HomeMy WebLinkAboutPermit Building 1994-12-30LD
RESIDENTIAL
PERM!T APPLICATION
lnspections: 726-3769
Office: 726-3759
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
LOCATION OF PBOPOSED WORK:l+ t"3 Lr=O L,
ASSESSORS MAP:rt=tr L\oF -18\ A l\A 13 TAX LOT
LOT BLOCK:4 F€SUBDIVISION:,r} DDr b f-J
To request an inspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspections requested before 7:00 a.m. wlll bemade the same working day, lnspections requested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
t',)
M
H
,K
K
K
EE
N
,M
E
,R
X
M
X
l-l Underground Ptumbing - priorlJ to fllllng trench.
l-l Flreptace - Prlor to faclng
-
materlals and lramlng lnsp.
Xtrarn,ng - Prlor to cover.
fi1-wa[lcelilng tnsutatlon - prtor to
-
cover.
ffi"r*"tl - Prlor to taplng'
l-l Wood Stove - After tnstailatton.
Eleclrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
lnsert - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior toplacement of concrete.
ffotn., Z.,lr. E__
MOBILE HOME TNSPECTIONS
[-l Blocklng and Ser.Up - When alt.J blocklng ls complete.
Temporary Electrlc
Site lnspectlon - To be made
after excavation, but prior to
setting forms.
Underslab Plumblng / Eleclrical /
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated,
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underll
- Prior to ng
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulation - Prlor to
decklng.
Sanitary Sewer - Prlor to filling
trench.
Storm Sewer - Prlor to fllling
trench.
Water Llne - Prlor to filling
trench.
Rough Mechanlcal - Prlor tocovet. ,qro 4, . fe.
Rough Electrlcal - Prlor to
cover.
Flnal Plumbing - When ailplumblng work ls complete.
Flnal Mechanical - When allmechanical work ls complete,
Flnal Buildlng - When ailrequlred lnspectlons have been
approved and buildlng is
completed.
Plumbing Connectlons - When
home has been connected towater and sewer.
fJJf-flnat Etecrrlcat - When ailryelectrlcal work ls complete.
K
g7'l'SiU"*"tk & Drtveway - After,7 excavation is complete, forms
and sub-base materlal in place.
n Fence - When compteted.
Electrical Connection - Whenblocking, set-up, and plumbing
lnspections have been approved
and the home is connected tothe servlce panel.
Flnal - After all required
lnspectlons are approved andporches, sklrtlng, decks, andventlng have been lnstalled.
bt'r ?.++oqr GPHONE:
I STATE:ZIP:
L=
q lL{t-1
OWNER:
ADDRESS:
CITY:
New I/-nEMoDEL ADDtloN DEMoLtsH orHER
DESCRIBE WOFIK
ADDRESS EXPIRES PHONE
08t I
I
rltiArs- I G.,J 1 .tr(- clQ I G
OIB 3yL 5-
Al ats
7q
CONTRACTOR'S NAME
q8r il
N^ b n i-'r-3
GENERAL:
ELECTRICAL:
O 0.\(t e". &o t^*MECHANICAL:
PLUMBING:
CONST,
CONTBACTOR #
8t.+11
VJ tr6E
F d
- OFFICE USE -
WATER HEATER:
FLOOD PLAIN
HEAT SOURCE:
BANGE:
LAND USE:
ZONING CODE:
* OF BDRMS:CONSTR. TYPE:
* OF UNITS:
OCCY GROUP:
* OF STORIES:
QUAD AREA:
, OF BLDGS
SECONDARY HEAT
SQUARE FOOTAGE:
H.*t: Prumbins - Prror to @::Xt l:Til,"ilhen arr requrred
? *srz
I
':, ,
Lot faces
Lot sg. ftg.
Lot coverage
Topography
Total helght
lo,?o o
L1 "/o
HAr
Lot Type\,
X tnterior
-
Corner
-
Panhandle
-
Cul-de-sac
r -S THE PROPOSED WORK lN THE .
HISTORICAL DISTRICT, OR ON 1 71
THE HISTORICAL REGISTER? A/ W
lf yes, this applicatlon must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED:
GAR ACCP,L.HSE -7'N
s g'
ktW
LOEgL
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls 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
butldings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
v:
/z
' Dal6 |vewed
Receipt Numbe
*,
Date Pald
Recelved
Plan Check Fee:
X $/SQ. FT.VALUE
93DDq\L
27,e 1 + /7,70
7rl-2.r2
/sz36o
(A)
/7qc/z
5l^ .7s
4 2.4'
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
Total Value
Bullding Permit Fee
State Surcharge
Total Fee
Systems Development Charge ls due on all undeveloped
properties wlthin the City limits which are being !mproved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
lsz ,(B)o./
ADDITIONAL COMMENTS
t
Au 7,8 c/7u A.Ert,tH
ITEM
Flxtures
Resldential Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
? 9> * 5,74 /9,4 |
(c)
FT.
FT.
FT.
20v,?/
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
Mechanical Permlt
lssuance
state surcharse zfi + /,fS
Total Permlt (D)
/b 10*" t_
j.e4
.g?
€/Ea
lr4/5
- _. !lg
L5,G3
/D,>o
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
Wood Stove/ln
Dryer Vent
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 certlly
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
hereln, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Building Safety Divislon.
I further certify that only contractors and employees who
are ln compllance with ORS 701.055 will be used on this
prolect.
I lurther agree to ensure that all required inspections are
requested at the proper time, that each address ls readable
lrom the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remain
Slgnature
I
(2
._.>Date
uring constructlonon the site at all times
MISCELLANEOUS PERMITS
Total Mlscellaneous Permlts (E)
23 f"
/4.fo
7 Ao
Moblle Home
State lssuance
State Surcharge
Demolltlon
State Surcharge
Sldewalk
Curbcut
?ot
?on
R
14 NoT peL
RECEIVED BY
AMOUNT R
DATE PAID
VALIDATION:
RECEIPT NUM
TOTAL AMOUNT DUE (excluding electrlcal)
(A, B, C, D, and E Combined)4e!
{,,.,i! :4':..
orl70
l I
N" ./- :^fo
-.-t--_-
4.te
du
/,so
ATTACHMENT 81
JB NO. Z//V/
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENI CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA}4E OR COMPANY:
LOCATION:7
DEVELOPMENT TYPE 6F o.
BUILDING SIZE:SIZ
1. STORM NRAINAGF
IMPERVIOUS SQ. FT 1s47.r X $0.209 PER SQ. FT
2. SANTTARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
3s-X $43.26 PER PFU
TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x /,o/ x $436.19>
x
-
x $436.19
x
-
x $436.19
3
$
t 482/r
Acln/s,7
eF/VrEyAy41
$
SUBTOTAL (ADD ITEMS 1,2. & 3) S ZI6/.f S
4. SANITARY SEt^lFR-1.,ll/,MC
N0. 0F PFU'S 7{ x $17.19 PER PFU + $10 [4l^ll'4c ADMIN.FEE
(Use PFU Total From Item 2 Above)
Mt^lMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
,
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
5 2, l/,G s-
S >o7 4,6 o
5. ADMTNISTATTVE FEES
(SUBTOTAL ABOVE) X .05
72 -zz- ?4
S
ig, P.E
i nator
o.8{
$ t.rt /./o
s.E 3
82. SDC
Date:
TOTAI SDC S 32 b.??
Ft.
FIXTURE UNIT CALCULAI tON TABLE: Nui;ibcr of New Fixturu- X Unit Equivalent = Fixture units
(NOTE: For remodels, calculate only the NET additional fixtur,:sl
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub.....I
z
adlHe
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
4
Z
-Z
-7-
---
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 Trailer)......
Receptor For Refrigerator/lvater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Sta1|..........
Shower, Gan9.........
Sink: Bar, Commercial, Residential Kitchen...
Wash Basin/Lavatory, Single.
Toilet, Public lnstallation.
Toilet , Private
Miscellaneous:
I
2
3
z
tTtarpBS sar 2
]'OTAL FIXTURE UNITS z/
CREDIT CALCULATION TABLE: Based on assessed value. lf irnprovements occurred after annexation date in table,
calculate credits separates.
Credit for'Parcel or Land Only lf Applicable
lmirrovement (if after annexation date)
x$
(tlate X Assessed Value)x$
(t'late X Assessed Value)
CREDIT TOTAL -$
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1 985
1 986
1 987
1 988
1 989
1 990
1 991
1 993
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o-15
1979 or before
1 S80
1 981
1 982
1 983
I 984
1 985
s3.46
3.38
3.32
3.21
3.O6
2.92
2.73
E
t
REgIDENTIAL - COYIYIERCIAL
SIDEIIJALK / CURBCTJT
APPL ICATIOI.I / PERi1IT
SPRI'r|GFIEL(,
225 NORTH FIFTI{ gTREET
9FRD.I3FIELD, oREGo|'{ 914'11
El.lG |NEERINC D lvl Slot lffilcE No. 126-A1>1
INSPECTION LINE, 126' 316A
JOB ADDRE99:
*A59E9WW t-lAP NO.',']<.D- TAx Lor No.
sJBDlVlglON, O
b't&Dcn\RECEIPT NO;
)xooxl
rY,C,?tEU)
CA+{
CHEC<
_L*
o,.,i,h.lER:L r-J
ITY: \a1 *
C.HECKED FOR DEL NAU=NCI=gO
\/i 17tE-PHCNF NO.,l
iIJOR< DESCRIPTICI.I:
gtDEuJAt_K, cuRS StD= _ g=T?AC< _
cuRB-cuT: !* R=gtDEhilAL
-
co'-lHERtcAL _
s=coND DRr\EruAy r sEE rRAr"rc s (!L.1 i L Vl
EaUIR=9 APPLlCATlo|:l FoR A EcoND DRITzEUJAy(T-4.1a)
OR A CO.JNTY APPLICA?IOI{ FOR FACILITY P=31IT (C AA-2OV)IF IN THE U65.
3I-q:;
..:)(l1 d-i/'*t'c
DATE G APPLI )-5 -? i- q5
10
CONTRACT
Arrt-55
ou.{:R CONTRAC;OR
-'.:(&€r*r,on *o.*l+=*=,=i
PHO\E:to."fly
FROCEDURE F€R IN9PECTIOhI REQIIE9T:
*
EXlSTl)!/s tsUILDlNG PE. '1|T No. (IF APPLICAtsL= ,)
cA-L 12b-3'169 (ECOrcER ) STATE YOUR Clr]r D=SIGNAT=D JO3 Nl..'|-i3=R, JO3 ADDR=99Jyp= cFlNgFEcTlot'l EaUE9TED Ar'lD L,Lrr{EN YOU IUILL B= R=ADY FOR lNgP=Cftort, cioXfnrCTORg o.R ct:}(=Rg NAl1= L\D
P|+ON= NIJI13ER EAU=9TS R=CEI\ED B=FOE 1.OO 41 I,IJILL 3E HADF TI]= gAr1E DAY, R=AU=gT5 #II-;R 1.OOAY UILL tsE I1ADE TI{= NEXT IUOR<ING DAY
L L
YOUR CITY D=5IGNA;ED ;Oa XO. 'SigEE BO'oK
SID=IUALK / DRI\6I.IJAYrcR ALL CONCRETE PAVING IUITi-.{IN
THE gTREET RIGI]T 4 IUAY, TO BE
IIAD= . =TER ALL EXCAVATING
15 COI-IPLETE AND FOB,1 UJOR<
AND 9'J3-3A9= IIATERIAL 15
IN PLACE
cU@ / APPROACI-] APRAN
AFTER FOB19 A.€ ER=CTE
BUT PRIOR TO POURING
C.ONCR=TE.
FEE9: SIDEIUALKS
TOTAL FERI-IIT FEE:
rlo.Oo + to.lb/LF.( X )
OF IUALK
r\O.OO + *O.\b/LF.( X )
COi-lHERICAL DRI\€I.UAY3 SHALL
HAVE 5'TO A'FLAIR9
3,- @" 9TA\DARD
CURB-CUT rlJAL< x
*{J
I ;-.IA\€ CAREFULLY EXAYINED THE COI-IPLETED APPLICAT|OI.I FOR PERIIIT AND DO HER=BY CERTIFY THAT ALLINFOSIATIOI..I I-IER=ON 19 TRJE A\D CORR=CT , A\D I RJRTH=R CERTIFY THAT ANY AND AL UJOR< PERFOR-1EDSHALL BE DONE IN ACCORDANCE TUITH TI{E ORDINANCES C THE CITY OF 9PRING#IELD, AND TI-]E LAI1}5 G TI-.IEgTATE OF OREGON PERTAINING TO TI{E UJOR< DESCRISED }.,iEREIN, AND TI{AT NO OCCUPANCY UJILL 3E HADEd ANY STF.JCTU= II,IITI]OJT PEB,1I55 IOII ff THE tsUILDlNG DIYIgIC}{ I FURiHEF? CERTIFY TI-{AT ONLY CONTR.ACTORSAND ET,IPLOYEE9 I1}-{O ARE IN cotlPLlANCE rutTr{ oRg 101o5> UJILL BE uS=D Ohl Tt{ts pRoJECT
f-L__-__a_(,SL
DATE
7c 7S
\
REAUIRED IN9PECTICNg
q'ly
spr- -:r fuu **:t)
IELO
PUBLIC WORKS DEPARTM ENT
,4DA4INISTRATION
ENG/NEEFING DIVISION
tttAINTENANCE
Ar,225 FIFTH STRI:I:7
SPRINGFIF LD Ot] 9: :;,'
APPLICATION FOR A SECOND DRIVEWAY / OVERWIDTH DRIVEWAY
\
APPUCANT (PROPERTY AJ SorJt=fr* etri,
DA'
ADDRESS OF PROPERTY FOR DRIVEWAY
APPLICANTS TEI-EPHONE
Please sketch the proposed driv'eway.
driveway, eristing driveway. and street
lnclude the following applicable ilems: house or building. proposed
names. lnclude dimensions and measurements lo property lines. road
AJ .{t-oJt
inlersections and driveways.(See attachment for an erample.)
l*ot tL
3 Clsr
Gmo3e-
Aof
t\
I
Aot i3
lo'
C r-,-i'1,
QO
uj i $,\bi,=u s sJ PL*c e-
P,+ui^rq LriJ+[ oNJ Ci*.cl- 9+\,
EJ
j
iD f\i QCa
APPUCANONS E THE CITY UMITS OF SPRINGFTELD THAT ARE WITHTN THE URBAN
BOUNDARY REQUIRE A I..ANE COUNTY PERMIT.
Note: The City of Springfield witl not grant a second driveway permil on an Arterial or Colleclor Street.
ADM|N\STRATtON/ENGINEF8/NG (503) 726-3753 FAX (s03) 726 s6B9
MATNTENANCE $As) 726 s761 FAX (503) 726 3621
C'TY OF
qs'O-rr^. Al$e-+^ 3a
a
1. Property type: Single Family Reside nrc" L Dupler
Z. fne proposed driveway will take access fiom which street
PROPERTY OWNER'S
APPROVED
DtvtstoN
BUILDING PERMIT
TRA 9..I
ATTACHivIENT: Msion Clearance, Example #1
Other
3. The distance from the edge of the driveway to the nearest corner (measured to the curb return) is
C- t l^c\ q--
4. The sera*driveway will give access to: gar.g"-fiarport- side yard- Other.--
5. The distance from tfre property line to the garage, carport, fence, wall. or other. (where the vehicle is
to bo parked) is lL, feet.
6. Will the propbied parking / slorage area create a.vision obstructiqn to
lo any vehicular movemenl on a public street? (See vision clearance
adjacent propertY ot
Apptrcant hereby agnees to install the requested driveway to City of Springf€ld standards- The appficant further
"ir."" to have i- of concrete in the sidewatk area (a{acent to the driveway),'and to pave the area behind tte
dck edge of the sidewath or driveway apron, with i minimum depth of 3'asphatth concrete or 6- of portland
cement concrele. The area behind lhe sidewalk shatl be paved a minimum of t8 feeL
The applicant agr€es that if he/she does not pave the area behind the sidewalk within 30 days of cufting the
curb opening, tlre Clty of Springrfeld has lhe authority to close the driveway access by removal of the curb cuL
All incurred cosG shall be assumed by the applicant and if unpaid, said cost shall become a l'ren of the property'
-
When this application is approved by the City. the applicant must obtain a curbcuUdriveway perrnil from the
Public Works Department. Engineering Division.
CurUcut t Orivewav P +'60 = tQ'?x
a. On an improved street (eristing curb): SlO.O0 plus S.15 per lineal foot of curb cut.
b. On an unimproved street (no curb): 512.00
c. on currentty unimproved streets that are under construction: s12.00
?f
4l
t
RESIDENTIAL
PERMIT APPLICATION
lnspections:726.3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT:
PFrII\lGFIELO
L
JoB NUMBE " ? 4/ g/ ?
BLOCK:
225 Fif th Street
Sprlngfleld, Oregon 97 477
TAX LOT:
SUBDIVISION:--
t
PH ON E:
STATE:ztP('<CITY:
ADDRESS:
OWNEB;
NEW
-
REMODEL ADDITION I DEMOLISH OTHER
-
DESCRIBE WORK:
ADDBESS EXPI RES PHON E
CONTRACTOR'S NAME
MECHANICAL:
PLUMBING:
G EN ERAL:
CONST.
CONTRACTOR /
('z
2 t/
- OFFICE USE -
WATER HEATER:BANGE:
SECONDARY HEAT: _
SQUARE FOOTAGE
FLOOO PLAIN:
ZONING CODE:
r OF BDBMS:OCCY GROUP;
g OF STORIES:
QUAD AREA:
# OF BLDGS
CONSTB. TYPE:
HEAT SOURCE:
LAND USE:
# OF UNITS
To
ma
[--l Underslab plumbtng/ Etectricat/
-
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Post and Boam - Prior to floorlnsulation or decking.
Floor lnsulation - Prlor to
deckl ng.
Bough Plumblng - Prlor to
cover.
request an lnspectlon, you must call 726'3769, Thls ls a 24 hour recorcllng. All lnspectlons requested before 7:00 a.m. wiil be'de the sante worklng'day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REOUIRED INSPECTTONS
Temporary Electrlc Rough Mechanlcal - prlor to
cover.Final Plumbing - When allplumblng worl( ls complete.
Slte lnspectlon - To tre madc
after excavatlon, but prlor tosettlng forms.
Rough Electrlcal - Prlor to []/ flnal Etecrrtcat - When al]A(gllectrlcal work ls complete.
Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
[-l Flreplace - prlor to faclng.d materlals and framlng lnsp.
lnsert - After flreplace approvql
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior toplacoment of concrete,
Sldewalk & Drlveway - After
excavatlon ls completo, forms
and sub-base material ln place.
Streel Trees - When all roqulred
treas are planted.
Final Mechanical - When allmechanical work ls complete.
K; 3 ;,3;,l3t?n";"Yl i?#' o u
"
napproved and bulldlng is
completed.F
,K,
Framlng - Prlor to cover.
Wall/Celllng lnsulatlon - Prlor to
cover.
Wood Stovo - After Installatlon
Othor
MOBILE HOME INSPE TIONS
Blocklng and Set.Up - When allblocklng ls complete,
Plumbing Connections - Whenhome has been connected towater and sewer.
i
Electrlcal Connection - Whenblocklng, set-up, and plumbing
lnspectlons have been approved
and the home ls connected tothe servlce panel.
l'Jfliifl;"1.::iJ,"o'"n - Prior g.,r*uu - prror to taprns
I--l Underlloor Plumblng / Mechanlcal
Prlor to lnsulatlon or clecklng.
Sanltary Sewer - Prlor to fllltng
tronch.
Storm Sewer - Prlor to fllllng
trench.
Water Llne - Prlor to filling
trench,I__] Fence - When compteted
:,' . .;:
ELECTHICAL:
/4 tl
I I
E
E
E
tl
l--l Final - After ail required.- lnspections are approved andporchos, sklrtlng, decks, andventlng have been lnstalled.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Ty,.
-
lnterior
__ Corner
*_ Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK IN THE.
HISTOFIICAL OISTRICT, OR ON
THE HISTORICAL BEGISTER?
-.
lf yes, thls appllcailon must be slgnedand approved by the Historlcal
Coordinator prlor to permlt lssuance.
APPROVED:
BUILDING PERMiT
VALUE
o!3 + 3,6e
X
f-o/7
(A)l3L,s t
.gt
ITEM
Main
Garage
Carport
SQ. FT,
-(e<
s/so. FT.
%74
Total Value
Building Permit Fee
State Surcharge
Total Fee
l2-!:
P!r.[D_tNG VALUE, PLAN CHECKAND BUILDINC PCNUIT
ThlS petmil is granted on the express condiilon that the saidconstructlon shall, ln all respects, conform to the Ordlnanceadopted by the City . of Sprlngfleld, includlng theDevelopment code, regurailng ine c-onstiucilon and use ofbulldlngs, and may be suspended or revoked at any tlmeupon vlolatlon of any provlsions_ of sald ordlnances.
Plan Check r"u, 2rq< e.lZD = fu*
Flecelpt Number:
zb,4rPlansByf-$ate -
Date Paid
Received
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undevelopedpropertles wlthln the City limits which are being lmproved.
PLUMBING PERMIT
ITEM
Flx tu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
FEE
N0
FT.
FT,
FT.
(c)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan No
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
By slgnature, r state and agree, that r have caref ulry examrnedthe completed appllcation and do hereby cerilfy that alllnformatlon hereon ls true and correct, and I f urther cerilfythat any and all work performed shall be done in accordancewlth the Ordinances of the Clly of Sprlngfleld, and the Lawsof the State of Oregon pertalnlng to the work describedhereln, and that NO OCCUPANCy wlll be made of anystructure wlthout perrnission of the Bulldirlg Safety Dlvislon.I further cerilfy that only contractors and employees whoare ln compliance wlth OBS 7O1.OS5 wlll be usect on thlsproject.
Mechanlcal Permlt
lssu ance
State Surcharge
Total Permlt
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk ..-- ft
Curbcut _ ft
Demolitlon
Statd Surcharge
Total Mlscellaneous permlts (E)
I further agree to ensure that all requlred lnspecilons arerequested at the proper ilme, that each address rs readablefrom tho street, that the permrt card rs rocated at the frontof the property, and the approved set of prans wilr remarnon the slte at all tlmes during construcilon.
(D)
natu
Date
PL.HSE GAR ACC
N
S
E
k
VALIDATION:
BECEIPT NUM
DATE PAID
AMOUNT R
R
//TOTAL AMOUNT DUE (exctuding etecrricaD /_327L(A, B, C, D, and'E Comblned) /_vz>-
RECEIVED BY
ED
j'i .
-
SPFlINCFIT
Qfr
225 .FIFTB STREEf,
SPRTNGFIELD, OREGON 97477
ntsrgCf,foN REQUEST z 726-3769
OFEICE: 726-3759 COHPLETB FEB SCBEDULE BELOU
Nev Residentlal-Single or
xuiti-r"*iIY Per dvelling unit'
Service Inc,uded, ,,"rs Cost
EI.^ECTRICAL PERHIT
Job Nurnber
AT
C\
Ci ty
PLICATION
-t lr l;l
TION
3.
A1.
ExP
S c Sumlf,i
JOB DES(HPTIONl- ,fZE Ar€<<r \r( E
O,
Perraits are non-transferable and-exp.iie
ii-"ort< ls not started vlthlri 180 di!-s
;; i;;;.irce or lf vork ls susPended for
1000 sq.ft- or less
Each additional 500
sq. ft or Portion
thereof
Each Hanuf'd Home or
Hodular Dwelling
Service or Feeder
I sBs.oo 95
3 gls.oo 4<
s 40.00
180 daYs
? . EO}TTRA.(;]]OR TNSTALI-ATION ONLY
Electrical Con t ra c to r |n"p{,E
Address 9Te.
Ct ty S Phone -orlt
Supervisor Licen:e Number 3 006. S
iration Date /0 'l -q{
Constr Co ntr. Number C)
Services or Feeders
.: .. r'l.^...t-l.r-^
1i15 Ldr*dlrvllr':l -'jr'
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
200 amps or Iess
201 amps tq 400 amPs .-
Over 401 to 600 amPs - '
0ver 600 amPs or 1000 volts
TemDorarY Services or'Feeders
i"r["ff"iion, Alteration or RelocationC.
D.. Branch Ciriuits
Each Additional' Clrcuit or vith Ser.vice
B
s s0.00
s 60.00
s100.00
s130.00
$3o0. oo
s 40.00
i'ration Date (,'t'."19
Nev, Alteratlon oi Extension Per Panel
"5i6rtBtr
$40
sss
s80
see
.00
.00
.00
Exp
Slgnature of Su pervlsing Electrician
Oyners l
Address
Cl ty
V,\,LA ^-
ta
tv,..r
O\INER ilST ALI..ATION
Ovners Signature:
DATts:
Phone 1qq - ciil Q
QL-$ 3s.00
The. installatloh is belrig made on
pi"p"iiy I ovn vhlch ls not intended
for ihle, lease or rent.
$ 2.00
E. Hiscellaneous (Serviie/feeder not included)
00
00
00
o0
SI.ETOTAL OP ABOVE
5Z'State Surchhrge
IorAL,
Da:
-Each lnstallation
Puinb or. irrigation
Sign/Outllnb t ighting
Llrqi ted Eneiiry/Res
-
Llml ted Energy/Comp "'
$ 40.
$ 40.
,s 20.
$ '36.
b
)(
LRECEIVBD
5
+3ob Adonin Fe-<40 (f
I
4)
C'fY OF
03/05/.92 1{: 12 t}SOS ? .}689
225 T:ITTE STBSET
SPRINCFI3LD, oREGoN 9
INSPECTION REQTIEST:
OFEICET 726-3759 0{to
1. IOCATION OT IN
I.EGAL 2-Z
JOB
Electri
Address
City rnone-lfl OYI/
Supervlsor Llcense Ndmber 3 OOG.9
Explration Date /o- t- q L
constr contr. Number 0 t Ya Y
ExP lration Date -1
of lng Blectrician
Ovners
Address
c1 Phone
OVNER INSTALI4TION
APPIJC,ATIOil
BELOI'
A. .Neu Besldential-Stngle or
Hultl-Fanily per dvelllng unlt.
Service Includedr
- oi-,
tems Cost Sun
sq.ft. or Jess q S 8s.oo -?,'S*
of issuance or lf vork is suspended for Hodular Duelllng
180 days. . Servlce or Feeder S 40.00
2. COIITBAGIOR NSIATLATION ONLY B. Services or Feeders
Perrrlts are non-transfcrablc and cxpirelf uork is not started vlthln X80 diys
cal con tr u"t o, lA-MAti1 - fns(tr ReI
s1-
Eaeh addltlonal 500
sq. ft or. portlon
thereo!
Each Hanuf,d Home or + s ls.oo ,&s.,*
tallatlon, Alterations or
ocatlon:
?ht[t 200 anps or less '
201 amps to 400 anps
-401 aops'to 600 ar-ps T60I amps to 1000 amps-
0ver 1000 anps/vo).ts -
Beconnect 0i1y
$
s
$
s 130.
$3oo
50
60
100
above
s 40.00
$ 55.00
$ 80.00
see rrBrr
$
$
$
00
00
00
00
40
40
20
00
00
00
00
00
00$ 40.
c.Temporary Senrlces or FeedersInstallatlonr Alteratlon or Relocatlon
The installation is being made onproperty I. oun which ls not intendedfor sale, lease or rent.
Ovners Signaturc:
D. Branch Clrcu{ts
Nev, Alteratlon or Extenslon Per Panel
One Ci.rcuit $ 35.00
sach Additional
Circult or vith Service
or Feeder Permit $ 2.00
E, )liscellaneous (servlce/feeder not lncluded)
200 amps or less
201 amps to 400 anps
-0ver 401 to 600 anps
over 600 altps or'rbooForts
-Each installation
Pump or irrigation
Si gnloutline Ll gh tinc-
Lisrl ted Energy/Res
-Lisrlted Energy/Comm
-SIETOTAL OT A3OVE
s 36.
-a4EDA?E:
RECEITIED BT;
5
5f State Surcharge?,fr+S
TOTAL
?o90 oo
Willamalane
Park & Recreation District
lob No.
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
PHONE:\NAME:
ADDRESS:
LOCATION OF FROPOSED
Street Address if Known:
1
srArE:Wr,rgH1l
B IL ING TE:
Platt Name:Tax Lot Number:
DEVETOPMENT TypE (Check appropriate dwellingk). 5DC Calculations and dwelling type
definitions are on the back-)
A. Single Family - Detached
J Single Family home Manufactured home not in a park
NO OF UNITS
B. Single Family - Attached
NO OF UNITS
C. Multi-Family APartment
NO OF UNITS
D. Manufactured Home Park
x $400 PE: ulrr -=
X $370 PER UNIT =
X $277 PER UNIT =
$
NO OF UNITS X $280 PER UNIT =
@
$
$
$
WPRD SDC $
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
;tp;*"[ se soi'iiiiit worksheei $
3. TOTAL WPRD NET SDC ASSESSED (lf SDC reduced for Credi0 $
@
Community ces
f2t., ^( c^.:^^{;^1,{
oo
q4\$1
\1cF24nn CC,tr.'\1
6
C'TY OF OREGO'U
Ths tollowin0 Projoct
zoning, arrd does not
as submltted has tho
require spec ific land use
.,.. l
225 YI.rrs SIREEf,97477 zana't L)2.(.---SPRTNGFIBID'OREGON
INSPECIION RBQIIEST:726-31$e_lLluiI
OFETCE: 726-3759
SPftltrGFIELO
BIJCTPJCAL PERHIT APPLICATION
City Job Nunber
; :' .,i'.'-. L]IBt -.-€oI{PLE[E-+EB scffiDtrt.e BEIos
.'j/'>.
1.OF o/
I^EGAL 2
JOB DESCRISTION
Perults are non-transferable and
lf vork ls not s tarted vtthtn 180 ,s
'of lssuairce or I f vork ls susP€nded for
'180 daYs.
2. CONTRACTOR INS*TALI,ATION ONLY
Electrical Contrac tor /,/l' WllPt5 Et'^f/-
Address 9tE-
A. Nev Resldentlal-Single or
Hulti-FamllY Per dvelling unit'
Service Included:Items Cost
(
1000 sq.ft. or less
nach additional 500
sq. ft or Portlon
thereof
Each Hanuf 'd llome or
Modular Dvelling
Servlce or Feeder
B. Services or Feeders
Insta}lation, Alterations
or Relocation:
$ 8s.00
$ 15.00
$ 40.00
$ 35.00
$ 2.00
Sum
t
OSNER INSTALI,ATTON
The. lnstallatloit ls belrig made on
;;;p;;ti-i-onn vhich ls not intended
ior- ia1e, Iease or rent
200 amps or less
201 amps to 400 amPs
401 amps to 600 anPs
-
601 amps to 1000 amPs-
Over 1000 amPs/volts
-
Reconnect 0nlYSupervisor License Number (
Expl ratlon Date /o-/-?5
Constr Contr. Number o/9
Bxplration Date - g-75
Slgna ture of Electrlclan
Orners Nqne
Address
cl Phone
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 4S.00
c.TemDorary Services or'Feeders
i""["ifuiion, Alteratlon or Re]ocation
200 amps or less I
201 amps to 400 amPs
-
Over 401 to 600 amPs =
0ver 600 amPs or 1000 volts
$
$
$
see aEE
.00
.00
.00
rlBn
40
55
80
].!
D.. Branch Ciriults
Nev, Alteratlon oi Extension Per Panel
Onners Slguature:
DATE:
One Circuit
Each Additional' Clrcult or vlth Service
SIIBTOTAL OE-.ABOVEiz st"t. Surcharge
IorAt
+3ob Adtnin lt-<-
B. Hiscellaneous (Service/feeder not included)
-Each installation
Plrp-'oi iirigation $ {Q'99
-iilii;i B""tEizco't', .- $ 36'00
RECBIVBD
5 -
ctty gf1o Phone 747-4tt
G-4TLe-