HomeMy WebLinkAboutPermit Building 1995-6-14
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726,3759
.
SPRINGFIELD
~SSESSORS MAP'
~\OT'
T'J"
I
2./
S-\-vee./T SO('jt<e.\d. 01<.
TAX LOT: t9 g; ~ <5 0
BLOCt<'
OWNER'l'o.......\ ~ c.';"''if ~ ('_D"''''-O\-c..
ADDRE'"'' 'L\ 1-11.. \ :\:,,'-, 'S.-\v t'~ +
CITY' 0:;0(; "'l: e..U
IA ,..;;-'hPt"A \e...A
DESCRIBE WORK:
NEW./ .REMODEL
,
...
"
I'
. STATE: _DI<
1"00"",", (<,\.A\I\v""O........ '1
~""
ADDITION
DEMOLISH OTHER
.
9~C)7fj.3
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
SUBDIVISION:
PHONE:
-, '"" \ - ?"3,~ \
ZIP:
'1, \oj.., ~
CONTRACTOR'S NAME ADDRESS
GENERAl' /D-hi\je., Co"S1v\^c:\"\",^. 'r~c...
5'-\\
CONST.
,CONTRACTO~ EXPIRES PHONE
S~W....\:.. ~O\'\" TLlOlo\'; C\'l\.Q! l<;l(..al~~'a'
eEl..(... '1io-07Otf
PLUMBING'
MECHANICAl.
ELECTRICA"
QUAD AREA: ~R~--",
. ClF BLDGS:
OCCY GROUP'
. OF STORIES:
, WATER HEATER.
- OFFICE USE -
LAND USE:--+W
. OF UNIT~'
CONSTR. TYPO".
HEAT SOURCE:
-
RANGE:
FLOOD PLAIN:
ZONING CODE: ..LQ/2-
'.
. OF BDRMS'
SECONDARY HEAT:
'SQUARE FOOTAGE:
rQ/tp
To request an Ins pee lion, you musl call 726.3769. Tl,ls Is a 24 hour recording. All Ins pee lions requested belore 7:00 a.m, will be
.,,. made the same working day, Inspectlons requested afler 7:00 a.m. will be made the following work day.
o Temporary EI~Clrlc
o Site Inspection - To be made
after excavation, but prior to
seltlng forms.
o Underslob Plumblng/Electrlca"
Mechanical - Prior to cover.
~ Footing - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundation - After (orms are
erected but prIor to concrete
placement.
o Underground Plumbing - Prior
to f1l1lnQ trench.
o Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam- - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to tilling
trench.
("Q'( Storm Sewor - PrIor to filling
~rench. .
o Water Line - Prior to filling
trench. '.
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical "- Prior to
cover.
D Rough Electr!cal - Prior to
cover. '
o Electrical Service - Must be
approved to obtain permanent
electrical power,
o Fireplace -'Prlor to facing
materials and (ramlng Insp.
~ Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywell - Prior to taping,
o Wood Slovo - After Installation.
o Insert - After fireplace approvel
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Fence - When completed.
o Street Trees - When all.,requlred
trees are planted. . \. '.
.. 0 ,Fln~1 Plumbing - When all
plumbing w9rk Is complet.c.
D Final EIOClrlcal - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
K/l' Final Building - When all
~requlred Inspections have been
approved and building Is
completed.
OOth.r
MOBilE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connoctlons - When
home has been connected to
waler and sewer.
o Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
Inspectlons are approved and
porches, sklrllng, decks, and
ventlng have been Installed.
('~
Lot faces
Lot ~ype .
l/'
_ Interior
Lot sq. Itg.
Lot coverage
Corner
Topography
Total height
Panhandle
ff
Cul,de,sac
BUILDING PERMIT
ITEM SO. FT., X $/50. FT.
Main
Garage
Carport
~~
Total Value
Building Permit Fee
Slate Surcharge 4,6 1-f' '3.79>
Tolal Fcc (A)
I P.L.
IN
Is
Iw
IE
Setbacks
HSE GAR
10'
VALUE
"
.L/~
92 ;5",0
'92.. ro
--.J.fl
99.'7/
SYSTEMS DEVELOPMENT CHARGE (SDC)-$
(B) if 4-1~
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT,
Storm Sewer FT., .In/V
Mobile Home
Plumbing Permit
~
State Surcharge
Tolal Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Ven t Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
~
FEE
2c;~
Z7:0 D
I ,~S-.
.?S"
'2 7, _D
a~,'31
.... -,;~,:~?"'~;".;::~:
~i -.
,
;. THE PROPOSED WORK IN THE,
HISTORICAL DISTRICT, OR ON
.THE HISTORICAL REGISTER?
If yes, Ihls application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
ACC I
I
I
I
I'
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condllion that the said
construction shall, in all respects. conform to the Ordinance
adopted by the City .01 Springfield, including the
Development Code. regulating the cOr),struction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
~a/3
~m~J
Receipl Number. /7C:;-o '7
ReceIV~_~~~
4viewed ~
Plan Check Fee:
Date Paid:
h/f.:/~\
ID~
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being Improved.
ADDITIONAL COMMENTS
#y P:I H'~l"'d J'IO(t:.. llll/I #lflIJ!!D
..d. .<r'fYJ~"'/T
/./A ~A p:;p
~Ace
-
t)
"
By signature, I stale and agree, that I have carefully examined
the completed application and do hereby cerllfy 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 01 the City of Sprlnglield, and the Laws
of the State of Oregon pertaining to the work described
herein, and thai 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 streel, that Ihe p rmit card is located at the front
of the property, an the proved set of plans will remain
~u:= at all mt ring construction.
Date (p, I 'i: "'7
I I
VALIDATION:
RECEIPT NUMBER /7777
~,/y..~7
1?C/.5/'
r2'~
/
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
.
.OB NO: cr'5D~-'.;;'3
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: Y'AU L ~ G-lI'.\.(,,~f2... C.Ot-lt-J oLE:.
LOCATION: 44-2.1 LVY -7>,1'.
'<:&0"2-00::,....1 - o~o~o
DEVELOPMENT TYPE: Ll>12-- - A.t>o I""{ ION
BUILDING SIZE: 12.". \ 4.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. 2.. \ '= X $0.209 PER SQ, FT.
LOT SIZE
SQ. Ft.
~4s'0
2. SANITARY SEWFR-(ITY
NO, OF PFU'S -- X $43,26 PER PFU
(See Reverse)
(-~
3, TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X X $436.19 G )
...... .....-
X X $436.19 $
X X $436.19 $
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADM FEE
(Use PFU Total From Item 2 Above)
$
TOTAL-MWMC SDC
$
r=-;
..... -----
$ 4S14
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
SUBTOTAL (ADD ITEMS 1,2,3 & 4)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
\~, ,,~_~.LvL. Date: S )"K>/"lC;
UKlp Burdick ' 'TOTAL SDC
SDC Coordinator
G ?7.("~
" ...-/
$ 47~
SI.IIINUI:I~l.U
~"f
""J'hp. rOllO"""l1g' : . ~..
225 FIFTH STREET :'~~inil, Md~~J~t:7. .~. 8d1l,j~~CAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 'h-'eva!. .r~UIr8 1lecI!ic/AAduee 1ovrl"i7
INSPECTION REQUEST: 726-376? Z~B3'n Ci ty Job Number '92cg.?9
OFFICE: 726-3759 Dnt~ \".I!
JlLJU COMP!:ETE FEE SCHEDULE BELOV
1. LOCATION OF INSTALLATIo~utherQUd Sjgn~lIre
~;.. &. ~rrUob .
i/vz.I /W--
LEGAL DESCRIPTION
~ 7' ......a--?~ ."$-z. c.?"'-1b~
/8~.~:;~tr;oitt~
Il ){ 'IV J (\ i f\..J <!..o1I\!i. 1 t t M'\ 0 fl.-J
!'
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical ContractorQ,~8 p DOl\i~ I ~.
I I
Address P,C, ~ ,4gJ,....
CitY~~.. ~hone"l41-~').5fo
Supervisor License Number I !:, ~ (" S
10 -I-q').....
0384Q
Expiration Date
Constr Contr.. Number
Expiration Date
q-I-Q1->
."~S";;:)L;;;~~)
Owners Name p~ (1~~
Address r:r.f1~ f.Y ~
City~~. Phone '14/- 33:3/
OIlNER INSTALLATION
The .installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE: ~/~--;?2..
RECEIPT t1: <'/"=?2
RECEIVED 8Y: ...-..:?.-....-=- ~
. ''?' -
sidential-Single or
Multi-Faml y er dwelling
Service Included:
Items
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
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
uni to
Cost
Sum
$ 85,00
$ 15.00
$ 40,00
$ 50.00
$ 60.00
$100.00
$130.00
$300,00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "'B" above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One ,Ci.rcu it
Each Additional
Circuit or with Service
or Feeder Permit
E.
5, SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00 ~O
$ 2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
.15'.00
1,'15
3h, rj 5'