HomeMy WebLinkAboutPermit Building 1994-08-17?-'t D / r\)
SP,lII\tGFIELE'
r\ o$ Str"efs
?trrrse ft o (Q.9-RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759 h,
JOB NUMBEB
225 Flfth Street
Spri ngf leld, Oregon 97 477
LOCATION OF PROPOSED WORK:s- N;t o
ASSESSOBS MAP:SA
LOT:/L BLOCK:OaK tr-e--
C{_
LOT
SUBDIVISION:
I;F
4_
PHoNE: Zct4 o ?t L
<-
STATE:ZIP:S 9,t q
"-1
d<>
OA
OWNER:
ADDRESS:
CITY:
|.TEW { REMODEL ADDITION DEMOLISH OTHER
SF<-tg urt Ld. ,\.i a (JDESCRIBE WORK:
ADDRESS
(?t rs
o8t
A.J L I
b 3-t 3+("
E
otJ G
n
7
o
GENERAL:
EXPIRES PHONE
otSsy
PLUMBING:
MECHANICAL:
ELECTRICAL:
coNsr.
CONTBACTOR ''CONTBACTOR'S
orri
\
WATER HEATER:
HEAT SOURCE:
RANGE:
FLooD pLaIN:
- OFFICE USE -
CONSTR. TYPE:
ZONING CODE:
r OF BDRMS:
# OF UNITS:
LAND USE:
SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GFIOUP:
I OF STORIES;
QUAD AREA:
* OF BLDGS:
To request an inspectlon, you must cail 726-3769. Thls ls a 24 hourmade the same working day, lnspections requested after 7:00 a.m.
recordrng, Ail rnspecilons requested before 7:00 a.m. wlll bewlll be made the followlng work day.
p'"-rtrarv Electrtc
REOUIRED TNSPECTIONS.r
| |, I Roueh Mechantcat - prtor to* GOVer.
ffi nough Electrlcal - prior to--f- cover.
l-_l Understab ptumbing/ Etecrricat/
-
Mechanical - prioi to cover.
Site lnspection - To be madeafter excavation, but prior tosetting forms.
Footlng - After trenches areexcavated.
Masonry - Steel locailon, bondbeams, grouting.
Foundatlon - After forms areerected but prlor to concreteplacement.
Underlloor plumblng/ Mechanlcat
- prior to lnsulatlon or decking.
Posl and Beam - prlor to floorlnsulatlon or decking.
Floor lnsulatlon - prlor todecklng.
Sanltary Sewer - prior to flllingtrench.
Storm Sewer - prior to fllllngtrench.
Water Llne - prior to filllngtrench.
Rough Plumblng - prlor to
cover.
F
tr
tr
m
E
[--l Wood Stove - After tnstailatlon.
f]l ln":t, - After flreptace approval
-
and lnstallailon of unlt.
[Fl Curbcur & Approach - After-T- torms are erected but prlor topfacement of concrete.
[-_l fence - When completed.
ffi Street Trees - When ail rbqutred-fY trees aro planted.
Electrlcal Servlce - Must beapproved to obtaln permanent
electrlcal power.
Flreplace - prlor to faclngmaterlals and framlng lnsfl
Framlng - Prlor to cover,
Wall/Celllng tnsutatlon - prlor to
Other
MOBILE HOME INSPECTIONS
fFl Ftnat ptumbtng - When ail7- plumblng work ls complete.
ffi flnal Electricat - When alt
Jv electrtcal work ls complete.
lYl rlnat Mechantcat - When a[
;1v mechanlcal work ls complete.
ffi flnat Buildtng - When ail-1* requlred lnspecflons have beenapproved and building lscompleted.
Final - After all requiredtnspectigns are approved andporc.hes, sklrtlng, decks, andventlng have been lnstalled.
m
ry
F
cover.
[-l Unggrground plumbing _ prioru to fllllng trench.Drywall - prlor to taplngr
F
F
ry
v
F
ry
Blod&ing and Set.Up - When ailbtocklng ls compleie.
Plumbing Connectlons - Whenhome has been connected towater and sewer.
Sidewalk & Drlveway - Afterexcavation ls complete, formsand sub-base materlal in place.
Eleclrlcal Connection _ Whenblocklng, set-up, and plumblnglnspectlons have been approvedand the home ls connected tothe servlce panel.
lht(
E
. t .ir.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Larc
327" G
fuT&\'
Lot Type
-
lnterlora\6!5-Aorn",
-
Panhandle
X crt-0"-"""
.- THE PROPOSEO WORK IN THE -
HISTORICAL DISTRICI, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPFIOVED:
ADDITIONAL COMMENTS
+
P.L.HSE GAR ACC
N l5
s 7o 1
W I 18',
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt ls 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
bulldlngs, and may be suspended or revoked at any time
ewed ByPlan
z/"#t
Receipt Numbe
By:
Plan Check Fee:
Date Pald
upon violation of ons of ord i nances.
x $/so. FT.
j? QJri,^
E
545
2E
(A)
2r 3>-
r5
Main
Garage 5*;
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) leLn
tTEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
",
3%\I,,*.^
(c)
ttrN0
FT.
FT.
FT.
<o
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert / Fl replace Unlt
Dryer Vent
t
MECHANICAL PERMIT
t5.
s%$d,'i
(D)
CC,q
rSl2\o.
3. s.e
ur .5()\ro.
\
Mechanical Permit
lssuance
Stete Surcharge
Total Permlt
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certily
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure without permission of the Bulldlng Satety Divislon'
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 will be used on thls
prolect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set ol plans will remaln
on the slte at all times durlng construction.
2 q
Slgnature
Date
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
stdewatk Jb rt a /;;
l.aCurbcut 11 tt ) ,r;--
Demolltlon
State Surcharge
Total Mlscellaneous Permlts (E)
tr{F
3.1Ba
&6.9
L
2{XrL
t4 sl
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALTDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrlcal)
(A, B, C, D, and E Comblned)
i8
t1l..sea
\?r.'82
\o.
N"6
llq
32
I
\lkt
AI IALIII'ILNI UI
JoB No. ?/oaas^
CITY OF SPRINGFIELD SYSTEMS DEVELOPMEIT I CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
DEVELOPMENT TYPE:EFP
NAI'IE OR COMPANY:
LOCATION:
S
BUILDING SIZE: LOT SI
1. 'ST0RH
nRATNAGF
IMPERVIOUS SQ. FT.
2. SANITARY SEI{,FR-CTTY
NO. OF PFU'S
(See Reverse)
2
3 TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x /,o/ x $436.19
x _ x $436.19
x _ x $436.19
Ft
376 2f X $0.209 PER SQ. FT.t2 o
X $43.26 PER PFU
$
f3?.5-
2 r7.o
4. SANITARY SFt,lFR-Hl^ll'4C
NO. OF PFU'
(Use PFU Total
SUBTOTAL (ADD ITEMS 1.2, & 3)
{117.19 PER PFU + $10 Mt^lr',tc ADMTN.FEE
Above)
$
5
rom Item 2
Mt.l|,lc CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
SUBTOTAL (ADD ITEMS 1,2.3 & 4)
Al'rHTttlsTRtrvt tttt
BAS C}.IARGE ABOVE) X .05
7-rr-?v
SDC
I
I
g
82, SDC
rdi
Date:
TOTA SNC S 2e27,/7
FIXTURE UNIT CALCULATION TABLEI Number of New Fixtures X Unit Equivalent = Fixture Units
(NOTE: For remodels, calculate onl\ : NET additional fixturesl
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub
Drinking Fountain....
Floor Drain
lnterceptors For Grease/Oil/Solids/Etc.
lnterceptors For Sand/Auto Wash/Etc..................
Laundry Tub/Clotheswasher...... .........,...
Clotheswasher - 3 Or More., Mobile Home Park Trap (1 Per Trailerl......' Receptor For Refrigerator/lvater Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.?
Shower, Gan9......... ............-...
Sink:Bar,Commercial,ResidentialKitchen....2
Urinal, StallilVall..l
Wash Basin/Lavatory, Single 3
Toilet, Public lnstallation
Toilet , Private....)2
Miscellaneous:
TOTAL FIXTURE UNITS 2{
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
Credit for Parcelor Land Only tf Applicable
lmprovement (if after annexation date)
c x$/z 7q
-6"1"X Assessed Valuel
(Rate X Assessed Value)
$
I 2
G
lHead
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
4
I
3
x$
CREDIT TOTAL
t
:l
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
1 980
1 981
1 982
1 983
1 984
1 985
$3.46
3.38
3-32
3.21
3.06
2.92
2.73
1 985
1 986
1 987
1 9BB
1 989
1 990
1 991
1 993
s2.46
2.14
1.77
1.37
o.97
o.61
o.44
0.15
3
C'TY OF SPF GI'?EG O'U
Ea
approval.
225 FII':TE STREBf,
SPRTNGFIEI.D OREGON
INSPBCEON REOIIEST:
OTETCB 726-3759
1.OF
IJGAL DESCRIPTION
JOB reutc€
Perults are non-transferable and
lf vork ls not started vlthln 180 c
of lssuance or lf vork ls susPended for
'180 days.
2. COIITRACTOR INSf,ALI.ATION ONLY B.
'9 EtkaElectrical Contracto r L./-1.
Address 4
cl 2 Phone = 47 - o8l(
Supervisor Llcense Number 3'aoL -5
Expiration Date C.
Constr Contr.Number Ot g
Expiratlon Da
Signa ture of Suiewlslng Blectrlclan
Owner
Address
c1 Phone
SPTTI,{GFI€LO
as submttted hrs the
roquire epeciflc land
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-
0ver 1000 amPs/volts
-
Reconnect 0nIY
5.. ST'BTOTAL OE ABOIIE
5tr'State Sutcharge
IorAL
+iob Adsnin tt-<-
BIJCTRICAL PERHIT APPLICATION
BBLOV
The lollowing project
zoning, and does not
A. Nev Resldentlal-Single or
Service Included:Items Cost
1000 sq.ft. or less $ 85'00
Each additional 500
sq. ft or Portlon
g""h-H.nuf'd Home or
-Modular Dvelling
Servlee or Feeder $ 40.00
Sum
$
$
$1
$1
00
00
00
00
00
00
50
60
00
30
4S.
$300
$
t
OTINER INSTAIJATION
The. lnstallatloir ls betrig nade on
;;;i;it i on n vhlch ls not tntended
for iale, lease or rent.
D.Branch Circuits
Nev, Alteratlon oi Extension Per Panel
one Circult $ 35'00
Each Additional' Clrcuit or vlth Service
B. Hlscellaneous (Servlce/feeder not included)
Temporary Services or'Feeders
Installaiion, Alteration or Relocation
2oo amps or less I q 19.99 -W
0ver 600 .rp" o.-i6OOt"ff"..see rBn aE66
-Each lnstallation
Puinp or lrrigatlon.
-
Stgn/Outllnb t ightlng-
t lAited EnefgY/Res
-
Ovners Slguature:
$ 40.00
$ 40.00
,$ ,20.Q0
$ 36.00
oolt-
DATB:
RECBIVBD
g-O;7 z CJ
l4,ltzZt
Willamalane
Park & Recreation District
fob No.
SYSTEMS DEVELOPMENT CHARCE
WORKSHEET
PHONE:
srerr:@r,r 41417ADDRESS:
LOCATION OF FROPOSED BU
Street Address if Known:
Platt Name:Tax Lot Number:
1 DEVELOPMENT TYPE (Check appropriate dwellingG). SDC Calculations and dwelling type
definitions are on the back.)
A- Sinsle Familv - Detached
I\ Single Family home Manufactured home not in a park
NO OF UNITS
B. Sinsle Familv - Attached
NO OF UNITS
C. Multi-Family Apartment
NO OF UNITS
D. Manufactured Home Park
X $400 PER UNIT *=
X $370 PER UNIT =
X $277 PER UNIT =
$
NO OF UNITS X $280 PER UNIT =
Y
N
$
$
$
@
WPRD SDC
2. SDC CREDIT (lf appticable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAT WPRD NET SDC ASSESSED (lf SDC reduced for Credit)
$g
$
Community Services
City of Springfield
o?1
I
'Il-
sion Date
$4'U)
400
,
tf
Page 22
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v
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I
triple lor14i 16,
three. When tooend 16, beamj.
?0
1rl0??5
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i
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llosissa_541 547
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27
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t. 4b
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asali
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107 88
SPFlllGFlELD
BACKFLOI.I PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIV]SION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
CITY OF SPRINGFIELD, OREGO'V
JOB LOCATION:
ASSESSORS MAP #:
OI{NER:
t1 ah'k/rf TAX LOT #:,?4x Vuutoc.<
ADDRESs, / y'l/S alrrny'L&4il Z.PHONE #:pl-y'///
CITY:SlZtrr/o Fr6- zo STATE:oR zw, ?7y'?7
BACKFLOV PERMTT IS $15.00 + $.ZS ISTATE SURCHARGE) * $.45 (ADMIN. FEE) = $16.20
CONTRACTOR:r1
ADDRESS:
CITY:?rra e-:,-i STATE: OP ZIPz ?Vto t
ru{7 Z"rrrrr PH0NE #: 66 7- 0 Z7L
CONSTRUCTION CONTRACTORS REGISTRATION #:4 EXPIRES:
BY SIGNING THIS PERI,IITIAPPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DBVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726.3769). I ALSO STATE THAT ALL INFORMATTON ON THIS PERMIT/APPLICATION IS
CORRECT.
FOR OFFICE USE
DATE OF APPLICAT]ON:4rlo,qq
RECEIPT #:ISSUED BY:
TOTAL AMOIJNT COLLECTED:0
JoB #, q{1Wf
, CITY OF SPR OR
apprcval.
33iiillfifi,j,*tffi", N s7 4n -
z*s)zN'--
iiri-iscrioN nsougsf, z Tltr*lJligivy "1t-1
aa has the
zoning, and dses not roquire epecific lar,d uso
ELECTRTCAL PERHTT APPLICATION
City Jo b Nurober
q,4 0??5
oFEICE:726-3759A,.rtirorizodSignaturofurEEscEEDUIaBELog
OT INSf,ALI.ATION
h
A.Nev Resldentlal-Single or
tlultt-FamlIY Per dvelling unit'
SPfII'{GFIELO
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or Portion
thereof
Each Hanuf'd Home or
Hodular DveIIing
Servlce or Feeder
LE
JOB DESCRIPTION
Perults are non-transferable and
lf vork ls no t started vtthln 180
of lssuance o r lf vork ls susPended for
180 days.
2. CO}ITRACTOR INSIIAIJ,ATION ONLY B'
Erectrieal contractot- L'4' llnt0o EIE f
Address 4s,
cl 9 ?t=P Phone ?+)_orll
Supervlsor Llcense Number 3 ooQ- I
ExP iration Date
Constr Contr.Number O I ?,n ?.
Explratlon Date ln'?-95
ervlslng ElectriclanSlguature of SuP
D.
Ovners S.,E
Address / +g/llrta rz-
cl I /f-? 'phone , ' O?/b
DATE:
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 0nIY
IJGAL\l o7 9rg Items Cos t
$ 8s.00
$ 1s.00
$ 40.00
Sum
_s9
4s2)
00
00
00
00
00
00
50
60
100
130
40.
$300
$
$
$
$
$
Temporary Services or'Feeders
Installaiion, Alteratlon or Relocation
200 amps or less $ 40.00
0ver 401 to 600 amps - $ 80.00
0ver 600 amps or rbOO-frfts..see rrBn a566
Branch Circuitsrl.
Nev, Alteratlon oi Extension Per Panel
one clrculg: S 35.00
Each AdditionalCircuit or vlth Service
or Feeder Permit $ 2.00
E. HlsceU.aneous (Servlce/feeder not included)
-Each lnstallation
Puinp or. lrrlgation
Slgn/0u tlln,q tisht lng_.,.
Ltuited Energy/Res
Llmlted Energy/Comm
i l.
$
$
,$
$
I
00
00
00
60
o9
40.
40.
,20.
36.
bo5. ST'BTOTAL OE ABOVE
5Z'State Surcharge
. IOTAT i
6 6.,>.! ao
RECETVED +306 Adtnin lt-<-l4o 1o
1.
O9NER INSAALI,ATTON.:
The. lnstallatloir ls belrig made on
property I ovn vhlch ls not intended
for sa1e, 'leaSe or rent.
9trS'" s11ture3
c.