HomeMy WebLinkAboutPermit Field Test & Inspection Report 2004-5-28
City of Springfield
Com:~U:ljl)' 5,j'\':~~' Djv!:;u;,
22Hillh Sucet
Springfield, OR 97477
Tel.phone: (HI) 726-3759
Fax: (541) 726.3689
Special Inspection And Testing
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Building Permit U
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Project Addre..
To applicants of projects requiring special insPeclion Dr testing as per S.clion 1701.5 of lbe Oregon SrruclUral Specialty Code. Please revi.w.the information below. When you .
hav. finished, acknowledge an understanding oflhe infonnation by signing below, and retum lbis fonn to lhe City.
BEFORE A PERMIT CAN BE ISSUED: The owner or own.r's repres.ntativ., on the advice oflbe responsible PrOject Engineer Dr Architecl, shall complete. sign, and submit
10 lh. City for review and approval this fonn completed on both the front and back.
The Owner and G.n....1 Contra.tor, where appli.abl., shall also acknowledge th. following conditions applicable to Special Inspection and/or T.sting.
I. Contractor Is responsible for proper nolificatlon for lbe Inspeclion Dr Tesling nf items listed.
2. Tesling laboratory shall like appropriale samples and transport lhem 10 their laboratory for proper evaluallon or lesling.
. Copi.s of alllabornory r.ports and Inspeclions are 10 be sent. to lbe Cily by th. Testing Agency.
3. Speclnllnspeclioll Ageney is to submil names and qualification. ofon.slte SpeciallnspectoTS to the City for approval.
4. Speelallnsp..lor shall provide Inspection repons to the building official of all inspection activities.
5. Contractor is r.sponsibleto revi.w the City approved plans for additional inspeclion Dr testing requir.ments lbat may be nOled.
BEFORE A CERTIFICATE OF OCCUPANCY WILL BE ISSUED: The Speclallnspection Agency shall submitlo the Building Official aslatemenl thai all items requiring
inspection have been fulfilled and reported and were to the best of the Inspector's knowledge, in confonnance wilh the approvcd plans, specifications and applicable workmanship .-
provisions. Those Items notlested and/or inspecled shall be noted i:. the stat.ment. Tho report Is to be submined to Ihe City prior 10 a requ.st for fir.al inspeclions. .,.,
ACKNOWLEDGMENTS
B"""'k.:....i $-(~~ L
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Owner Name (Printed)
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Engineer or Architect Finn (Print.d) Engineer Dr Architect Signa lure
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Testing Laboratory Name (Printed)
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T.sting Labol1ltory!ll<'p SignllUre .
Nc."I",,'T"'~ c..o)..;';;-u.-,<-,1...v
Gen. Contractor Finn Name (Print.d)
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O..nera1 Contractor SignAture
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Sp.elalln~oeclion: ~ame (Printed)
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Building Official Name (Printed)
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Special insp: ~ Rep S~n.
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Building Official Signature
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SPECrAL INSPECfION AND TESTING SCHEDULE
"ReJD(orced Concrete. Guoit., Grout Bod MDrtlr:
CDncrele I (iunlfe I C'.KIouf f Mortar .
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PruasUP~lrelJed COne-rele:
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Arereaalft Te~1 D'Mhr De:JfD'n
P~DT"<Ct
Mh. DeJi.n.Wd.hmstrCert.
Re'nfoch" Pllcem!,.,
Continuous Ditch Plll:nt Insp
In!.pl!~ PII!II!tinr
rll!. ~arnpL!1
~~:~~,~~~~~,:?~liVl.rp.dl
A"~lftll!l Tt."',.
D-,'nrftn:lno Te'll:lJr
T~ndon Ted
1-A'iWnf!:llv,...
R~;;,r.;.;i~. PI..eme.,
Inn" Place' ,~"t
f"..,ncrete Alllchlnr
~ele PlaCl!RlCDr
'R!ltlllla:tlon In~'ion
ClIsrSan,plflC
Pick~llp ~8mrtle'
Comprenlon Te'tll
. GRADING, EXCA V ATION, AND FILL
A...pl.... ...ts . PSF
EsI.blish Ilnat grade
Fill placement inspeC:lionlconrinuous
SoU Oensity
STnUCfURAL STEEI.lWELDING:
Sample and le.l (Iill spe.iIl. members below)
Shop m.lerlatldenlllleation <mill '.<1)
~ W.ld in'pec"nn ~ Shop ~ field
Ulira.oni. ""po" ion Shop r-icld
High st"'ng'h bohlng Shop Fi.ld
AJ2' N X r-
A490 N X F
M.,.' d""k w;j;j]"S in.pe7.iOn
Reinfor.lng SI..t welding Inspeellon
Reinforcing sle.1 mill..nillc.'.
M.lal .tud welding in.peclion
..)t. Concr... In!en w.lding insp.clion
MOlllent re.isling sleel rrames
STRUCTURAL WOOD:
Sh.... ....U nailing inspecliOIl
Sh..r ...all anch...
In.pecUon ofOlu,'om rob. . TIC psi
InspeeUon orlrv..)oi.. rib.
Sample and test components
f'abrlclltion welding o~ aeel acceuorics
SMOKE CONTROL:
L.akaiellSling
Conlrol verificalion
ROOFING
Insulacion in,S1ftUarinRlR-valluet
TCS1 slrlps/seams.
FIREPROOFING:
Placem.nlln.poction
Denslly Te..s
Thickne" ...t.
. Inspcel botching
ADDITIONAL rNSTRUCI'IONS, OTHER TEST, & INSPECTIONS.
E pa"", ?.,-,.""'\ \ ~~ ,. \"'" "'~9...l 0;:, ";'"';t..~1 ," "~,..~<,,
MASONRY:.. Iljc:c>.' '2 So.r.> f">~
~ SpeclallllSpeel'on slr....s oscd' -,---% _rg
Prcl!minary aeccprnnce tesls (masonry unics, wall prisms)
Subsequenllesl. (man"" groul, field wall priSlnJ)
PIDccmenl inJpecrion of units, Rnel reinfhrccrru:nt
Masonary, mcnar. groul, anti reinrorcing slcel certifleales
Porm complel'd by:
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'PIIOVlDE STRENGTH REQUIRED BY ARCIIITECT OR ENGINEER OR CONTRACf DOCUMENT LOCA TION OF VALUKS
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,. AlTACHMENT A _
CITY O~UNGFIELD SVSTEMS DEVELOPMENT CHARGE ~HEET
JOURNAL OR JOB NUMBER COM2004.00568
NAME OR COMPANY: MINDS IN MOTION
LOCATION: 445 HARLOW RD
MAP & TAX LOT NUMBER: 17032244 07200
DEVELOPMENT TYPE: CHILD CARE CENTER?
NEW DEVELOPED AREA (S,F,): 11.226,00
EXISTING DEVELOPED AREA (S,F,): 3.700.00
TOTAL IMPERVIOUS SURFACE (S.F.): 30.357
ITE:
ITE:
LOT SIZE (S.F.):
565
210
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::3 t ...
u ': ~ 91
~8'~ h
1 STO.'" IJRAINAGE
IMPERVIOUS SQ. IT,
x
$ 0.290 PER SF
TOTAL STORM DRAINAGE SDq $ 12.059.07 1070
41,583
2 SANITARY SFWFR..c.IT":
A. REIMBURSEMENT COST:
NUMBER OF DFU's
B. IMPROVEMENT COST:
NUMBER OF DFU's
(SEE REVERSE SIDE)
95
x
$ 22,64 PER DFU
x
$ 17.21 PER DFU
95
I $
2,150.80 I $ 2,150.80 1091
, $
1,634.95 I $ 1,634.95 1092
3 TRANSPORTATION
TOTAL LOCAL WASTEWATER SDC:' $
3.785.75 I
BLDG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR
NEW
A. REIMBURSEMENT COST:
11.226 x 79.26 x $ 17.23 PER TRIP x 0.7 NTF 1$ 10.731.55 I
B. IMPROVEMENT COST:
11.226 x 79.26 x $ 76,01 PER TRIP x 0,7 NTF 1$ 47.342,14 1
EXISTING
A. REIMBURSEMENT COST:
-4,000 x 9.57 x $ 17.23 PER TRIP x NTF 1$ (659.5611
B. IMPROVEMENT COST:
-4,000 x 9,57 x $ 76,01 PER TRIP x NTF 1$ (2.909.66>1
TOTAL TRANSPORTATION REIMBURSEMENT SOC:I $ 10,071.99
TOTAL TRANSPORTATION IMPROVEMENT SOC: $ 44,432.48
:Ii 54,504.47
TOTAL TRANSPORTATION SDq $ 54,504.47 ,
4 SANITARY SFWF. - ~
NEW:
A, REIMBURSEMENT COST:
NUMBER OF FEU's 11.226 x $89.89 PER FEU
B. IMPROVEMENT COST:
NUMBER OF FEU's 11.226 x $61.21 PER FEU
EXISTING:
A, REIMBURSEMENT COST:
NUMBER OF FEU's -4,000 x $314.63 PER FEU
B. IMPROVEMENT COST:
NUMBER OF FEU's -4,000 X $214.23 PER FEU
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
1093
1094
1$ 1.009.161
1$ 687,12J
1 $ (1.258.5211
1$
(856.91)1
$
$
$
$
l $
1054
(249.36) 1054
(169.79) 1055
1056
(419.15)
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TOTAL MWMC REIMBURSEMENT FEE:
TOTAL MWMC IMPROVEMENT FEE:
MWMC ADMINISTRATIVE FEE:
SUBTOTAL (ADD ITEMS 1,2.3, & 4)
TOTAL MWMC SDC:' $
'$ 70,349.29 I
.s.......AQMINISTR "" TIVE FEES.
BASE CHARGE (SUBTOTAL ABOVE)
$
70,349.29 X 5% $ 3.517.46
TOTAL TRANSPORTATION ADMINISTRATION FEE:I $
TOTAL SEWER ADMINISTRATION FEE: $
2.725.22
792.24
1078
1079
I $
73,866.75 .
JULY 2001
TOTAL SDC CHARGES
steveI'\. W. Beau'''!1 Bar"'-lS 6/1512004
C(j~1'MlIIIOll.IN MOTION. 445 Ha"ow,xJs DATE
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXllJRES x UNIT EQUIVALENT - DRAINAGE FIXTIJRE UNITS
(NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXllJRES)
MINDS IN MOTION
FIXTURE TYPE
BATHTUB
DRINKING FOUNTAIN
FLOOR DRAIN
INTERCEPTORS FOR GREASEJOIUSOLlDSIETC.
INTERCEPTORS FOR SAND/AUTO WASHlETC.
LAUNDRY TUB
CLOTHESWASHE~OPSn<K
CLOTHES WASHER - 3 OR MORE (EA)
MOBILE HOME PARK TRAP (I PER TRAILER)
RECEPTOR FOR REFRlGERA TORIW A TER ST A TlONIETC.
RECEPTOR FOR COMMERCIAL SINK! D1SHW ASHERlETC.
SIIOWER, SINGLE STALL
SHOWER, GANG (NUMBER OF HEADS)
SINK: COMMERCIAL, RESIDENTIAL KITCHEN
SINK: COMMERCIAL BAR
SINK: WASH BASINIOOUBLE LA V A TORY
SINK: SINGLELAVATORYIRESIDENTlALBAR
URINAL, STALUWALL
TOILET, PUBLIC INSTALLATION
TOILET, PRIVATE INSTALLATION
MISCELLANEOUS:
FIXTURES
NEW OLD
UNIT
EOU1V ALENT
3
1
3
3
6
2
3
6
12
1
3
2
2
3
2
2
1
5
6
3
5
1
I
2
I
9
1
8
NUMBER OF EDU'S.
TOTAL DRAINAGE FIXTURE UNITS~
.EDU (Eau~ent Dwelling Unit) is a discharJ!e equivalent to 8 sinwe fwnilv dwellinJ~ (20 DFU) set at 167 Ral10ns per day
DRAINAGE
FIXTURE
UNITS
o
o
15
3
o
o
3
o
o
o
3
o
o
3
4
2
9
5
48
o
o
o
o
95
CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AFTER ANNEXA llON DATE IN TABLE, CALCULATE CREDITS SEP ARA TEL Y
YEAR RATE PER SI,OOO YEAR RATE PER SI,OOO
ANNEXED ASSESSED VALUE ANNEXED ASSESSED VALUE
1979 or before S 5.04 1992 S 1.52
1980 S 4,95 1993 S 1.38
1981 S 4.88 1994 S 1.19
1982 S 4.75 1995 S 1.03
1983 S 4.58 1996 S 0.87
1984 S 4.41 1997 S 0.68
1985 S 4.20 1998 S 0,46
1986 S 3,88 1999 S 0.27
1987 S 3.50 2000 S 0.09
1988 S 3.07 2001 S 0.04
1989 S 2.60 2002 S
1990 S 2.14 2003 S
1991 S 1.71 2004 S
CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE SO.OO X 0,000 SO.OO
IMPROVEMENT (IF AFTER ANNEXATION DATE) X SO.OO
CREDIT TOTAL SO.oo
COM20D4-00568, MINDS IN MOTION, 445 Harlow.xls
JULY 2001