HomeMy WebLinkAboutPermit Building 1995-2-21
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RESIDENTIAL
PERMIT APPLICATION
. Q4\CUn
JOB NUMBER
Inspections: 726.3769
Office: 726.3759
225 Fifth Street
Springfield, Oregon 97477
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. TAX LOT: 0 y.onn( ?() 1
SUBDIVISION: JJ)j 0 l An ru.cti.--
OWNER: r;\onf'.. \).'-rlr\'N)~! 1 PHONE:1Vo.~f='-lQ()
ADDR~S~~G~ C\\ ~ ,,~ ~ J:".d. \) )( ~ B) (I
CITY:~\(\~~o.]JJ STATE:~rn ZIP:-914~
"'~7f';O" &&1\0 , ~l ~ l,\ \ \l, t\ic\o l'l'Q
NEW REMODEL ~ ADDITION . .' DE~L1SH OTHER
I
CONTRACTP{l~ NAME ~ ADDRESS'
GENERAL: \."'IfH\f\\Luf't~QV .
PL~~BING: Yl~ ~\.\.J.fi\~\r\'0.
MECHANICA~~A::; ~ t. !" ~ ' \
ELECTRICAl ,~ f\ \\ "-, -
. ,
LOT'
BLOCK'
CONST,
CONTRACTOR'
\()21.. ~
~
"I ~l\'{)_
EXPIRES PHONE
~.\\.a.~
~%4.1f47)
() '~4.C\S ,~'S~ \1:6
L.o.\J.{:) ltRl.I~z..
QUAD ARe?.~~~ _
· OF ~GS' \ .
OCCY\GROUP: ~a\ }J\
. OF STORIES: \
tf./
- OFFICE USE -
\\ \ \
\
CONSTR. TYPE: V A./
HEAT SOURCE: f'S
G
LAND USE:
FLOOD PLAIN'
ZONING CODE: \ f)Q)
~
SECONDARY HEAT: ~ P
SQUARE FOOTAGE: -1!]n ~ .
. OF UNITS'
. OF BDRMS:
WATER HEATER:
RANGE:
To requeSI an Inspection, you must cafl 726.3769, This Is a 24 hour recording, All Inspections requested before 7:00 a,m. will be
made the same working day, Inspectlons~req~ested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
'{t])remporary Elaetrle
hO S Slto Inspection - To be made
after excavation, but prior to
setting forms.
rvrRo~gh Mechanical - Prior to
~ cover. -
.1.. .
~ Final Plumbing - When all
~ plumbing work Is complete.
. ,
1\:71 Rough Electrical - Prior to
~ cover.
~Inal EleClrlcal - When all
~ electrIcal work Is complete.
o Underslab Plumblng/Eleetrleal/
Mechanical - Prior to cover.
,rPr""Flnal Mechanical - When all
~ ~echantcal work Is complete.
~ Electrical Service - Must.be
~ approved to obtain permanent
electrical power.
IV'!' Footing - After trenches are .
~ excavated.
~Inal Building - When all
~ required Inspections have been
approved and bUilding is
completed.
~ Fireplace - Prior to facing
~materlals and framing Insp.
o Masonry - Steel location, bond
.beams, grouting.
r-vr Foundation - After forms are
~erected'but prior to 'concrete
placement.
gr Fra~lng - Prior to cover.
o Other
IVr Wail/Ceiling Insulation -;- Prior to
~ cover. .
, .
" \\
,
o Underground PlumbIng - Prior
to filling trench,
lV7f Underfloor~/~han~
~ - Prior to~ or decking.
~ Drywall - Prior to taping:
MOBILE HOME INSPECTIONS
o Wood Stove - After Installation.
f\:7f Post and Beam - Prior to floor
~ Insulation or decking.
f\71 Floor Insulation - Prior to
~ decking.
o Blocking and Set.Up - When all
blocking Is complete.
o Insert - After fireplace approval
and Installation of unit.
o Plumbing Connectl~ns - When
home has been connected to
water and sewer.
~ Curbcut & Approach - ~fter
~ forms are erected but" j:>rlo.r to
placement of concrete.-'
f'C;( Sanitary Sewer - Prior to filling
~ trench.
.'..'
o Electrical Connection - When
blocking, set-up, and plumbIng
Inspections have been approved
and the home Is connected to
the service panel.
i"'\7r Sidewalk & DrIveway - After
~ excavation Is complete, forms
and sub.base material In place.
~ Storm Sewer - Prior to filling
~ trench.
I'V1 Water LIne - Prior to filling
~ trench.
o Fence. - When completed.
o Final - After all required
Inspections are approved and
porches, skIrting, decks, and
venting have been Installed.
~reet Trees - Wh~n all required
~~es are planted. " .
~ Rough Plumbing - Prior to
~cover.
-..:L
Lot sq. ltg. ?g/'Y)
Lot coverage ~
Topography LZ?..
Total height ~. )
BUILDING PERMIT
::i~ IA~~\ x~.fu \AA\~L
Garage ~ (4, 10 " W r:f:t S
Lot faces
Lot Type.
X Interior
Corner
Panhandle
Cul-de-sac
Carport
Total Value
Building Permit Fee
Slate Surcharge
l~pS'r /0.33
Total Fee
(A)
.~.
.?",: c'\~'.;>\{;'~)
.& THEPROPOSED WORK tN 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.
Setb'cks .
I HSE GAR I Acc'l
I P.L
IN
Is
Iw
IE
r"} S/(~7
~/fC
..2.!;. ~
~9:l,/.H
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
2/3o.~:>
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N' 2-
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge 'i!!:>f!!D T -t.~o
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
~
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
MechanIcal Permit
Issuance
State Surcharge ,'JIB T ,(Pe,
Total Permit (0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
,{,e
2tI-
fl
lt
Curbcut
Demolition
State Surcharge
.'
FEE
..L&LJ()O
/2..&-0
...LZ2- 90
0-
4,~a
9.6/0
..5 .b-C
2.2... '50
/t!>.So
I.~I
5~.31
20.210
-8,'"
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding ele~trical) "2.7IP / ~4f:l-
(A, B, C, D, and E Combined)
3/
:2,0
o
I.
I
APPROVED'
/z
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction shall, In all respects, conform to the.Ordlnance
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 J1>r~sl~ns of saId ordinances.
Plan Check Fee: Cl( 0"1.~
Date Paid' . I~' I b:J .
. r
Receipt Number:_~ \ c:s )21
Received~~ -
Plans Reviewed By
/ //<J/JS-
'/ 'l:f.>te
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
<;:, '1...J)Q y 6cxrl. (\ n ~
\ -
l~(\~9)(. - \\ '^ )
\ ~-r' ,0 1:\1:': ?1rl~W
f
~~:~ ~,.T ~.d?/T /~
#~~.bl '
'P/t11-I1
B~ 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 ~hat NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further ce.rtlly 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~t , and the approved set of plans will remain
on the site al )tlmes during c~nfructlon. .
Xlgnature v' ~ ~-r#Y
Datp
VALIDATION: '1.A1
RECEIPT NUMBER \ \0,-;\
DATE PAIr> ~ .~\ ..GtS
-,- .~-:..
AMOUNT RECEIVED .5 ~U i.
R ECEIV E 0 BY .).....h r::::/)'-/
~
,
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fi Y.'!i!IJ!".n~!~~
Job No.
Q4\QDS
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME Got \ Q l\{\ \Llo. ~O r . PHONE l'llo.<;:)'6IJJ
ADDRESS: \~D ~\orUJ.Jn\o" ~~STATE~IP Q141i
LOCATION OF JilROPOSED BUILDING SITE: l '\.\....\ I'l
, Street Address if Known: 4.\ ~ 4-- m )11 ,
, j
PI,. N>m~ 1I\1~ ~T~ '" Nom"',
&ot
\'If\f\t\n\A OQDCO
. I.A;N-J - (j}OJ
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back'>
A. Sim!le Familv - Detached
\ Single Family home
NO OF UNITS l
Manufactured home not in a park
$ 4lD.r/)
X $400 PER UNIT _=
B. Sim?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
$11)n[D
$jj
$ 4\)0 .00
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
~~m~"i~~1!.~f:
r:... ,....tc.......;..........+;I"\I~
~ /~I /!D
Date
. ATTACHMENT B1
.B NO. q4 1'105""
CITY OF SPRI~GFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA'1E OR COMPANY: GL0J N '
LOCATION: 4&iiD4 l-\OLL~
iJAC:,t-Ic(L
5\.
i-\p..\D~N J.oItAOovJs L.T.:;
DEVELOPMENT TYPE: L.D~ - ;.If-v.! SF R
BUILDING SIZE:
~OT SIZE
~Q. Ft.
1. STORM ORATNAr,F
IMPERVIOUS SQ. FT.
Z3ttl
X $0.209 PER SQ. FT.
5'Z...
$ ~"o-
2. S8MlIARY SFWFR-rTTY
NO. OF PFU'S .
(See Reverse)
3. TRANSPORTATTON
120
X $43.26 PER PFU
, $118~
NO OF UNITS X TRIP RATE X COST PER TRIP
X 1.0\ X $436.19
$ lf40. 55'
X
X
X $436.19
X $436.19
$
$
SUBTOTAL (ADD ITEMS 1. 2, & 3) $ 1,0'12$
4. S8MlIARY SFWFR-MWMC
NO. OF PFU'S I~ x $17.19 PER PFU + $10 ~wMC ADMIN.FEE
(Use PFU Total From item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
IQIAI -MWMr. sue
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$ :3 \'\ 'fz..
$ 0
$ ~\q~
11
$ 'Z.O%.."\-
5. ADMTNTSTATTVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
$ \Ol~-
1R.O'::J ,,^LALLiST~R-
Date:
Iz/-2_9/9'1
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. ., ---:::I't""t't" ~. _- _.::;._
.--5B€-:VVI J;, l~ t.:.. -
Iill1II snr
$ "'2-130 ~
B2 . SDC ..