HomeMy WebLinkAboutPermit Building 1994-12-5
LOCA;ION OF PROPOSED WORK', 0.9?, ~ '/1 L;A-.c/ ~
ASSESSORS MAP' "I Rn ~ nri- .Q.,~
c,
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOT:
~
.
l...
.
JOB NUMBER
t7~c)~?~
BLOCI<'
225 Fifth Street
Springfield, Oregon 97477
7'JA .','
-
C )S~J..[X)
<Lf~~~/77S/~
TAX LOl'
SUBDIVISION:
7 ~/?7?9" /ULlVZ:>S<-- /~~L~/DO~ PHON!" "7 $1";> -6 YS-=? '
/;3YV C"L~~;";'/f..>>'/ _'j'~' 1'M?Jlt~ 1S~.I"1-~J
~~LZ>__ STATE:~~~ZIP: 4?~B-
, - /' :':E --~" _
..-=;;. ,,,?:', ~ =- .:::;'
- -.... -
OWNER'
ADDRESS'
CITY'
DESCRIBE WORK: 6,v?,/.,.z1.tt->~ ,?'-
NEW.( REMODEL ADDITION
CONTRACTOR'S N~E
GENERA" ~~~~
..
PLUMBING:
MECHANICAl'
ELECTRICA! .
'"
..,
QUAD AREA' ~~
. OF BLDGS: -,
OCCY GRoup:K~"\ N\
. OF STORIES:' ' A
f'f
WATER HEATER:
DEMOLISH
OTHER
\
ADDRESS'
CONST.
CONTRACTOR .
PHONE
I'V"I'Rough Eh.ctrlcal ...... Prior'to
..I::::::::.J.cover. .. , .
I'V't Electrlca' Service - Must be
IAJ approved to obtaIn PCtrmanent
electrIcal power. ;, ~:..~
o Fireplace - prior to facing
materials and framing Insp.
~ Fra;"lng - Prior to cover.
~all/Celllng Insulation - Prior to
~ cover. ,
~DryWall....... Prior to taping.
o WoodStoVG - After Installation.
o Inaert - After fireplace approval
and Installation of unit,
,)
~Curbcut & Approach - After
~forms are erected but prior to
placement of concret,e. '
- OFFICE USE -
LAND USE: \ \ \ \
. OF UNITS' ','})
CONSTR. TYPE: l/.
HEAT SOURCE: G{:;cc::;r. Ci:fZ ~
--RANGE: f' .../
EXPIRES
FLOOD PLAIN:
l r\ I'd.--
ZONING CODE: A J
· OF BDRMS' ~
SECONDARY HEAT: ~p
SQUAREFQOTAGE: ~\81
......
.- ',-, request an Inspection. you must call 126-3769, This Is a'24 hour recordll;g, All Inspections requested before 7:00 a.m. will be I
rriade the aame working day. lnapactlons requeated after' 7:00 a,m. will be made the following work day. ,rI
REQUIRED INSPECTIONS
IC7f R~ugh Mech~nl~al ....: Prior to
~ cove~ .
~emporary Electric
r<::7r'Slte Inspecllon - To be made
,JOJ after excavation. but prior to
aettlng forma. ~ t!> ~t. S;
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
I"=VI"Footlng - After trenches are
~xeavated. ..
o Masonry - Steel location. bond
,beams, grouting,
1"<;7( Foundetlon - Atter forma are
~erected'but prior to.concrete
placement.
o Underground Plumbing - Prior
to filling trench,
-r:::;;;r Underlloor. ~/Mechani~
~ Prior to rnSUl8t10n o'r deCKing.
~ Post and Beam - Prior to floor
~ Insulation or decking.
rv;( Floor Insulailon -' Prior to
~ decking.
I'\7l'Sanltary Sewer - Prior to IIl1ing
~ trench,
rc:::t Storm Sewer - Prior to filling
~ trench. '
1'1:71 Water Line - Prior to tilling
~ trench,
~ Rough Plumblng'- Prior to
t..J.4...! cover.
I"V( Sidewalk & Driveway - After
)<'="-excavatlon Is complete, forms
and'sub-base'materlalln place.
o F~n~e,'- When co.~pleted.
.' .'
@ Street Trees - When all required
trees are planted. , r... -. .
I's?('Flnal Plumbing - When all
~Plumblng Work Is complet,e.
~ Final EI~ctrlcal - When all
~ electrical work Is complete.
"f;7I' Flnat Mechanical - When all
~ mechanical work Is complete.
~Flnal BUilding - When all
~ required Inspections have been
approved and building is
completed.
D'Olher
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 aervlce panel,
o Final - After all required
Inspections are approved and
porchos, skirting, decks, and
venting have been Installed.
,.
-
Lot faces ~
. ,.~' .
.~t~P..
Interior
Lot sq, fig.
Lot coverage
TOPOgraPhY~
Total helg( ,tff1
Corner
Panhandle
f Cul.de,sac
~
ITEM
Main
,
Garage
Carport
Total Value
Building Permit Fee
Slale Surcharge
Total Fee
27 ~+I(,'3
(A)
. .:.~ ':1
....~. ,~ " :.': ".!,..,;::t.,~ ~:.'.:' '.~:'.'~eJ:'~:.
IP.L,
IN
Is'
Iw
IE
Setbacks '
HSE GAR
tz..
5
"2--'7
BVILDING PERMIT
~'~;;c: ~~2-
~1
_d-3.g-.
5:Y1.1>
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
12JJt:.. 'Ie.
PLUMBING PERMIT
ITEM
Fixtures
Residenllal Bath(s)
N'
-;z.
Sanitary Sewer FT,
Water FT,
Storm Sewer FT.
Mobile Home
1--,
Plumbing Permit
State Surcharge
Total Charge
e~f-4~
(C)
MECHANICAL PERMIT
Furnace
Exhauat Hood
Vent Fan
N'
:z..
Wood Stove/lnaert[FT",~lace '.lnIP"
Dryer Vent
Mechanical Permit
Issuance
/,73 r /.0.1
State Surcharge
TOlal Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ~ fI
3-1- fI
Curbcul
Demoilllon
State Surcharge
~ A!i!'P/6:J
Tolal Mlsceilaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. 0, and E Combined)
/2.~(,SIO ,
-~,-
~
FEE
-L?~CO
J7~,SO ,
~8'0
4..9D
,
C::. ,~
.L5 tH'
~ ,(1"0
~,?O
,/to. 0fD
2..77
~727
:2.2 ,90
/5/0
~1:$"8>'
4:.7Z.!6.
,3t;>/'O.?'<' :
ACC I
I
I
.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.
.
APPROVE,.,'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condillon lhat the aald
construcllon shail; In all respects, conform to the Ordinance
ad.opted 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.
-:z _-/, .!;f, / ~.~
Plan Check Fee: d. "" ~ ~ ~
Date Paid:
,Receipt Number'
Received ~
,~~
Plans ,Reviewed By
/~~h
/ Date)
Systems Development Charge is due on ail undeveloped
properties within the City i1mlts Which are being Improved,
ADDITIONAL COMMENTS
\~\
, \'-U\\N:1~G:c\~
~~\,:~,q{d)~ ,
t 9\r\f\9.X:.1\'\ ~: \~ l n(')
~
~f)lOA~- . ,
U 'In Vl'.. 'bJ l6(,11i11()1V
d^'~~
LJt;!J;f .
By slgnature,l,stale and agree, that I have carefully examined
the completed application and do hereby certify that ali
Information hereon is true and correct, and I further certify
that any and ali 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 wlil be made of any
structure without permission of the Buliding Safety Dlvlsl,?n.
I further certify that only contractors and employees who
are In compliance with ORS 701,055 wili be used on this
project.
r
!
I further agree to ensure that all required Inspections are
requested at the proper time; that each addresa Is readable
from the street, that the permit card Is located at the front
of the property, and the approved set 01 plans will remain
on the site at ali tlmea during construction.
~ature o"qh~,r;;;~~~ ~,L---"
'(/~'
Date .I ;;J/o{'/o, 1/
r
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY,
/5&&']'
, ..o'~). L:( i'J14J
:Iifn.,3S1 '
~~"
-,
-
\.- \'
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN_IlARGE
WORKSHEET
(COMMERCIAL ~ RESIDENTIAL)
~
NAME OR COI1PANY:
LOCATION: tP'1Z3
v;~ f ~ -q~L/7
G~ d.
\.
DEVELOPMENT TYPE: c,pL)
BUILDING SIZE: ,lOT SiZE SQ. Ft.
l. STORM DRAINAG~
IMPERVIOUS SQ. FT. fo11s0 , X 50.203 PER SQ. FT. (}21.0
2. SANITARY SEWER-CITY,
lW. OF PFU'S ;"i X 542.0B PER PFU ~S7'.#) ~-
(See Reverse)
3. TRANSPORTATlOll,
NO OF UNITS X TRIP RATE X COST PER TRIP
/ X /,0/ X $424.31 0.2J'.5'~
<..... ..-/
X X $424.31 S
X X 5424,31 s
4. SANITARY SEWER-t1WI1C,
NO. OF PFU'S /f' x 515.125 PER PFU + 510 MWMC ADM FEE S 7-'82.25-
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) S 10,19
TOTAL-MWMC SDC,~
.----" '-- ./"
SUBTOTAL (ADD ITEMS 1,2,3 ,. 4) S :z. 2~S",.,r
-...-----
"5: ADMINISTRATIVE FEES,
,
\,
GE <J[jYT . ABOVE) X .05
(Iv' -:f-/s--7fZ
. i: ~
C Coordin
all,,2:->
........... ../' ~"
,
TOTAL SDC s...s:3.;~.r::'
2.> 311.7 J
"
.'
. ,fr~TURE UNIT.CALCU.~ON TABLE: 1~1I11\~'t'r (11 New l'i,ll1/('s X L1n;; [qlliV:i1t'1l1 ~ Fi,'.Jle Unlls('-:VI<::
For (cm~t'ls. c.l'cul~le only Ihe ~fl;l(1n:i1 '''l'''l''.) . '
l~l'l,lGEn OF L':':Il" f1XTl,lRE
FIXTURE n'pE NEW F1X1UI1ES EOl'l\'i,L1:IH UNI IS
"
2.
Balhtub......................,......"""..,.., ",.."...."..'
Drinking Fount3in,.,.........."..,..,..., ..,....,........,.."...."
Floor Drain......................,...., '..0...""'........'.. ...........',
Interceptors For Greasc/Oil/Sollds/EIC.................
Interceptors For Sand/Auto Wash/Etc,.................
Laundry Tub/Ootheswasher.........,.....,... ....,.....,.....
Ootheswa~her . 3 Or More.....................................
MoLlile Hdme Park Trap (1 Per Trailer).................,
Recep!or F9r Refrigerator {Water Slation/Elc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single.StaIL....,............,.............,..............
Shower, Gang...........................................,........:.....
Sink, Bar, Commercial..................,...............,..........
. Urinal, Stall/Wall.......................................................
Wash Basinflavatory. Single..................................
Water Oose!, Public Installation...............,.............
Water Ooset. Prr..ate........,.......,............."..,......,...,.
Miscellaneous:
~
.,
:z.
3
G
2
G
G
1
3
2
I/Head
2
2
1
6
'2.
I
:z.
2.
'Z"
'2.
~
'1
TOT;',l FIXTU?E UNITS
=
/'i
CREDIT CALCULATION TABLE:
rCUlate cred~s ~~:~S.
Based on assessed value, If improvements occurred after annexation date in table.
Rate per $1.000
Assesse-j Value
Year
Mnexed
Rate per $1.000
Assessed Value
II
II
1979 or before
1980
1981
1982
1983
1984
'1985
$3,21
3.13
3.08
2.!f5
2,82
2,63
2.51
1986
1987
1988
1989
1990
1991
1992
S 2,24
1.93
1.57
1.18
,_-_-_..J:?a _~
Improvement Cd after annexation date)
~..2/ 'X $ .2/,9~o
(Rale X Assessed Value)
X $
(Rate X Assessed Value)
CREDIT TOTAL
=
10.47
~
1tJ.n
..
Credh for Parcel or land Only If Applicable
=
= $
"
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Resid ent iaL..... ...................................,..:......... 0.4
CommerciaL................................................... 0.9
Ind uslrial........,...............,......., ...... ..,...........,..... 0,45
GovernmentaL..................,............................. 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
"
.
.
o y!i!I.1!,I!!!!~!!~
Job No. Cttl:PH2..
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME \&xYl t' ~ 11\~! ~ \n'~ ~QNE f\'\f\ lcA'i:13
ADDRESS: \~l\.4 ~~~ la\-VQ X ~ STATE:~IP ~
LOCATION OF ~ROPOSED ~UllRW.G SITE: C \ ' .
Street Address if Known: l rfJ..<I:1J \.":'1_ ~ ()_ ,?_,
Platt Name: IDD{'~nO<\\rth~ax Lot Number: \p{')9..illEr3 (y5:H')
\~ .~ -
1. DEVELOPMENT TYPE (Check appropriate dwellingCsl. SDC Calculations and dwelling type
definitions are on the back,)
A. Single Familv - Detached
\
Single Family home
I
NO OF UNITS
Manufactured home not in a park .II T'!\ c()
X $400 PER UNIT ~, $ \\.)0, ,
B. Single 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
$4CO~
$ (2f
$4ro~
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for CreditJ
~'
/2... I_S IY/
Date
Community Services "Ji,sion
City of Springfield
I,"
.
.
The, foilo'Ning prcjec1 es sllbmlttad has tho foil
zOillllg, and doeo not roqulrEl r.peciflc land u"'e
approvel. .,
225 FIFTII STREET L-p/J
SPRINGFIELD, OREGON 97477 Zoninil IC,./,
INSPECTION REQUE'ST: 726-Oli1roJl-11 - Lq /'t'-t
OFFICE: 726-3759 I
Authorized Slgnalure
City Job Number
ELECTRICAL PERMIT APPLICATION
q4D30~
~ r.OMPI~TE FEE SCHEDULE BELOV
1. t~lj/~ ~~!.ro e A.
\ytfjfL~N O~-=ro
P.~: ;:!:",:'~:l::~~
if vork is not started vithin 180 days
of issuance or if,vork is suspenaed for
180 days.
2.-' CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
.
,
- -
Ovners Name \lO rY1.1' \ ,
Address t?-.44 (\ ~ \.
Ci ty~r1. Phone t\l.[~
OVNER INSTALLATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
.
~wners Signature:
~ /. ~ tt'-.-r-
~-~-7'---tT-7JfD'T't?t--------
DATE: 'L-, ''11~. ,{/\
RECEIPT 1I: (; I \~
RECEIVED BY: ~(jl(). / ,-
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof S 15.00
Each Manuf'd Home or
Modular Dvelling
Service or Feeder S 40.00
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
Branch Circuits
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Nev, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less \ $ 40.00, 1[}W
201 amps to 400 amps S 55.00' "
Over 401 to 600 amps S 80.00
Over 600 amps or 1000 volts see "B" above
$ 35.00
S 2.00
no t included)
S
$
$
$ 36.00
40 .ex?
r-f/.l!,U
~~
40.00
40.00
20.00