HomeMy WebLinkAboutPermit Building 1992-10-6
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF pnOPOSED WORK'
ASSESSORS ~p.
LOT II ( )
.~ 225 Fifth Street
~_;I Springfield, Oregon 97477
(J\ 1 ~ -+ f3Clf) DD 4lo't-iU
SUBDI:~s~oLf7{udfru
PHONE: 'l4lo -( ) \ I I!:f
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STATE: ~ YP )
.---
CITY:
DESCRIBE WORK:
NEW ~ REMODEL
J. llUJO
\DDITI~N
QUAD AREA:6~ _ /
. OF I3LDGS:--1
OCCY GROUf':_=R0-t~
. OF STORIES: __I
WATER HEATER:
7"
DEMOLISH
OTHER
.
q~,
'..
- OFFICE U~ -
LAND USE: -Ilflt)
. OF UNITS: )J ,
CONSTR. TYPE: _, V N
H EAT SOURCE' i= z..
7
RANGE:
JOB NUMBER
ZIP:
R,;~q j l:r:C)/7Q
~~()
?-,c;.la5J
t;}!:>.=-"\9'J
IOili,
I '-f7-74'-/S
7-;).b .q3()~,
FLOOD PLAIN: V
ZONING CODE: UJ {
::ltd
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE: -2.JO)1
To request an Inspection, you must call 726<H69. 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
Sile Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumblng/Electrlcal/
Mechanical - Prior to cover.
~ Footing - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
'fV1 Underlloor Plumbing/Mechanical
~ - Prior to Insulation or decking.
~ Post and Beam - Prior to floor
insulation or decking.
IOl Floor Insulalion - Prior to
~ decking.
~ Sanitary Sewer - Prior to filling
~ trench.
g Storm Sewer - Prior to filling
trench.
'0"] Water Line - Prior to filling
~ trench.
ri?f Rough Plumbi~g - Prior to
~ cover. ~
. .
'"
REQUIRED INSPECTIONS
~ Rough Mechanical - Prior to
~ cover.
~ Rough Electrical - Prior to
cover.
~ Electrical Sarvice - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
~ Framing - Prior to cover.
f':A' Wall/Ceiling Insulation - Prior to
LAJ cover.
gf Drywall - Prior to taping.
o Wood Slave - After Installation.
o Insert - After fireplace approval
and installation of unit.
~ Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
~ Sidewalk & Driveway - After
~ excavation is complete, forms
and sub-base material in place.
o Fence - When completed.
d1 Street Trees -' When all required
~ trees are planted.
.
~ Final Plumbing - When all
~ plumbing work is complet.e.
IU Final Electrical - When all
..J.6J electrical work Is complete.
I\A"Final Mechanical - When all
'~ mechanical work Is complete.
[7l Final Building - When all
~ requIred inspections have been
approved and building is
completed.
o Other
;..'
MOBILE HOME INSPECTIONS
o ElI.ocklng and Set.Up - When all
bloc~ng Is complete.
'.
o PlumbIng Connections - When
home has been connected to
water and. ~ewer.
;~:~
o Electrical Connection - When
blocking, set.up, and plumbing
inspections have been approved
and the home 15 connected to
the service panel.
~.;:;
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~ :-.
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'ii',
1 ~.:
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,,,
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o Final - After all required
Inspections are approved and
porches, sklrttn'g, decks, and
venting have been. Installed. '.
f~i:~
'.'
Lot faces
Lot TYP.
Lot sq. flg.
_ Interior
~ Corner
Panhandle
Lot coverage
Topography
~f
Total height .-G::L
Cul-de-sac
Setbacks
I PL. HSE I GAR ACC
.is THE PROPOSED WORK IN THE
HISTORICAL DiSTRI~. OR ON \^.....
THE HiSTORICAL REGISTER? VIAl
S
N
----
If yes, this application must be signed
and approved by tile Historical
Coordinator prior to permit issuance.
.'!:!.-- - --
E
----
BUILDING PERMIT
::::.. ~2 '*IJ9"fl~
IIlD('id)
~':J
'2..1..\.aL
5at~
SYSTEMS DEVELOPMENT CHARGE (SDC) It5
. (B) ~?&;'2.~
Carport
Total Value
Building Permi I Fee
State Surcharge
Total Fcc
(A)
PLUMBING PERMIT
ITEM
Fixtures
FEE
Residential Bath(s)
No,Q.(I~ (~O~
~1(P().uO -
FT.
Sanitary Sewer
Water
FT.
FT.
Storm Sewe~
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
~ e (p.CD
& e 4.50
NO 4- P 3~
Furnace
Exhaust Hood
yent Fan
Wood Stove/lnsert/Flreplace Unit
Dryer Ve~t ~ @. 3 pO
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk llL It
A \'
Curbcut ~ ft
Demolition
State Surcharge
,FJHO.UU
1(P~
,~W.
j8.ro
q.CXJ
\ 9_ .co
LPpu
'2Q 00
"':'J 'aJ
In.
,F)t~'.~~
~~~ lt~
Total MIscellaneous Permits (E)
TOTAL AMOUNT DUE (exciudlng eiectrical) ~lorl ~7
(A, B, C. D, and E Combined)
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
~eRB:'
Plans Reviewed By
q.t2-q2-
Date
Systems Developmenl Charge is due on all undeveloped
properties within the City limits which are being improved.
\~~K:C~o/
. As~s Vo.1..fI II <;(~
~jL_.J!LIeQ
By signature, I state and agrec, that I have carefully ex?mined
the completed application and do hereby certify that all
information hereon is tru~ 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 Slate 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 Witll cRS 701.055 will be used on this
project.
I furtiler agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from tilC street, thai tile permit card is locnled at Ihe front
of the property, and the npprovcd set of plans will remain
on the site at .~I j>lles during construction.
Signature J~~ C &...dL-
/6 - c., - 9 ~
Date
VALIDATION:
RECEIPT NUMBER__~ ij//
/tt:?-b qz
AMOUNT RECEIVED 47/""9... V?
/?'. . .
//~~
/--7.'. .,.,-
~ .
DATE PAIP
RECEIVED BY
.'
.,'
.:.
"OBNO. <1"2.1"2..<40 .
CI-TY OF ,SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
. WORKSHEET' '. .
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: WA~\.-E-t-.le:. CPF.:.e:.
LOCATION: 4"Ylo 1-\01..1...<;' f:>"I ~ ':J, y.(" ~ S-r .
\~020c;.\'2.- 01o..{00
DE~ELOPME~T TYPE: L-D~ - r-J~,^I Duf'\.-e:.-,(,
BUILDING SIZE:
1. STORM DRAINAGE
LOT SIZE'
SQ. i't': ..
IMPERVIOUS SQ. FT. L.{.oc,Cf
2. SANITARY SEWER-CITY
NO. OF PFU'S ~y.
(See Reverse)
3. TRANSPORTATION
.X $0.192 PER SQ. FT.
C 11'\....1)
-- .---:
X $39.78 PER PFU
~~?"2..~1)
'-- ----
NO OF UNITS X TRIP RATE X COST PER TRIP
7.. X \,00<; X $401.05
X
X $401. 05
G e,6eo,0
--- -
$
X
X $401. 05 $
SUBTOTAL (ADD ITEMS 1,2, & 3) $ 1.-~?-'~
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
('l'-l~~
~ ---
TOTAL-CITY SDC $ Z;o8Y-~
5. SANITARY SEWER-MWMC
NO. OF PFU'S ?'t x $13.62 PER PFU + $10 MWMC ADMIN. FEE $L\-l~~
(Use PFU Total From Item 2 Above)
~'--'")~L--L
:--(f 'Kip Burdick
sac Coordinator
'1/II/'i'J.-
( f
$ ??~
TOTAL-MWMC SDC~
TOTAL SDC $ ?':;'"'2.y ~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
. .. <<
FIXTURE UNIT CALCULATION TABLE: Number of New Fixtures X It Equivalent = Fixture Units (NOTE:
For remodels, calculate only ttie NET additional fixtures)
'.
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT
EQUIVALENT
FIXTURE
UNITS
z.
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
4-
Bathtub.. .......... ......................:: ......... .............. ...........
Drinking Fountain.......................,......... .............. ......
Floor Drain.. ,......... ....................................................
Interceptors For Grease/Oil/Solids/Etc......,..........
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub jClotheswasher. ':.............,.......... ........
. :' ClotheSwasher c..3.:0r More.....:,.........................:....
Mobile Home Park Trap (1 Per Trailer).....:,:....:.....
Receptor For RefrigeratorjWater Station/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:
"2-
'1.
'-l-
7..
<+
~
~
-+
\(..
TOTAL FIXTURE UNITS
=
'Y4
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
c1alculate credAitsnYn:e:x:eadrates, ., - - Rate per $1.000 Year Rate per $1,000 11
Assessed Value Annexed Assessed Value
'I
I
!
I
l
1979 or before
1980
1981
· 1982
.1983
'-'1984
$2.83
2.76
2,71
2.60
2.46
2.33
1985
1986
1987
1988
1989
1990
1991
$2,16
1.90
1.60
0.25
0,87
0.50
0,16
Improvement (if after annexation date)
"Z .'2,30 X $ \ \ ,6"3-
(Rate X Assessoo Value)
. X $
(Rate X Assessed Value)
CREDIT TOTAL
=
??~
Credit for Parcel or Land Only If Applicable.
=
= $ ::,?~
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
ResidentiaL,..................,..,................................ 0.4
CommerciaL,.........,.......,................,..............,.. 0,9
IndustriaL....:..................................................... 0.45
GovernmentaL.....................,..,......,..,.......,..... 0,5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
. ~~
t, , bnl~\mj hag the fo!!cwlng . ~
225 FIFTH STREET The 10110wln9 r~tllOc I ~O'";~I''' 'p6cniC l.r,d ",ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97 4 7~:~;~~;7."d dM no r q;V\ I (\/1 T'\
INSPECTION REQUEST: 726-3769 \ City Job Number eX ~-;( )
OFFICE: 726-3759 (onln" - -
. '.'oJ.' . ~U 3. 0 PLETE FEE SCHEDULE BELOV
1,,1 ,.JIAC~ION OF INSTALLAW~~ Si""O\L'9L / . '
~( ) \-\r--,\ \ '~~~h ,/'in\'" A. New Residential-Single or
. . - - Multi-Family per dwelling uni t.
I X'0^h.Df)cg\~ (J,4(X) Service Included: Items
['\. JO)l,. pESCRIl1'ION i ~ ~.r-.") 1000 sq. ft. or less r!J.
l. \h \1.' \ Q;{ -+- b. om ~ l(f1L-/ Each addi tional 500
:\ . sq. ft or portion
Permits are non-transferabl and:expire thereof ~, $ 15.00
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder
2. CONTRACTOR INSTALLATION ONLY,
Electrical CO.J1.!rac,tor~ \~ ~ y~ Q rt ).
.. D () ~ \\jlofl
~hone l?J()-ct~[)3
Number ~ lof( tS
\\),\,q~-
?J:\ lcbl
,~ .? _~ .C\ \0
Address
city ~Ad
) -
Supervisor L ense
Expiration Date
Constr Contr. Number
Expiration Date
~ Electrician
owner~ Nani:cNC\l\ \ 0 i\ L 0 cf\ .f'1!;L.." D.
Address l~?' ~ ~()YY\ 0 ~
City. ~rl. --' Phonel4h-nCfj
OYNERrI~STALLATION
The 'installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE: /0-6-9z.
RECEIPT II: tf:j y.,,( /
RECEIVED BY: ~,~ ~
S."JIINGFIELD
B.
Services or Feeders
Installation, Alterations or
Relocation:
Cost
Sum
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
$ 85.00
nD
30
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
S 40.00
$ 55.00
$ 80.00
see liB"
~
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
above
New, Alteration or Extension Per Panel
One Ci-rcuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$
2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE cJ4T),OO
5% S ta te Surcharge /":"J ,UU
TOTAL rV..~ ,cJU