HomeMy WebLinkAboutPermit Building 1992-03-16SPrrI^rGFIELO
RESIDENTIAL
PERMTT APPLICATION
lnspcctions: 726-3769
Officc: 726.3759
LOCNTION OF PROPOSED WORK
ASSESSORS MAP: - -70e
3
OWNER
ADDRESS:
CITY:
CONTRACTOTT'S NAMt:
CENERAL:
PLTJMAINC:
MtTCHANICAL
ELECTRICAL:
Sile lnspection - To be made
af ter excavation, but prior to
setting forms.
Underslab Plumbing / Electrical /
Mechanical - Prior to cover.
JoB NUMBE ^9-ru39*,
efr,
225'Fif th Street
Springfielcl, oregorr gi q77
,SrtI 15"+ l'q
Lor: l-BLOCK
IAX LOT:
SUBDIVISION
PHONE €r-+
e_-srArE: eWq -4tK;l::ZIP
Fc, D-8. : _
ADDRESS
tg6-tD;\lnw,fie-
CONST.
CONTRACTOR 't
EXPIRES PI-ION E
Q3-s77
r'l'.
To request an inspection, you must call 726-3769. This ls a24hour recording. All inspections requested before 7:00 a.m. will be
macle the same working day, inspections requested after 7:00 a.m. will be rnade the following work day.
REOUIRED INSPECTIONS
w
w f-V Final Electrical - When allL41 electrical work is cornplete.
fVl Temporary Eleclric
-,/zvp drzzCzn
Rough Mechanical - Prior to fncover.
wB
Wl orVwatl - Prior to taping
Wood Slove - After installation
lnserl - After flreplace approval
and installatlon of unit.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
w
Rough Electrical - Prior to
cover.
Electrical Service - Must be
approved to obtain permanent'
electrical power.
Fireplace - Prior to facing
materlals and framing lnsp.
Framing - Prior to cover.
Wall/Ceiling lnsulation - Prior to
cover.
Final Plumbing - When all
plumbing worl( is complete.
Final Mechanical - When all
mechanical work is complete.
Final Building - Wlren all
required inspections havc. been
approvecl and building is
completed.
Footing - After trenches are
excavaled.
Masonry - Steel location, boncl
bearrrs, grouting.
Foundation - After forrns are
erected t)ut prior to concret()
placernen t.
Underground Plumbing - Prior
to filllng trench.
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
Post and Beam - Prior to floor
insulation or decl<ing.
Sanitary Sewer - Prior to filling
trench.
w
w
n
w
a
A
a
fV Floor lnsulation - Prior tolAJ decking.w
w
W4o,n.,%5refuee
CIn{
Sidewalk & Driveway - After
excavation is complete, forrns
and sub-base material in place.
f_l Fence - When cornpletccl
Slreet Trees - When all required
trecs are planted.
t
MOBI HOM IN S
Blocking and Set-Up - When all
blocking is complete.
Plumbing Connections - When
home has been con.nected to
water and sewer.
Electrical Connection i- When
blocking, set-up, ancl plumbing
inspections have been approved
and the home is connected to
the service panel.
Final - After all re<luired
inspections are approved and
porches, skirting, decks, and
venting have been installecl.
hqqi€-
sPE@roN
ffi Storm Sewer - Prior to fillingl'4 trench.
IXY"*: Line - Prior lo fillins|+ trcncll.
ffi Rough Plumbing - Prior to
-
covcr. . i.-
EN €DESCRIBE WORI(:
ADDITION DEMOLISH OTHERNEW / REMODEL
a\2
n
€,IRANGE:
OCCY GROUP:
WATER HEATER:
g OF STORIES:
FI-OOD PLAIN
Y OF UNITS:
OUAD AREA:
# OF ALDGS
SECONDARY HEAT:
SOUARE FOOTAGE:
ZONING COD
# OF BDRMS:
- oFFtc
LAND USE: ll
CONSTR. TYPE:
HEAT SOURCE:
B
a
E
r
tl
Lot Iaces
Lot sq. ftg.
Lot coverage
TopograPhY
Total height
Lot Type -.
ln terior
-Corner
--- Panhariile
-
Cul-de-sac
Setbacks
P.L,
N
S
c
teZo
?&
E
GARHSE
,blz
//d
/d'
I THE PROPOSED WORK IN THE
-lIISTOBICAL DISTRICT, OR ON
THE, HISTORICAL REGISTER?
-
lf ycs, tlris application must be signed
and aPProved bY thc Historical
CootcJirrator prior to pernrit issuance'
APPROVED:
ewcd B
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pcrnrit is grarrted on tlte express conditiorr tlrat the said
consiruction shall, in all respecls, conform to the Ordirrance
adoptecl by thc City of Springfield, including the
Developrtcnt Code, rellulating the construction and ttse of
buildings, and may bc suspen<1ed or revol<ed at any tinlc
upon violation of any Provisions o[ said ordinances'
PIan check Fee:.-- %3j "-
BUILDING PERM!T
VALUE
%,za_?45_16_
/:22:2?
Date(A)
/L-7>
X $/SO. FT.
3:
Receipt Numbe
Date Paid
Received BY:
SO. FT.
%a--
ITEM
Main
G arage
Carport
Total Value
Builcling Permit Fee
State Surcharge
Total Fee
aaa,e9
-ZAH/%.2
Systems Developrnent Charge is due on all undeveloped
properties within the City limits which are being improved'sYSr E M s D EV E Lo P * r *r,"l r
^ L%lrr? *
ITIONAL COMMENTS
ITEM
Fixtu res
Residential Bath(s)
SanitarY Scwcr
Watcr
Storm Sewer
Mobile Home
N' zx /? I i7a;2-'2
FEE
FT.
(c)
Z 2?
PLUMBING PERMIT
rr.
FT.
Plumbing Permit
State Surcharge
Total Charge
,, a2_le.
v3a-aP
MECHANICAL PERMIT
Fu rnace
Exhaust Hood 2X4r;2
Woo<J Stove/ lnscrt / Fireplace Unit
2*7
Vz.z6:(D)
a64Drycr Vctlt
Vent Fan N" ?XV
Mechat-rical Pcrtrtit
lssuance
State Surcharge
Total Permit
-
I aA.4t.
abJa._/, o,
-? aD(D.
By signature, I state anc.l agree, that I have caref ully examined
the completed application and do hereby certify that all
informationhereonistrueandcorrect,andlfurthercertify
that any and all worl< ;:erformed shall be done in accordance
with ttlc Ordinatrcr:s ol tlrr: City o{ Sprirrgfir:ltl,;rrrd l}rc L;tw:;
of tlre Statc oI Orcllotl pr:rtairrin.q to tlle w<:)tk tlr:scril;c<l
Ircrein, ;rtrcl lltat NO OCCUPANCY will bt: ttta<lr-' of i.ttty
structurc witlrout lrcrtrtissiotr of the Buildinl; Safcty Division'
I f urthcr ccrtif y tllat orlly contractors ;rncl otttploycr-'s wtlo
are in cornpliancc witll ORS 701 O55 will t-:o r'rsecl on tltis
proiect.
I f urther agree to cnsurc that all required inspections are
requested at the proper time, lhat each address is readable
at all tim
Signatu re
Date
from the street, that the P ermit card is located at the front
d set pl
n
remainof the pro
uctioon the
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk -Q-- n
curbcut ff;- ,,
Demolition
State Surcharge
Total Miscellaneous Perrnits (E)
/q-o>
y'?..%
/<'/2--7q1
VALIDATION:
RECEIPT NUMBER 7'€ -.q-a 1-7?DATE PAID
RECEIVED BY
AMOUNT RECEIVED
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, arrcl E Combined)
9236-9
Yo'z?&'
4P.a>
I.a IC'TY OF
225 FIFTB STPGET
SPRINGFIELD, ORBGON 97477
INSPECTION RBQIBSTt 726-3769
0FPICE: 726-3759
1. LOCATION OP INSTALI,ATION
LBGAL DESCRIPTION
JOB DESCRIPTION
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COMRACTOR INSTALI..ATION ONLY
Electrical Contractor
Address
Ci ty
Supe
sl'rilN(;FTELU
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
B. Services or Feeders
Installation, Alterations or
ffiR eloca t i on :
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
0ver 1000 amps/volts
Reconnect 0n1y
Aitr
ELECTRICAL PERHIT APPLICATION
city Job Nu b", ??OVBE
COXPI.^ETB PEE SCEEDULE BELOS
Nev Residential-Single or
MuIti-FamiIy per dwelling unit.
Service fncluded:Items Cost
? $ 1s.00 72
s 40.00
3
A
Sum
s s0.00
$ 60.00
€,1 - phoneT/>--?
rvisor License Number ;97 ? "- >;
$100.00
$130.00
$300.00
$ 40.00
Expiration Date y'd-az-
constr contr. Number 3l l5{<--
c'
Expiration Date /A -f Z-'
Signature of Electrician
44
rs Name
Address 4
OIINER INSTALI..ATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE:
RECETPT
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less / $ 40.00
201 amps to 4oo amps
* S 55.00
Over 40L to 600 amps _ $ 80.00
0ver 600 amps or 1000 volts see I'Bfl
a
aEoE
not included)
40.00
40. oo
20.00
cirv ?q4phoneA*aff57
D. Branch Circuits
New, Alteration or Extension Per Pane1
One Circuit $ 35.00
Each Addi tional
Circuit or vith Service
or Feeder Permit $ 2.00
E Miscellaneous ( Service/feeder
-Each installation
Pump or irrigation $
Sign/Out1ine Lightine- S
t imited Energy/Res
-
S
Limited Energy/Comm _ S
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
RECEIVED BY:
5 2y'2.6€
"a ar6/1-efz-e
,a a
:ia't ul.lc;l'ILLL)
0i!
225 ITIITII STRIIIiT
st,RINGFrIiLD, OIIEGON
INSPECf,ION REQUEST:
oFPICE: 726-3159
1 ON
97 471
726-37
€s
B
C
COHPI,BTE FEB SCIEDULE BELOV
APPLICATION
al-Single or
per dvelling uni t.
ee ilBil
(YUdP,H3T olq3 Service Included:
Items Cost
1.000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf 'd llome or
Modular DweIling
Service or Feeder
$ 8s.00
$ 15.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocation:
A200 amps or less d
201 amps to 400 amps _
401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/volts
Reconnect Only
Temporary Services or Feeders
Installatlon, Alteration or Relocation
iden t i
tallation
rrigation
ine Lighting_
nergy/Res
nergy/Comrn _
A
HuI t i-
Sum
PTIONC\-
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTAL ION ONI,Y
Electrical Cont ractor
Add r
Ci ty
Supe
ess
oll
rv r sor icense Number
s s0.00
$ 60.00
$ 100. 0o
$130.00
$300.00
$ 40.00
Expiration Date
Constr Contr. Number
Expiration Date
Signature rv].sl EIec tri cian
Ovners Name
Add ress
Ci ty one
OVNER ALLATION
The installation is being made on
property I own vhich is not intended
for sale, Iease or rent.
Ovners Signature:
DATE:
200 amps or less $
201 amps to 400 amps _ $
0ver 401 to 600 amps _ $
0ver 600 amps or 1000 volts s
40.00
55.00
80.00
above
D. Branch Circuits
Nev, Alteratlon or Extension Per Panel
One Ci rcui t
Each Addi t ional
Circuit or with Servi
or Feeder Permi t
$ 3s.00
$ 2.007b eo
E. Hiscellaneous (Service/feeder not included)
-Each
Prrmp o
Sign/0
Limi te
Limi te
insri
ut1
dE
dE
40. 00
40.00
20.00
36.00
5 STIBTOTAL OP ABOVE
5Z State Surcharge
TOTALr0(
RIiCEIVID IIY:
$
$
s
s
PERHIT
Ci Number
@
c
&)
C'TY OF S OFEGO'U
SPlrTllGFIELD
225 FIrTE STREBT
SPRTNGFTEIJ, OREGON 97477 (,
INSPECTI0N REQUBST: 726-3769
0PPICE: 726-3759
Cu":b
Pe its are n t rans f exp lreifvork is not started vithin 180 days
of issuance or lf vork ls suspended for
180 days.
2. COITITRACTOR ONLI
Electrical Contrac or
Address
cit Phone
Superv License Number
Explration Date q
Constr Contr. Number
Expiration Date
Slgna ture of Supervlsing Electrician
rs Name
Address
Cl ty pnon" (/
OSNER
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Orners Signature:
DATE:
EIJCTRICAL PERT{IT APPLICATION
City Job Nunber
COTIPLETE PEB SCEEDULE BELOV
Nev Residential-Sing1e or
MuIti-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
-Modular DveIIing
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Services or FeedersInstallation, Alteratlons
or Relocation:
l^0R
'_ l>*-'AG
1
rlff5.frET"bqt3 Sum
B
c
D, Branch Circuits
New,Alteration or Extension Per Panel
200 amps or Iess
201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only
Temporary Services or Feeders
Installation, Alteratlon or Relocation
-
200 amps or }ess "S 40.00
201 amps to 400 amps
-
$ 55.00
over 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000-Til[s see uBu a5tiE
s s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
/a
one Circuit .-:"/ S 35.00
Each AdditionalCircuit or vith Service
or Feeder Permit $ .2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
sign/0utIine Lighting-
t,imi ted Energy/Res
-Limi ted Energy/Comm
$ 40.00
s 40.00
$ 20.00
$ 36.00
SUBTOTAL OT ABOVB5f State Surcharge
TOTAL
RECBIVBD
5
t+ l?)
ct)
ard\h ttttn
.(p
!!
JOs N0.AU2hb-
crTy 0F sp--r{cFIELD SysTEHS DEVEL0PMET". c[{ARGE
WORKSHEET ,
(c0t{t{ERcIAL & RESIDENTIAL)
NAIIE OR COI1PANY:G*e * V*"tev C-o . oe ot l Ir.fC .
LocATIoN: lru4t6, +*r<u Loo, \1orVrz,-lqtz
DEVELOPMENT TYPE:Mr:e - n.\ew Dupr 9-L
BUILDING SIZE:OT SIZE s a. Fr.
1. STORM DRAINAGE
IMpERvIoUs sQ. FT. tRq + x $0.186 PER sQ. FT- S-"1o?9-(i."n.,.rseFornuffiIfActualImperv.AreaIsUnknown)
2. SANITARY SEI.'ER-CITY
NO. OF PFU'S ?z X 538.55 PER PFU s lzbbG:
(See Reverse To Deternine Total PFU'S)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
L x ,o09 x s388-61 s 18tl9-
x x $388-51 s
x $88-6I s
(See. Attachment C To
4 ADI.IiNISTRATIVE FEES
'BASE
CHARGE (SUBT0TAL A80VE) X .0s s I tcl &9-
TorAL-cITY soc s L9o*9
5. SANITARY SEI.IER.HI.IHC
N0. OF PFU,S bL x 513.25 PER PFU .+ S!0 t'|l{t'lc AOI{IN. FEE S 4b4=_
(Use PFU Total From Item 2 Above)
Mr.rMc CREDIT IF APPLICAELE (SEE REVERSE)s 4o13
T0TAL-HI,JMC SDC S 7nbL3
K p Burd ck
Determine Trip Rates
51'BTOTAT
)'(ADD ITEl.lS 1,2, & 3) S2?Z*3'-'-
SDC Coordinator
7 a az s2 B r*
TOTAL SOC
FTXTURE UNIT CALCULATION TABLE: rlumoer ol Nert Firures X Unit Equivalerll = Fixture Units (t'JoTE
For rernodels, calculate only the tr!fl Jiiional {ixrures)
NUMBEF OF UNIT FIXTURE
FIXTURE TYPE NEW FIKTURES EOUIVALENT UNITS
L z+
Floor Drain-.
lnterceptors For Grease/Oil/Sotids/Etc----------------
I nterceptors For Sand/Auto Wash/Etc---------:.------LLaundry
Clotheswasher - 3 Or
Mobile Home Park Trap (1 Per Trailer)--------
Receptor For Refrigerator/'\ffater Station/Erc--------
Receptor For Commercial Sink/Dishwasher/Etc-:
Shower. Singte Qr2lt
L -vT
Miscellaneous:.
TOTAL FIxruRE UNTTS 2--l
/ rArr rAar E. Eraaa{ aa a<o<sl rahro I rred after annocation datg in faHe'cBEDtT CALCUI-AION TABI E: Based on assessed value lf lmprorernents occu
credits
Credit for Parcd or [-and Onty lf Apflicable
lmprwement Sf after annocatbo date)
L,(-xs r6 .91 4o13
(Rate X Assessed Value)
(Rate X Assessed Value)
CREDIT TOTAL - S 4o-3
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
4
/HeadShower. Gang-......-.-.
Sink Bar. Commercial
Wash Basin/Lavatory. Single------
Water CIoset, Public lnstallatioru-
Water Closel Private-..--
7
_ lb
t<o
xs
Year'
Anne<ed
Bate per S1.00O
Assbssed VatueYear
Annexiid
Rate perS|.0OO
AssessedVdue
1S5
1986
1987
1988
1989
1S0
sl.69
1-35
1-15
o-92
o59
o.23
1979 or before
1980
1981
1982
1983
1984
sz66
2&
253
L47
z1g
ZM
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
L
1l
llnra
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
SPRINGFTELE)
t-) o:r'4"4I
JoBNUMBE" qeO 388--
225 Fifth Street
Springfleld, Oregon 97477
TAX LOT:nlq 11
Zfr,
ASSESSORS MAP:
LOT:BLOCK:SUBDIVISION
PHONE:
cfiyi €b/2?1., &ZIP:
2,47-7n)/
STATE:D,Z
ADDRESS
OWNER
REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
ruEW ,t(
ADDRESS EXPIRES PHONEr+*
CONTBACTOR'S NAME
MECHANICAL:
ELECTRICAL:
PLUMBING:
GENERAL:
CONST.
CONTRACTOR #
\
SQUARE FOOTAG
\\\
RANGE:
# OF BDRMS
WATER HEATER:
- OFFICE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
SECONDARY HEAT:
* OF UNITS:
OCCY GROUP:
* OF STORIEST
QUAD AREA:
r OF BLDGS:
C.ONSTR. TYPE:
llEAT SOURCE:
To request an inspection, you must call 726-3769. Thls ls a 24 hour recording. All lnspections requested before 7:O0 a.m. will be
made the same working day, inspections requested after 7:00 a.m. will be made the following work day.
REOUIRED INSPECTIONS
Temporary Electrlc Rough Mechanical - Prior to
cover.
Final Plumbing - When atlplumbing work is complete.
Site lnspectlon - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.Electrical Service - Must be
approved to obtaln permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.Fireplace - Prior to faclng
materlals and framlng lnsp.
w Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, grouting.Framing - Prior to cover.
Foundalion - After forms are
erected but prior to concrete
placement.
Other
Wall/Ceiling lnsulation - Prior to
cover.
tl Underground Plumbing - Prior
to filling trench.Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decking.lnsert - After fireplace approval
and installation of unit.
Blocking and Set.Up - When all
blocking is complete.
Floor lnsulatlon - Prior to
decking.Curbcut & Approach - After
forms are erectec, but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Slorm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Water Line - Prlor to fllling
trench.[-_l Fence - When completed
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Rough Plumbing - Prior to
cover.
*(da
\
.qa
fl
E
Er
E
tf
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Typ,-
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks IS THE PBOPOSED WORK IN.THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL BEGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED
P.L.HSE GAR ACC
N
S /2
-.
E
VALUE
?5ZXLp
1/f,22.2v
(A)
X $/SQ. FT.
lq tD 1ffi
Total Value
Bullding Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT,
Main
Garage
Carport
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.
ewed By Date
i)-| -q?
Recei pt *u^our, (&.18
By:Qq
Plan Check Fee:
Date Paid
Rec
SYSTEMS DEVELOPMENT C
(B)
HAR?E (sD8 6 Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
No
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ Insert/ Fireplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exh.aust Hood By 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 f urther 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 that 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 201.055 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 ls located at the front
of the property, and the approved set of plans will remain
Signature
Date
on the site at all time ng construction
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (exctuding etectricat)
(A, B, C, D, and E Combined)
/a 77 IV
DATE PAID
RECEIVED
AMOUNT
VALIDATION:
RECEIPT NUM
- JoB No ' 1zo?b b
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(C0MMERCIAL & RESIDENTIAL)
NAME OR COMPANY:G<ee*Vutt-z>t Co. oF OR.ECrtN TIC
LOCATION ' ,U, ,^,ru ,oo " \1ozz'zzz t ' o ln \7
DEVELOPMENT TYPE:MoK xlew
BUILDTN G SIZE : l? tz!SIZ sQ. Ft.
I. STORM DRAINAGE
IMPERVIOUS SQ. FT.21?x $0.192 PER SQ. FT.
2. SANITARY SEt^,ER_CITY
(See Reverse)
3. TRANS TAT I ON
NO OF UNITS X TRIP RATE X COST PER TRIP
X x $40I.05
x -- x $401.05
x x $401.05
$
$
SUBT0TAL (ADD ITEMS I,2, & 3)$ +z+Z-
4. ADMIN ISTRATIVE FEES
BASE CHARGE (SUBT0TAL ABoVE) X .05
TOTAL-CITY SDC sbb
5. SAN ITARY SEt,lER-MI,JMC
NO. OF PFU'S $13.62 PER PFU + $IO MI^IMC ADMIN. FEE $
(Use PFU Total From Item 2 Above
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MI^,MC SDC
TOTAL SDCK'ip Burd'ick
SDC Coordinator
F
)
o 4
nbL
IL l/'
$
x
>z+3