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Home My WebLink AboutPermit Building 1991-9-13 (3) ..:: j RESIDE'i\JTIAL PERMIT APPLICATION - - qJIO~ JOB NUMBER Inspections 726 3769 ...~ 225 Fifth Street Office 726 3759 ~" Springfield, Oregon 97477 LOCATION OF PROPf~~~B~qLQ ~ )~t2..- ~o. .- ASSESSORS MAP 't:^--~ j~~ - TAX LOT verI) LOT 4 \ BLOCK 1-- SUBDIVISION 6DlGl'll,TI (Ya..Gt .- OWNER ~[)~.-J \ ~().-I~ ~td.' - . PHtlNE --r\-',\ ~ '\ \ 0\5 ADDRE,<:: ;?l4~C::S d)b~o l-)\O~ ilJPu.,o) CITY '- ,\1t5-f"L STATE (( )f D~ ZIP Cf11- U \::)('i. 1 ~~ __ ~\ )\ r\Ln \'(\ ~ DESCRIBE WORK NEW X REMODEL , ADDITION DEMOLISH OTHER CONST tPN~Rt9[.OR # l.\~1 CONTRACT~rf)1EQ fu~~ \ A~RESS :~::::~-~-l6.f~ ~- MECHANICAL J) - ELECTRICAL C\~ S YQQ.f\l ) QUAD AREA ~t= \ OCCY GROUP ~~ # OF STORIES 1 # OF BLDGS WATER HEATER P..; ---- EXPI~S \.'5 '1. ~(Z. PHONE ("RQ'17bz t) 3ef\(-{ g. \ .q~ '141.ZZ3k. - OFFICE l,lSE - LAND USE \\5SC) # OF UNITS 1 CONSTR TYPE HEAT SOURnF .(::"U f"-/ RANGE FLOOD PLAIN ZONING CODE lJ)~ /.l, # OF BDRMS SECONDARY HEAT SQUARE FOOTAG E \ C{l5 To request an Inspection, you must call 7263769 This IS a 24 hour recording All inspections requested before 700 a m Will be made the same working day, inspections requested after 700 a m Will be made the follOWing work day ,.. D Temporary Electnc D Site Inspection - To be made after excavation, but prior to setting forms D Underslab Plumbing! Electncal! Mechamcal - Prior to cover ~'Footlng - After trenches are l?-1' 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 Underfloor Plumbing! Mechamcal - Prior to Insulation or decking D Post and Beam - Prior to floor Insulation or decking D Floor Insulation - Prior to deckl ng I~ Sanitary Sewer - Prior to filling ~ trench r"v"T Storm Sewer - PrI or to fl II I ng J~ trench r~ Water Line - Prior to filling ~ trench T~ Rough Plumbing - Prior to .........J cover REQUIRED INSPECTIONS D Rough Mechamcal - Prior to cover D Rough Electncal - Prior to cover IY1 Electncal Service - Must be ~ approved to obtain permanent electrical power D Fireplace - Prior to faCing materials and framing Insp D Framing - Prior to cover D Wall!Celllng Insulation - Prior to cover D Drywall - Prior to taping D Wood Stove - After Installation D Insert - After fireplace approval and installation of unit ~D<1 Curbcut & Approach - After ~ forms are erected but prior to placement of concrete ~ Sidewalk & Dnveway - After ~ excavation IS complete, forms and sub base material In place D Fence - When completed rP\1 Street Tre,es - When all required ~ trees are planted D Final Plumbing - When all plumbing work IS complete ..... D Final Electncal - When all electrical work IS complete D Final Mechamcal - When all mechanical work IS complete D Final Building - When all required inspectIOns have been approved and bUilding IS completed , ,. D Other MOBILE HOME INSPECTIONS ~lockln9 and Set Up - When all ~blocklng IS complete C&Plumbln9 Connections - When home has been connected to water and sewer ~ Electncal Connection - When ~ blocking, set up, and plumbing inspections have been approved and the home IS connected to the service panel ~ Final - After all required , inspections are approved and porches, skirting, decks, and venting have been Installed Lot faces Lot sq ftg Lot coverage Topography Total height BUILDING PERMIT ITEM SO FT Main Garage :f,port _ 5\~ To j Value BUilding Permit Fee State Su rcharge Total Fee , j. .... Lot Type _ Setbacks _E PROPOSED WORK IN- TH~ Interior I PL HSE GAR ACC I HISTORICAL DISTRICT, OR ON IN I THE HISTORICAL REGISTER? Corner If yes, this applicatIOn must be signed Is I and approved by the Historical Panhandle Iw I Coordinator prior to permit Issuance _' Cui de sac IE I APPROVED X $ISO FT '.1/l)CrO. BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT /plans Reviewed By Date ~:O. (A) ~~.50 \ \~ ~.l05 . ,- SYSTEMS DEVELOPMENT CHARGE (SDC) nv.I'5 A-l q-s. ~ (B) 1=l' \1:1:,,,,,,, - PLUMBING PERMIT ITEM Fixtures ReSidential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan FEE ... NO FT c0500 ~500 c9~. 00 FT FT (C) tXS.OCJ .~~W 'JR.'JS Dryer Vent Wood StovellnsertlFlreplace Unit NO Mechanical Permit Issuance State Surcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk Lo'l... ft Curbcut .2B ft Demolition State Su rcharge I ri~.DO d)().00 ~.~ \'420 Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) ~t:=)B (A, B, C, D, and E Combined) Systems Development Charge IS due on all undeveloped properties within the City limits which are being Improved ADDITIONAL COMMENTS 1 - ~~~ )\b~lr1.o~d(jOJ lnO r) .~ ;gJ/Ot L ~1lWdlE0 (00 .11 V) fU:kA,_ ,cl\lflO{(l;.1~fnt(L; 7971 -:cA~~-_lh !U1JL: Iq 7/0 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 Springfield, 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 are In compliance With ORS 701055 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 s,gn~, ~, 4, ~ Date q-/3 -9/ VAll DATION RECEIPT NUMBER L.i 2-1' 3 cl- ZIZ-'lt:) DATE PAID q ;E. ~q / AMOUNT RECEIVE~ ' C~ l ~ RECEIVED BY .).//U~ . .. . '.I . - - Issued by q Ilnlo3 rf? !f fp L;; {ac ~ ( ;fl /f1 rL- O~ Date q~f.~1( Permit No Address _ STATEMENT. INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701 055(4), reqUires residential bUilding permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the bUilding permit can be Issued Licensed Architect and Engineer applIcants, exempt from registration under ORS 701 010(7), need not submit this statement This statement will be filed with the permit Fill In the applicable blanks, and Initial box 1 and either box 2A or 2B \. I 1 I 1\ I J / 2 A I Y I /' I own, reside In, or will reside [' the completed structure My general contractor IS C7 ooCU v1 +tn VV'J S62/1 Contractor registration number G lot) l \1 I will Instruct my general contractor that all subcontractors who work on. the structure must be registered wIth the Construction Contractors Board OR B I I will be my own general contractor If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board If I change my mind and ao hire a general contractor, I will contract with a contractor who IS registered with the ConstructIon Contractors Board and I will Immediately notify the office ISSUing this bUlldmg permit of the name of the contractor I hereby certify that the above information IS correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ;'<;7 --/ \ ~~.b ___~ h/)/J-^- Signature of Pern;nljAppllcant 7/-- /3 -- 9/ Date CONSTRUCTION CONTRACTORS BOARD 0244J 10/24/89 PI\Ju , W1:1I:r-E COpy TO ISSUING AGENCY PERMIT FILE VJ kvtL- PlbJK-COPY TO APPLICANT @s .. - _FIELD ,- " DEVELOPMENT SERVICES PUBLIC WORKS METROPOLITAN WASTEWATER MANAGEMENT 225 FIFTH STREET SPRINGFIELD, OR 97477 (503) 726-3753 MANUFACTURED HOME SET-UP AGREEMENT As required by the City of Springfield that with the approval of the attached manufactured homes wIll be placed at Springfield, Oregon, CIty Job Number Development Code, I understand and pe~its~one o~ ~Prlollowing 0q"-1l~ LA U!J C Ln~ C~<~ agree ~ Class A Manufactured Home. A manufactured home of not less than 24 feet in wIdth and 16% (not less than 2:12) roof pitch, with exterior dImensions enclosIng a space of at least 960 square feet, wIth roofing and siding materIals that are commonly used or compatible with sIte bUIlt homes. / D Class B Manufactured Home. A manufactured home of not less than 12 feet in wIdth and 16% roof pItch, wIth exterior dimensions enclosing a space of not less than 500 square feet, wIth roofing and sidIng materials that are commonly used or compatible with sIte built homes. I further state, by my signature below, that I have been provided with the following information: - MobIle home blocking - Sanitary sewer connection - Water lIne connection - Electrical connectIon - Street tree standards - Minimum requIrements for permanent steps y ~~-~~ (S\gna ture - ~ tl / 9-/3 '7/ Date cr 'OF 'PRINGFI ELD SYSTEMS [ ELO"" ~NT CHARGE 4t=-q \ \ Oe:, ~ WORKSHEET NAME OR COMPANY' '1<0 S~ \ot?71- LOCAT ION S~C) Co \..-'L-A.:L.. \.-~N."E- DEVELOPMENT TYPE: l-t/~ ~Mt. BUILDING SIZE: (Poj..Vo 10-' \ <"60-2.-0 ~-z.~ - O~I() 0 Dw l~)l\'\ LOT SIZE SQ Ft. 1. STORM DRAJNAGE IMPERVIOUS SQ. FT. \~Lt'2-- X SO.186 PER SQ. FT. $ ~0\ ~ (See Reverse For Runoff Coefflclents If Actual Imperv. Area Is Unknown) 2 S~NITARY SEWER-CITY tw. OF PFWS l~ X $38 55 PER PFU (See Reverse To Determlne Total PFU'S) OjO 5> <oo,=? -- 3 TRANSPORTATION :,: ~~ UNITS X TRIP RATE X COST PER li\:? x LeoS X $388 61 s ~qo XSS x X $388 61 s x X $388.61 $ (See Attachment C To Determlne Trlp Rates) SUBTOTAL (ADD ITEMS 1,2, & 3) S l y.,-\-S ~ 4 ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X 05 S 12-~ TOTAL-CITY SDC 5> l5 \1 ",,-, 5. CREDITS IF DEVELOPMENT IS PROFESSIONAL OFFICES OR INDUSTRIAL: L I /A. TOTAL-CITY SDC X (50%) = ADJUSTED CITY SDC S ~/~ 6. SANITARY SEWER-MWMC NO. OF PFU'S \3 -:;'0 x $13 25 PER PFU + $10 MWMC ADMIN. FEE $ 2'-lce. - (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) \~ ~~~ r Kip BurdiCK SDC Coordinator 4/(\ (C11 , $ k-~ ~'1 TOTAL-MWMC SDC $'Z'Z-O~ 9'5 . TOTAL SDC $ \,~, -^ ., FIXTURE UNIT CALCULAT N 1": ~LE: Number of New Fixtures X For remodels, calculate only the NET additional fixtures) FIXTURE TYPE NUMBER OF NEW FIXTURES Bathtub Drinking Fountain Floor Drain Interceptors For Grease/Oll/Sollds/Etc Interceptors For Sand/Auto Wash/Etc Laundry Tub/Clotheswasher Clotheswasher - 3 Or More Mobile Home Park Trap (1 Per Trailer) Receptor For Refrigerator jWater Statlon/Etc Receptor For Commercial Sink/Dishwasher /Etc Shower, Single Stall Shower, Gang Sink, Bar, CommerCial Urinal, StalljWall Wash Basin/lavatory, Single Water Closet, Public Installation Water Closet, PrIVate Miscellaneous 1- '2.- '2- TOTAL FIXTURE UNITS t Eql ent = Fixture Units (NOTE UNIT FIXTURE EQUIVALENT UNITS 2 4 1 2 3 6 2 2- 6 6 1 3 2 1/Head 2 2- 2 1 -z.. 6 4 'B \~ CREDIT CALCULATION TABLE Based on assessed value If Improvements occurred after annexation date In teDle calculate credits separates Yeer Anrexed Rate per $1,000 Assessed Value Year Annexed 1 ;'9 or beror'? 1980 1981 1982 1983 1984 $266 264 253 241 219 204 ....- .....- ,.............. 1986 1987 1988 1989 1990 Rate per S 1,000 Assessee value J II :1 q 1 35 1 15 092 059 023 Credit for Parcel or Land Only If Applicable "'2-. (p~ X S 10 ./l 'l~ '--t!.. (Rate X Assessed Value) Improvement (If after annexation date) X $ (Rate X Assessed Value) <1 CREDIT TOTAL = $ 7~ '"t_ RUNOFF COEFFICIENTS FOR STORM DRAINAGE ReSidential CommerCial Industrial Governmental 04 09 045 05 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT , I 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REQUEST: OFFICE: 726-3759 97477 726-3769 1. ~~~~F\ ?)S~f'1hj)~. :: \ ~~E(~~ o~f)(Y) ~~~::~~:?s:rab~n~ire if work is not started withln 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor 0A S Address ~ 0 ~ry \48~ Ci t~h. \r\L Phone :141- QQ%7 Supervisor ,rdcense Number \ \ D~lO:S Expiration Date \ (). \ q?- Constr Contr. Number t:)~~~' Expiration Date q.(,q~ The installation is being made on property I own WhlCh is not intended for sale, lease or rent. Owners Signature: ftP;VL ~f)/}~ --________________~_L~_________________ DATE: q -(3 -9/ RECEIPT it: 2 -(l/q 3 RECEIVED BY: /~r7 City Job Number COMPLETE FEE SCHEDULE BELOV New Residential-Single or Multi-Family per dwelling unit. Service Included: 1000 sq. ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling 11 Service or Feeder ~ B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only C. Items Cost Sum $ 85.00 $ 15.00 $ 40.00 PI) $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Temporary Services or Feeders Installation, Alteration or Relocation Miscellaneous (Service/feeder -Each lnstallatlon Pump or lrrlgation S+gn/Outllne Lighting Llmlted Energy/Res ^ Limi ted Energy /Comm 200 amps 201 amps Over 401 Over 600 or less to 400 amps to 600 amps amps or 1000 Signature of Supervising Electrician ,fiJ~d~%~ &~/ f'Cn/'\ - ", D. Branch Circuits Owners NamV l JX O~ tV\ n ~ \) '"'\C"f'I' . ~ ",' <"'W New, Alteration or Extension Per Panel c Address ~t'1\ C) 1''' t ,~ _ I )\ ( lI.,~ J ~ rll . - "'--l.A\- - '\1 \ C' One Cireui t $ 35.00 City J,_~_.Phone It 11l. Each A~dltlonal . ~ Clrcult or wlth Servlce OVNER INstALLATION or Feeder Permlt E. 5. SUBTOTAL OF ABOVE 5% State Surcharge TOT--AL "', '-~ $ 40.00 $ 55.00 $ 80.00 volts see "B" above -. ' $ 2.00 not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 ,8Q.C~ '3UU ~ CY') '.