HomeMy WebLinkAboutPermit Building 1995-2-28
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOT:
ADDITION
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICAl'
ELECTRICAl'
QUAD AREA:~ ~0.j
. OF BLDGS' \
OCCY GROUP: ~2)o\-}v\
\
. OF STORIES:
. _ _ r WATER HEATER: _Y /
t~,.e~~
JOB NUMBER~
225 FI fth Street
Springfield, Oregon 97477
.
:PPIA/II)' I
PHONE:
I
ZIP: -11IDK
ADDRESS
CON ST.
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
ryl Rough Mechanical - Prior to
LfirJ cover.
ril Rough Electrical .- Prior to
'-P'J cOl/er.
rvl Electrical Service - Must be
~ approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
[AJ Framing - Prior to cover.
m Wail/Ceiling Insulation - Prior to
~ cover.
[:;xJ Drywall - Prior to taping.
D Wood Slovo - After Installation.
D Insert - After fireplace approv41
and tnstallallon of unit.
~ Curbcut & Approach - After
L.4-J'- forms are erected but prior to
placement of concrete.
m Sidewalk & Driveway - After
~ excavation Is complete, forms
and sub-base material In place.
D Fence - When comPle.te~.
r"'\f1 Street Trees - Wh~_n all;requlred
~ trees are planted. _~ (.
EXPIRES
FLOOD PLAIN'
ZONING CODE: ~ ""
~
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: \~~~
To request an Inspecllon, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons requested before 7:00 a.m. will be
made the same working day. InspectIons requested after 7:00 a,m. wlll be made the followIng work day.
BLOCK'
.~
STATE:~
DEMOLISH
OTHER
~ Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlca"
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, groutl ng.
~ Foundation - After forms are
~ erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
!:Xl
Underfloor Plumbing/ Mechanical
- Prior to Insulation or decking.
~
Post and Beam - Prior to floor
Insulation or decking.
f\7I Floor Insulation - Prior to
L,6J decking.
m Sanitary Sewer - Prior to filling
~ trench.
i=::7l Storm Sewer - Prior to filling
~ trench.
rVl Water Line - Prior to filling
LpJ trench.
l1SJ Rough Plumbing - Prior to
cover.
- OFFICE USE -
\ \\ \
\
CONSTR. TYPE: \J~
HEAT SOURCE: \= t.,
~ ./
LAND USE:
. OF UNITS'
RANGE:
rYl Final Plumbing - When all
\ plumbing w9rk Is complet.e.
f\Jl Final Eleclrlcal - w.tlen all
r electrical work Is complete. C
r":'tl Final Mechanical - When all
Ll=I mechanical work Is complete.
I\Tl Final Building - When all
~ requIred Inspections have been
approved and buildIng is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - Whep all
blocking Is complete.
D
Plumbing Connections - When
home has been connected to .
water and sewer.
D
Electrical Connection - When
blocking, set.up, and plurgblng
Inspections have been approved
and the home Is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot faces
Lot TYP.
/Interlor
Lot sq. ftg.
Lot coverage
Corner
Topography
Total height &D..5
. (Q2.1
Panhandle
Cul.de.sac
,
BUILDING PERMIT
\~&1
~
l " ';';' '",!'J i::~:r~tf~~f
Setbacks.
_S THE PROPOSED WORK IN THE _
HISTOI;lICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
h~L. HSE GAR ACC I
I N I
I S I
Iw I
I E I
X $/SQ. FT. - VALUE
5lo. flD 'lS<1~2-
l4:. In ,,~,-A()
ITEM
Main
Gatage
Carport
APPROVED: .
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condlllon that the said
construction shall, In all respects, conform to the 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: M \ 0 . ~
R\ \ 0'l.2- Date Paid:
Total Val ue
~11,~ Receipt Number
Building Permit Fee
State Surcharge \~,"t~T '3"t 30~ ~y: d~15
40<\. ~
Total Fee (A) Plan"-Sleviewed By Date
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
:l. I" (,., 'ii.
PLUMBING PERMIT
ITEM
Fixtures
, ~
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permll
e. r.!2 ~ "!>'"&
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
3.
Wood Stovellnsert/Flreplace Unit
....,,\ -
Dryer Vent \P,~\...t'~
~li..cd-'i\.~i t~~
Mechanical Permit
lssuahce
I.~:. '" ~ "a
State"Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ~~
Curbcut ~"
It
It
Demolition
~ulcnarge . \~~~~~
Total Miscellaneous Permlls (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
'bO Q!2-
L Coo ce.
\l).~
t1 ~. '@
G?5
~.~
'\. <;a
05
'Q!:.
~.
UL~
~,~
\ (). taD.
~, .s.'i
~tl-lct,
~tl,~()
\ ~,<tQ
~~.~
._-n'.'3Q
.9..BC{ 1. \1.
_ _,_oJ
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
..~ll ~ar 6nrri (IQJ)~
l_Jk+T~ 1.6COt.wt'l
~1\[j[I: \004
"",
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify Ihat 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 Clly of Springfield, and the Laws
of the State of Oregon pertaining to tho 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 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 prope y't nd the approve~J of plans will remain
on the sIte t all tImes durln~onstr ct~n.
Slgnatur ''iJ.//.//~r1?!.~
tr
Date, 2- 2/1-'/>
VALIDATION:
RECEIPT NUMBER
DATE PAIP
AMOUNT RECEI'19
RECEIVED BY f(-,.
.
J(;P q39
'2/ 2. ~ /'tr
'"3.a,. CJ 7 n
(. /J K' /-"'" 10 -f.jS
- A .......
if" /[;~
r
.
.
o y!ill!!!!!!~!!~
Job No. Cf4\QHo
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAM"~ I ~I f\ \!~ ()~ ~H) . "<ONE f'A \0. ltAldI:
ADDRESS: c::\\o\ b '-\~~ \{d...\. ~ STATE:~IP itl113,
lOCATION OF ~ROPOSED BUilDING SITE: u '. kh _ . 1-
Street Address if Known: 4\030 ~Dlli~ ~_)llllJ\ . .
PI,. N,moI. &i~ ~II. IT~ l~ Nom"", \9.i'l'd.OSI::J. no. ad)
1. DEVElOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back,)
A. Sinl!le Familv - Detached
, Single Family home
NO OF UNITS
Manufactured home not in a park
$ 4m pO
l
X $400 PER UNIT _=
B. Sinl!le Familv - Attached
NO OF UNITS
X $370 PER UNIT =
'$
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
$ 1-nl) pO
$%
$ 400 .tJD
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Creditl
'u.to ) \\r ~
CommunitY servic~on
r:.......( c........;.........(;I"'lI,..l
2- I :2- <l> / 1')_
Date
ATTACHMENT BI - 'I . j,'
.. ""B NO. '7 1"1 <0
CITY OF SPRINGFIELD SYSTEMS DEVELOPME~HARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: k8JiH
P!:.ouw
LOCATION' '-/Ct, so !-IOLl_~ ST.
tlAiO~,", >-lEA Dc"; <;
dif
2. ~ANTTARY SFWFR-CTTY
NO. OF PFU'S :
(See Reverse)
3. TRANSPORTATTQtl
NO OF UNITS X TRIP RATE X COST PER TRIP
X LOI X $436.19
\'\ ' .'
X $43.26 PER PFU
$
82.\11
Ii' 55
S .,,\0 -
X
X
X $436.19
$
X $436.19
s
SUBTOTAL (ADD ITEMS 1.2. & 3) s 1'7:>5,3
4. SANTTARY SFWFR-MWMC
NO. OF PFU'S \'\ x S17.19 PER PFU + $10 HWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
HWMC CREDIT IF APPLICABLE (SEE REVERSE)
IQIAI -HWMr. SDC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
s33lc ~
$ 0
$ ~:;c<o &\
$ 2,0'\ -z!3 if
,
5. 6nMTNTSTATTVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
b"Z-
S IOY-
-1k.o~ M-'f\LLI ST~
Date:
rz./z cl'H
..
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B2 . SDC .