOSED WORK IN 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.
Setbacks
HSE GAR ACC
BUILDING PERMIT
ITEM SO. FT, X $/SO. FT.
VALUE
Main
Garage
Carport
Total Value
Building Permit Fee
Slate Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace ;-t~~l'
Exhaust Hood
m~" J
Vent Fan
N'
Woo.d Stove/lnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
/5 <:70
/ C), (.J"O
75"
2S".7S
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
-2 oS": ? S-
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition thai the said
construction shall, in all respects, conform to the Ordinance
ildoptcd by Ihe 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:
Receipl Numuer-
Received By:
Plans Reviewed By
Dale
Systems Development Charge is due on llll undeveloped
properties within the City limits which arc being improved.
ADDITIONAL COMMENTS
~
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 further certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfleld, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
arc 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 lime, 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
::~::u:~~;~~;(
Date
Y2Y9,
VALIDATION:
RECEIPT NUMBER
96 CJ 2...-
-:?/?-~~ ~
( 2 c::; ,7 S-
,~f7~-
DATE PAID
AMOUNT RECElv~n
RECEIVED BY
~'"
CITY OF .IUGFIELD SYSTH1S OEVELOrt..T C!lARGE,
WORKSHEET 'd-I<;"O '(J..~~
. (CO","RelA' , ",SIDEllTIAL) ~c9- \ LV
rWIE OI( COl'll'f\NY: J':Lo.".l.:L.:.__.bQ.I0.t>. t'A.9-"'" L'=.l"-- ~ow\ I::. . PA-~ .
LOCATlOrl: SDC -rc;7~_e..\-j.JL\0J!:lY:N MOP.:>I I.-12-W-orvlS I ":> M~\JtG~\ k.\ .
DEVELOPMENT TYPE:
[JUILDING SIZE:
LOT SIZE'
,SQ. Ft.
1. STORl.\ ORA WAG F
II'IPERVIOUS SQ. FT. X SO.18G PER SQ. Fr.
(See Reverse For- Runoff Coefficients If f\ctual I~perv. /',rea
Is 0-
Is UnknO\m)
2. SANITARY SEWER-CITY
1:0. a:: rFU'S I + X S3l3.55 PER PfU
(See Reverse To Octenninc Total rEU'S)
Is ??q I~I
_i . IrY~L~!~D.!~Ti~TJ_Qj I.
r:o Or- UUITS X Ti(I[l !u\TE X COST PER TRIP
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. t-:":'I L~
::: S32S.Gl
Is -z.:7. ";,0'::"1
v
X j:SS.Gl
i,
.--.'
v
'!. S3SS.Gl
To octeminc Trip R;!tc::)
SU[JTOTAl '(ADD
c.
(See ^ttacl;~ent C
ITEMS 1,2, & 3) S
( to:'" ~~
4. AD1HNISTRATIVE FFES
'[JASE CH/',RGE . (SUBTOTAL /'illOVE) X ;05
Is "7'OIj. I
TOTr.~_-CIIY S~C
90
.:; See-
5. SANITARY SEWER-MWI'\C
'.' :...., NO. OF PFU'S
,.--., -. ,'.
, ,..f-
.x S13.25 PER PFU .+ S!O 1-I11HC ADXIN. FEE s f"1 C; ~
.....',...,...
....: .....
i . .~_
........
">:..<':"(Use PFU Total From Ite~2l\bove)
,., ,. . '._ . :," , .'.._ . ".'.' :...... .'.:: ':-'~ .~, ,;.'-,,' .' c.' ~".: .
... '. '~
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. .' " .. ~.
.~. ......- . .
NW11C CREDiT IF APrUCABlE' (SEE REVERSE)
-J ,-:;,,::' .
- '-f /"1 /1 'V
;;.:' . .~
. -. . ~
TOTAL-MW~lC SDC ~ 1"7r;~ 1
TOTAL SOCS qq C, ~
~."-"
. ,..(1 Ki P Burdi ck
SDC Coordinator
. <"~~._'.. ~:
-.-, '.-, ,~,- .
.,. .',
..
-~~:.-' ..-.~"...._~: -'--
.... ~., .
H " ..
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~153-:'.
(0 Wv
! q y~5~ CITY
,
OF S.rlGFIELD SYST[l-IS OEVELOPI'l"'- CllAlIGE
WORKSHEET -I L (7
(COHI1CRCIAL t, RESIDENTIAL) .:::P- d \. J
NAlI[' Oft COIWAN\': J'::Lo.~T.:.___"=Q-'.fi.,0~_<?J';, L~f"" ~OW\ I::. . p",f-j:::
LOCATI~rl:....2Pc.. "'Io?__Le:::d.JL\0J!:lV~ !V\OP.>II.-lC. U-orvlS I":> Mo\JtG~\f-.\.
~BP~
DEVELOPMENT TYPE:
[JUILDING SIZE:
.LOT SIZE'
.SQ. Ft.
1. STORr.1 DRAINAGE
Il-1PERVIOUS SQ. FT. . X $D.18G rER SQ. Fr.
(See Reverse For Runoff Coefficients If Actual Impcrv. Area
Is 0-
Is UnknO\;n)
2. SANITARY SE>iE!Z-CITv
NO. OF rru's IL~ . X $38.55 PER PeV
(See Reverse To Detel~inc Total rrU'S)
Is ??Cj "~ I
J. lil[~L~J2S)3I!~lT+QJ1.
r~() Or: UUITS X T!\l';l !,/\TE X COST PER TRIP
;-
C'IL~
__ ___u___.~___+
;: S32S.C!
Ie,. 1 '7 - 0'. I
. /_#;'-1
___________.+ _.._____n._ ._.___
x
'!. ~:SS.Gl
\.
-;-.
.,
,',
X S3S3~Gl
To Odcminc Trip Rates)
SU[JTOTAL '(ADD ITEI':S
1r.~1:"
1,2,&3)S v'--
(See Attach:nent C
4. AOllllHSTRATIVE FEES,
'[lASE CHARGE' (SUBTOTAL fillO\'E) X ;05
I~ "7'OIj. I
TOT/:.~-CII'1 St)C
90
.r SeD _
"
I
5. SAN ITARY SEWER-H'..!IK
__' NO. OF PFU'S' r..f-
x S13.25 PER PFU .+ S!O 1-II-IHC ADMIN. FEE s l"l C; ~
,,_, ,..c.:..
....
}'-:"(Use PFU Total From Ite~2Above)
.. ,., -' '~'" -. . - '-,.
. . :....~ -'. .
~H'___"
...U Ki p [Jurdi ck
SDC Coordinator
~/7--1/1'V
,$
TOTAL-MW~'C SDC b I~'?~ 1
TOTAL SOCS Cf q ~ 't!!.-
~IWI1C CREDIT IF APPLICABLE (SEE REVERSE)
+ .' ~:: ,,",' .
,',' .
--~"-' .:..-.- '.~:
". "+"
.' "
:. '....,.. .
.. r'>::~<:"},,<;
.- ~"~'.:' 'i::':(.'::
.. .....
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