HomeMy WebLinkAboutPermit Application 1995-3-28
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
If Ol65&~
ASSESSORS MAP'
LOT' 1'....,
..
BLOCK'
OWNER' :p..,LH.J
ADDRESS:' J. ~~_S
StJ-C1 rl
J4k/A1s ,
(7 J'<?~LAJ4-~
L.4.
STATE:.'yA~
CITY'
DESCRIBE WORK: !1IfI.JU F, -f./DM e.
NEW ~ REMODEL ADDITION
3 - q- /~
.
JOB NUMBER c;l 5 DrZ 1-
225 Fifth Street
Springfield, Oregon 97477
SUBDIVISION:
PHONE: 7d?-:J.ct'/L'S
J,w ~~ID -2..f!:. '57 (tc))
C}?t??1d
ZIP:
,;( /I,/1/l 4.lJ.e~fe <\- (lA/?j70/2.?r
DEMOLISH OTHER
CONST,
CONTRACTOR' EXPIRES PHONE '
;L49.<> .twj}O-t) /hJL aQJJ.9~t, 7/tzr 3-15-;;;179
,
CONTRACT~;Mh ' - ADD~ESS
GENERAL: ~I+,.B~_/1V<T, ..JJ4I"
PLUt\1BING: f)Li.JAJ pL- '
MECHANICAl'
ELECTRICAL: Jl-,#(I' ;;~ l?..l7U ~
QUAD AREA:
'h ~0.(l /
I
(i?,+rY1
I
. OF BLDGS:
OCCY GROUP'
. OF STORIES:
WATER HEATER: _Y
~./1.1\1'::,:
,.", : '
;,
ZtJb ~ e..
I2r'~- 74J-04~
'"-' OFFICE USE -
LAND USE: Jt5l:l--;\
. OF UNITS' LC~J
CONSTR. TYPE: Vr-!'~
HEAT SOu~c~,~fe;~->-
r.
RANGE:
FLOOD PLAIN'
ZONING CODE: /~(,-DYC:~,
1...
. OF BDRMS'
SECONDARY HEAT: -
SQUARE FOOTAGE: 1441?,
TO request an inspection, you must call 726-3769, 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
D Site Inspection - To be made
after excavation, but prior to
~_ett~ forms.
0~~ a urn In 1~lectrlc-:i1
Mechanical ~ Prior't v
~~ting - After trenches are
excavated.
o Masonry - Steet location, bond
beams, grouting. .
~ndatiOn - After forms are
. erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling t~ench.
o Underfloor Plumbing/Mechanical
c Prior to insulation or decking.
o Post and Beam ~ Prior to floor
Insulation or decking.
,
~ Floor Insulation - Prior to
decking,
~~anitary Sewer - Prior to filling
lk::f ;~nch.
~rm Sewer - Prior to filling
trench.
r-1kater LIne - Prior to filling
LV' ;;ench.
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
~~U9h Electrical - Prior. to
cover, ~
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - PrIor to facing
materials and framing Insp.
~ing - Prior to cove.r.
,~
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Sto,:,e - After installation.
)"0 Insert - After.flreplace approval
and Installation of unit.
~rbcut & Approach - After
forms are erected but prior to
placement of concrete.
~~ewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
D Fence - When completed.
o Street Tr~es - When all req'uln3d
trees are planted. .
o Final Plumbing - When all
plumbing work Is complete.
'I
/
CL:}-Flnal Electrical - When all
electr,lcalq~
o Final Mechanical - Wtien all
mechanical work is complete.
/
~Inal Building - When all
requIred Inspections have been
approved and building is J
completed, M~(I0 Utltt
f\0 Oet lJ r--',
~er 1J.I FR A t;r((Vc.rvte./.E.
A CCl5.17ff$ g ':1 C ITj
MOBILE HOME .INSPECTIONS
~cking and Set.Up - When all
blocking Is complete.
~mblng Connections - When
home has been connected to
water and sewer. .
~trical Connection - When
blocking, set-up. and plumbing
inspections have been approved
and the home Is connected to
the service panel.
~al - After all required
inspectlo'ns are approved and
porches, skIrting, decks, and
v.entlng have been installed. .
Lot faces Lol Type. Setback"J . THE PROPOSED WORK IN THE
Interior I P,L, H'SE GAR ACC I HISTORICAL DISTRICT, OR ON
Lot sq, ltg, IN I THE HISTORICAL REGISTER?
Lot coverage Corner If yes, this application 'must be signed
I,s 1 and approved by the Historical
Topography Panhandle 1 Co?rdinator prior to permit issuance.
Tolal height ~. Cul.de.sac W
(?(I' ) IE I APPROVED'
BUILDING PERMIT
SQ, FT.
14~?) .-
19,J
"~i!..
ITEM
X $/SQ, FT, ~ VALUE
~l)5, 6lJ1l,UC
//t') 51:-
S~ 35'
Main
I"" /t$>
I~ 1'0
Garage
Carport
.m#~
. I
~;] \'nH
Total Val ue
~ 2.43
\4\0.5:)
\ \.13
h t=fn.2,3
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) 4f'2..~,,?.,~$
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT,
fJ:5.cD
Ac:::::,90
AS pu
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
~~ou
(o.cO
~ ( .W
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
c/
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
lir, 00
0.1)0 .00
Q.~~
~!;l .W
_l{j.UO
'- ~. lC::;
State Issuance
State Surcharge
Sidewalk ~
Curbcut ~
It
It
p., ..,~ ~
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electricalP/U r-t'l'; .ns
(A, B, C, D, and E Combined)
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 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' 9~.';2. 3
Date Paid: 0~ ~
Receipt Number' /~
Received By: -4'~
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
(Lf-1 ': {f;r&Ii, I.P (fAL)
[lJ1J1.(X/ J #Il' fCtertl- r5/
~tL( I ~hu..Jt1. tV
By slgnature;1 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 Ordinanc~s of the City of Sprlngfleld, and the Laws
of the State of Oregon. pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Buildi.ng 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 property, and the approved set of plans will remain
on the site at all times during construction.
Signaturp ,.7'.. ~Q ~_
Date '3 -:J..'? - 9.s-
VALIDATION: t\ !l
RECEIPT NUMBER t l Q l \V\
DATE PAID /~ .rQ ('q .G{:j
AMOUNT REC~ -0~~ .\ ~
RECEIVED BY (~ I.(O-.J
I
/41
... ATTACHMENT 81
~ NO. 9'5o?::>2.4
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR CmlPANY: ?>\)D AKlf-.l~
LOCATION: 4S44- LVY s-r,
I "i!,o7-0 S O"? - Cl"?'2.o0
DEVELOPMENT TYPE: Lt:>lZ- - f-lE::.vJ N\M u, t-l-oME.
~ IV\ E. P. w G./>,ll.A<>€
BUILDING SIZE: 'Z..,~o;....I7.""~O ~e"u I,OT SI7F
, '
CA;Q..Pol>--': ~9,c."2-1
1. STORM ORA TJ:lAGE
IMPERVIOUS SQ. FT,
'?"0r '2.-
X $0,209 PER SQ. FT.
2. S8NlIARY SFWFR-CITY
NO. OF PFU'S I~
(See Reverse)
3, IRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
. X $43,26 PER PFU
\ X \, 0 I X $436, 19
X
X
X $436.19
X $436.19
--
SQ. Ft,
C;04-"TZ-)
.......... ~
~l€>"~
'-- .-/
C:440 '5~ )
"--- ---
$
$
SUBTOTAL (ADD ITEMS 1.2, & 3) $ \'4'2-"!:>~
4. SANITARY SFWFR-MWtl[
NO, OF PFU'S _ I~ x $17.19 PER PFU + $10 MWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
IQIAI -MWMr. snr.,
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
5. ADMINISTATIVF FE~
BASE CHARGE (SUBTOTAL ABOVE) X .05
k-':" ("Y ~LJe..-
~ .. Iln,.~;:-
SDc" Coordi~~tor-'
Date: ? /11 /96
IQIAI snr.
82,SDC .
$QI.,,4....
$ \4-~
($ =-o4-~
$ -z. '2- "2-- e. S2-
c;\\\~)
-- ---
$ '2..'?Q9 9~
FIXTURE U~'T CAf-CULA" T A,BlE: Number of New Fixtur.nit Equivalent =, Fixture Units
(NOTE: For remodels, calculale only the NEI addItIonal f,xtures)
NUMBER OF UNIT FIXTURE "
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
'.',,"
2
1
2
3
6
2
6 ..
6
1,
',3
2'
1/Head
2
2
1
6
4
4-
Bathtub.....,.."""..., ....".."""..,..,..",..,.. ,.....................
Drinking Founlain,.."""""""",."."""",.."".",..,.".",
Floor Drain,.,..........,.."""""."""",.""""",.",.,.."."",
Interceptors For Grease/Oil/Solids/EIC,...,....,..,....
Interceptors 'For Sand/Auto Wash/Etc..,....,..,.......
Laundry T ub/Clotheswasher.,.""" ',":""."""""....,':'
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..,...............
Receptor For Refrigerator/Water Station/Etc......:.'
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.....,...........................................
Shower, Gang...........,....... ... ..... ,...,.. ....... ..... ..... ;.. ....
Sink: Bar, Commercial, Residential Kitchen..............,..........
Urinal, Stall/Walt:...,......,.... ... ,........, .... ..... ...... ... .......
Wash Basin/Lavatory, Single..................................,
Toilet, Public Inslallation.,....,..,.....,..,.,...........,.......
Toilet, Private,..,..........."...,.."."."", ,..,.,..,.....,......
Miscellaneous:
1-
'Z.
"
..
'2-
2-
'1-
'l.-
~
TOTAL FIXTURE UNITS
\~
CREDIT CALCULATION TABLE: Based on assessed value. If improvemenls occurred aller annexalion date in table,
calculale credits separates,
'r-
Year
Annexed
Rale per $1 ,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
" ,198,1
1982
1983
1984
,1'985
$3.46
3,3B
3.32
3.21
3.06
2.92
2.73
1985
1986
1987
1988
1989
1990
1991
1993
$ 2.46
2,14
1.77
1,37
0,97
0,61
0.44
0,15
Improvement (if afler annexation date)
'3 .4-lo X $ 4,?
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=
14-~
Credit for Parcel or Land Only If Applicable
=
CREDIT TOTAL
, ~e.
= $ 14--
.
~,... Willamalane
'-tg' Park & Recreatio~ District
.
~
lob No. q5'o ~4
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME: ~ (JJiJ;~s
ADDRESS:.Jlf!Jh r) f /J A/IV rt111
- '
PHONE:
'? tf1-- ~ Ct t1 <"
() fl-zIP a1lt7 (
L-h16
STATE:
Lq<:ATION OF PROPOSED BUILDIr:-\G SITE:
, Street Address if Known: L/Elilf 1ivY
Platt Name:~! lJlliuf.
t,j.1u} ,
Tax Lot Number: _l ~ 0 t ()c:;tP; t1?JMo
1. DEVELOPMENT TYPE (Check appropriate dwellirig(sl. SDC Calculations and dwelling type
definitions are on the back.) , , ,
A. Sinl!le Family - Detached
Single Family home
NO OF UNITS I
B. Sinl!le Family - Attached
NO OF UNITS
C. Multi-Family Aoartment '
NO OF UNITS
D. Manufactured Home Park
--, .
NO OF UNITS ,
WPRD SDC
--1.. Manufactured home not in a park .' ciJ
X $400 PER UNIT .3=.. $ ~. ,
.
X $370 PER UNIT =
'$
,
i,
X $777 PER UNIT =
$
,
'I
X $280 PER UNIT =
/
,
$ '--
--)
$'.( -100 ~tf j
$ ..fl
~:101)~ '
2. SDC CREDIT (If applicable! SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (I( SDC reduced (or Credit!
- -
r^...~...~.....:... c:",....:,.....,. ~;,.j,..,....
~ //)j / q~
n~f(lo .
.
SPAI.ELO
b l\Ied haS lhe lollowlng
The 10llowlnQ pro\~ ~~~I':SPecl1lc land u&8
225 FIFTH STREET zOnlng,:dcjoee /), ELECTRICAL PERMIT APPLICATION
SPRING~IELD. OREGON 97m'ov '1--PW nC:'...ID-,n/\
INSPECTION REQUEST: 726-37~lng. - 'Ci ty Job Number '-\ -J 1Q:J;i
OFFICB: 726-3759' Li _1-"1 ('
1. }.OCA,;rIpN \~p INSTAL~;~ed Slgna\u~ tJ JII' 3.
~~ ~n )1 t~,\\C\o1."" A.
LEGAL DESCRIPTI~ 0' /',
\MQf)~ r>~A u
JOB DESCRIPTION~\
'- XY\C\ r\ll~" q'lrwno ./
Permits are non-~ansferable and expire
if york is not started vithin 180 days
of issuance or if york is suspended for
180 days.
I
2. CONTRACTOR INSTALLATION ONLY
,
Electrical Contractor ARC ELECTRIC
Addres85783 HWY 99 SOUTH
Ci ty ~IIGENE
Phone 741-0494
Supervisor License Number
20985
Expiration Date
\ \l . \ .Q~
..
~. ~ .,;:
Constr Contr. Number '~00603
~'. '
Expiration Date \&, \\0 as
S1?gn~t d)e supervis~n~'i{~~trician
\ '" "" ,,~.
, '--ffl""'.~ ~
. . ..1...
, ( 1.1_ ' '.#l/, L-. _
Ovners Name,\ 1\rl "c1S.W~i~~~ =
Address \?~~ C\~~\~, .~-'-YQ <
City ~,~ Ph(i;;~: ~'1.aCbs
mINER INSTALLATION'" '
The, installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
------------A--- ------------
DATE:~.f1,~
RECEIPT I: r I) ) \\O~
RECEIvED BY: c---J\\ur \ ..' A - I
r.OH~' "~" 'i'EE SCHEDULE BELOII
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items
Cost
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 85.00
$ 15.00
c9-
$ "0.00 P('J
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to "00 amps
"01 amps to 600 amps
601 amps to 1000 amps
'Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ "0.00
,,'
C.
Temporary Services or'Feeders
Installation, Alteration or Relocation
,200 amps or less
201 amps to "00 amps
Over "01 to 600 amps
Over 600 amps or 1000-vorts
$ "0.00
$ 55.00
$ 80.00
see tlB"
above
D.
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
$ 35.00
$ 2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
S1gn/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
"0.00
"0.00
20.00
36.00
not included)
5.
$
$
$
$
pt),CX)
-,",,\-(0)
("\1.4-"
8(Q~o
SUBTOTAL OP ABOVE
5% State Surcharge
'f6Tkb-~ 9"0
lol:o 0