HomeMy WebLinkAboutPermit Building 1998-06-18SPRINGFIELD
t
Office
Inspection Line
Page 1
ilob Nnrnber: 980592
RESTDENTTAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMI'NITY SERVICES DIVISION
BUILDING SAFETY
225 North Fi-fth Street
Sprj-ngfie1d, OR 97477
Location of Proposed Work: 551 S 5TH ST
Assessors Map #: 17033534
Lot: 10 Block: 3
7 26 -37 59
7 26 -3't 69
Tax Lot. #:
Subdivision:
o6200
VALLEY VfEW
Owner: GREAT WESTERN HOMES
Address: 5024 MAIN STREET
DcScribe WorK: T{ANUF HOME & CARPORT
Phone #: 725-217L
City/State/Zip: SPRINGFTELD, OREGON gi47B
NEW
General:
Plumblng:
El-ectrical-
ConEractor
GREAT WESTERN 0046472
5024 MAIN STREET SPRINGFTELD OR 974
GREAT WESTERN 0046472
5024 MAIN STREET SPRINGFIELD OR 974
HERTTAGE INV 0053137
1042 HARN LANE EUGENE OR 974O4OOOO
Const.
ContracEor #Expires
1,1,/1,2/98
LL/1,2 / ee
t2/27 /eB
Phone
'726 -21-'7L
'726-21'7L
588-1600
QUAD AREA: 1RSW
# OF UNITS: 1
CONSTR. TYPE: VN
WATER HEATER: E
-- OFFICE USE --
LAND USE: 1150
ZONING CODE: LDR
# OF BDRMS: 3
RANGE: E
# OF BLDGS: 1
OCCY GROUP: R3
HEAT SOURCE: FE
SQ FOOTAGE: 1,280
To request an inspection, call- the 24 houy recording aL 726-3759.
A11 inspections requested before 7:00 a.m. will be made t.he same working day,
inspections requested after 7:00 a.m. will be made t.he following work day
--- REQUTRED INSPECTIONS ---
FOOTING - After trenches are excavated.
SLAB - To be made after al-l insl-ab building service equipment, conduit
piping, and other equj-pment items are in place but prior to concrete
SANfTARY SEWER LINE - Prior to filfing trench.
STORM SEWER LINE - Prior to filling trench.
WATER LINE - Prior to fillj-ng trench.
MANUF HOME/MOBILE HoME SET Up - when all- bl-ocklng is complete.
MANUF. HOME/MOBILE HOME ELECTRICAL - When blocking, setup, and
plumbing inspections have been approved and home is connected to panel
I'ANUF. HOME/MOBILE HOME PLITMBING - After home has been connected to
water and sewer.
ROUGH ELECTRICAL - Prior to cower.
FRAMING - Prior to cover.
FINAL ELECTRICAL - When all electrical work is compl-ete.
FINAL BUILDING - When all required inspections have been approwed and
the building is complete.
FfNAL SET UP - After all required inspections are approved and porches
skirting, decks, venting, house numbers, etc. have been instalfed.
Lot Faces: W Lot Tlpe:
Setbacks
SWE
520
44
INTERIOR
>C,>12
=95#E*6H'uB,
q8, Eq!r
H3ffiE*FT*
EgF6=II!-m},26
orl-tx
House
Garage
N
1B
6
--- BUILDING PERMIT
Square Feet xItem
Main
Value
30, 000.00
$/Square Feet
SPRI]trGFIELO
2fr,
.fob Number: 980592
g7T OF SPruNGFIEID,t
Page 2
Garage
FTG/PERIM FOUNDATION
Total Value
Buildlng Permit Fee
Surcharge/admin
TOTAL FEE
0
5, 000
38,180
00
00
00
(A)
74.50
5 .97
80 .47
PLWBING PERMIT
ftem
Sanitary Sewer
Water
Storm Sewer
Plumbi-ng Permi-t
Surcharge/admin
TOTAL CHARGE (c)
Fee
25.00
25 .0O
25 .00
75.00
6.00
8r_.00
--- MISCELLA.I{EOUS PERMITS
Mobile Home
State Issuance
Surcharge/admin
WILLAI\&\LA}IE SDC
ELECTRICAL PERMIT
PLAN REVIEW FEE
CITY SYSTEM DEV CHG
TOTAL MISCEI,LANEOUS PERMITS
105.00
20.00
8.40
1, 000 . 00
88.56
48 .43
2 ,17,2 .55
(E)3,382.95
(Excluding Electrical)
unless oEherwise noted
TOTAL AMOI'NT DUE - - -
(A, B, C, D, and E combined)3 ,544 .42
BUILDING VAtUE, PLAN CHECK AND BUII,DING PERMIT
This permit is granted on the express condition that the said construction
shalf, in al,I respects, conform to the Ordinance adopted by the City of
Springfield, including the Devel-opment 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.
Received By:
Plans Reviewed By: LISA HOPPER
Building Site Reviewed By: LISA HOPPER
DaLe: o5/28/98
--- ADDITIONAI, COMMEMTS
CARPORT REVIEWED AND APPROVED BY AL WARD 6/9/98
DRIVEWAY REQUIRED TO BE PAVED
2 STREET TREES REQUIRED
By signature, I state and agree, that I have carefully examined
Lhe compleLed application and do hereby certify that aI1 informaLion hereon
is true and correct, and I further certify thaE any and all work performed
shall be done in accordance wi-th the Ordinances of the Ci-ty of Springfield,
and the Laws of the State of oregon pertaini-ng to the work described herein,
and that NO OCCUPANCY wil,l be made of any structure without permission of the
Community Services Division, Building Safety. I further certify that only
contractors and employees who are in compliance with ORS 701.055 will be
used on this project.
OTTOF
SPRlNGFIELO
Job Number: 980592 Page 3
I further agree to ensure that afl reguired 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
wi 11 on the ite at all ti during constructj-on
a
C-rs-?{,l ure v Date
--- VALIDATION ---
Receipt Number
Date Paid
Amount Received
Received By
)0)70
b-16 ?(
4 3eee, q)/
lc h)4 TLD
8b/22/98 l'{r24 I 541 9r -?35 riEnflt:lx I NE P.t2
Eeomars
PROFESSIONAL ENGINEERS
LI\ND SURVEYOR6
BUILDING OESIGNERS
806 N. NlNTrl S IREET COTTAGE GROVT OREGON s7424
-ELEPHONE {5.1,9a2 0126 FAi( ii{1) 942.79:15June 22, 1998
Terry Travess
Great Western Homes
5024 Main Street
Springfield, OF.97477
ENGINEERED FILL INSPECTION
551 S. 5u Street
Springfield, Oregon 97 471
BP # 9t0592
Dear Mr. Travess
Geomax inspected the engineered fill at the above location on June 22, 1998 The filI depth varies
from 0" to 4'-0". Springfield Quarry supplied the l-112" crushed rock. The rock w'as reportedly'
placed in 4" lifts and compacted with a 3 ton vibrating roller compactor.
The rock as placed will meet or exceed the soil bearing capacity of 1000 p s.f. as rcquired by the
1997 Oregon Structural Specialty Code Table l8-1-A.
Yours Truly,
Geomax, Inc.
'/aqd,
Jeff van den Eikho{ EIT
Project Engineer
cc:Bob Barhart, City of Springfield Building Official t-lz
E:\WPDOCS\Geomax Documcnls\98 FilcstgS I 39.upd El(PirES: z lzt lqe;
N
RE:
(il I,i 5
l;- i r'-.
i-
JoB No . 780572
ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME OR COI'4PANY
DEVELOPMENT TYPE
BUILDING SiZE
2. SAN ITARY SIr/ER -C ITv
NC OF PFU'S IB
(See Reverse Side)
3. TRANSPORI-,^TiOliI
NO OF UNITS X TRIP RATE X COST PER TRIP
I x l,ol x $472 49
Hx zt*48 - tZ-?(e1. ST0RM DRAINAGI ca..*,r Rvut -- z-1^%^Dzt,.Ei4YDV++= 5LO
IMPTRVIOUS SO FI
%:
CT SIZ rL
7-X $0.225 PtR SQ. Fr 5 47-3t
x $.16.86 PER PFU s 643 , 4g
s 47- zr
x _ x $472.49
x _ x $472.49
4 . SAw ttRnv sEwER -nhlrc
DtJ's
N0. OFfEtrT / x ZJ_,lt_pER FEU + $10 MI,ll\4C/ADlvl FEE S 2t' 7(2
Mt^lMC CRIDIT IF APPLICABLE (SET REVERSE)$ - -73,8o
TOTAL-MI^JMC SDC $ zl 3.qa
SUBToTAL (ADD ITEMS 1,2.3 & 4) $ Ztol/.q6
5. ADMiNISTRATIVI FEES
BASE CHARGI (SUBIOIAL ABOVE) X .05 $ /oo,60
$
$
1
SDC Coordi nator
Date: f^ Zn -76
ToTALSDC $2/'- 5G
lTr{P xl
LOCATION.
a tr\ r vI tr- \rrala I
(NOTE: For remodels
FIXTURE TYPE
Bathtub......
Drinking Fountain.......... . ...... . . . . .. .. ... ........ .. .'
Floor Drain..
lnterceptors For GreaseiOil/Solids,'Etc.............
lnterceprors For Sand/Auto Wash1Etc.............
Laundry TuoiClotheswasher.
Clotheswasher - 3 Or More.....
Mobile Home Park Trap (l Per Trailer).............
Receptor For Refrigerator/Water Station/Etc....,
Receptor For Commercial Sink, Dishwasher/Etc.
Shower, Single Stall...
Shower, Gan9.........
Sink: Bar, Commercial, Residerrtial Kitchen......
Urinal, Stall/Wall...
Wash Basini Lavatory, Single..
Toiiet, Pubiic lnstailation.
Toilet, Private.......
Misceilaneous:
vtlr-rv\Jr-^ I l\.raY I AlJLc. NumDer oI New,-rxtures X Unit Equivalenr = Fixture Units
calculate ontrhu NET additional fixtures)
MBER oF uNrr FrxruRE
NEW FIXTURES EOUIVALENT UNITS
2
2_
TOTAL FIXTURE UNITS
eaH
2
1
2
3
6
L
b
b
1
3
2
it
2
2
1
6
4
-
4
-
-f,-
t7
z-
CREDIT CALCULATION TABLE: Based on assessed value lf improvements occurred after annexation date in table,
calculate credits se arates
3,q7Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
x $ ,6,tqo 7<-Bo(Rate X Assessed Value)x s_
(Rate X Assessed Value)
s 73 -8oCREDIT TOTAL
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,COO
Assessed Value
'r9BO
1 981
1 982
1 983
1 984
1 985
1 986
3.83
3.70
3.55
3.39
3.20
2.91
f ore
3.8
$3.97 1 987
1 988
1 989
1 990
1 991
1 992
1 993
1 994
1 995
1 996
vz.co
2.17
1.73
1.31
o.92
o.74
0.61
0.45
o.31
o.17
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimating Purposes Only)
Hesrdeniiai..........
Commerical........
lndustrial...
Governmental......
........ 0.4
........ o.9
o5
........ o.5
lMPERVlous AREA = TorAL Lor slzE x RUNOFF coEFFtctENT
I
'--
v a
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLI9ATION DATE:DATE ISSUED:
aPittaoTtal,
PERMIT NUMBER:
226 FTFTH Srneer
ENCROACHMENT PERMTT
NUMBER:
SPRINGFIELD, OREGON g?477
ENGINEEBING DIVISION
oFFtcE TELEPHONE (503) 726-3753
.LOCATION OF WORK
ON
STATE:
,r': > ^a4.2 ?/4T?^ZlPz
SITE ADDRESS:
APPLICANT
SUBDIVISION:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOR BEGISTRATION NO:
PROJECT SUPERVISOR:
TAX MAP:
TAX LOT:
CITY:
EXPIRATION,DATE:
ADDRESS:
PHONE:
ZlPt
PHoNE: ^T€
. . _r.ZE:
REOUESTED PERMITS:hB?CCTK)N8 REOUIiTOI APPTJCATION FI!
'
OEPOSIT ACCOUII NOrtrENCROACHMENT PERMIT NOt ......... ......................
VALD FOn slxTy taol o^ys rnoM o^r! ot lsuAtlcc g r'zo.oo I
Q ousr coNTRoL trypE oF coNTRou
tro
trrtrror
Er
Q rsexnr
TYPE OF SECURITY DEPOSIT
Q aunrer sunEry BoNo e sunnw eono E casx, cHEct(
fl cuna cur pERMtr Nor...................,Q 010.00+t.16/FT.[r3tE."roili CURB , AppROACfi AfTEn FOR r,t8 AII GRESfEO
Q secox6
vAtD FOn tlo oAYt tnoil OAIE OF BEUAXCE.bnvarev tsEE sEpARATEI snrwaLK pERMlr No3....................
VALD roi rro DAv! FioM OAT! Ot EtuANCe
FT.
-
Q Clo.oO+C.ts/Fr.
fr
O tew El nEMovE / BEpAtR El pAvE prANT srBtp
Qierarcx ecunasroe ELENoTHlN"F rrdN' llloEw^Lx , onvrw^Y-Foa Au. col{cim ?AvrNo wrHtNTH! grnEg, iroHT oF wAy, To BEMAoE AFrEn
^LL
Exc^v^rsro n courtg?i,-^ndt6if iiiih:i exo suaaerE MATEa&AL E N ?r^c!.
SANITARY SEWER CONNECTION ;X ea'oo r 4>vAt D FOB 8tXW t!o, oAyE rnou DAr! Ot rS3uANC!
Q ro srua O MAN UNE (EASEMENT-B/wI E orHEn
I srcinrvr SEWER CONNECTTON pERMIT: .......,......vAtD FOi EtXTy taot o^ya tion oATt Or Etu r{ct
Q crrcx aAsr.l , luBErER E srus e uanunr
PROOF OF INSURANCF. SSOO,OOO MINIMUM, Q rrracxeo O REOUIRED AMOUNT
E C5.oo /
TOTALDUE: C
TOTAL DUE WITH PERMIT I
DESCRIPTION OF PROJ ECT:
ITAPPLICATION
PERIOD OF USE OR NME OF CONSTBUCTION:. u PLANS (TwO SETSI ATTACHED
FROM DATE:
TO DATE:
TIME:
TIME:AREA: LENGTH:IJVIDTH:
TYPE OF WORK: CUT: eAGrEo
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIUTNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTTLIZED
NAME OF OTHER UTILITIES IF THIS IS A JOINT
WARNING DEVICES TO BE UTILIZED:
DESCRIPTION:
WORK SHAIL COMPLY WITH
DEPTH:HEIGHT:
Adv.nca tlenlne .nd work ronc prot.etloo to b. ln oompll.nc.wlth tha MrnlJrt on Unltorm Trrgtc Cont ol D.vlc.r lMUTCOl.
X ARTICLE 6 OF
REvrstoNs ct21tg6 FORM ' IIt
THE CTTY CODE COMTRACTOR TO COMPLY WITH MUTCD
<277
tr_
E-
E_
RB/IEW COMMENTS / SPEC'NL INSTBUCTIONS:
SFiIPTmB's$#Bfd^iidltI,'&'U#?tlJfr 8H['EYdtr EOSNNG CTTY CODES AND}TgICMPUANCE WITH CUBRENT
001
002
003
0O'l
000
000
007
008
009
0r0
011
0t2
ot3
Oltt
or6
0r0
017
,0t8
Erclfllt wlth l'mlnur rcck.
Comp.ct rvcry I 8' loor drpth.
Rrquk[ comPrstlon wlth r rrrl rolllrr.
A.g. to mrtoh tht gt..t.r ol lxlrtlng dopth or 4'.
A[ outt rrrlcd lor llncl lnrprotlon.
Trmpor.ry p.toh may br urcd tt tht and ol thc daY.
Stgnlng rnd Zonr'Proralon to complY wlth MUTCD
Cut ooncrcb only on rcorc llncr ol cold lolnr.
8ldrwcltr rnd drlvrwryr mln 3,O00PrL
Curblng mln 3,!0Opd I No patchworl lur thrn 3'.
Mcct mh. lcqulf.mcntt on curo outtr 3Pld. coda.
8!dor. pllnt.d.crou. Spld. cod. 208.3.06
Sprc. lo Borr I Jrol I No A.C. cur.
Mochrnlccl oomp.ctlng laqulnd.
No p.tchwort rllowrd.
btcr.l autt to hrvr aonttol d.illty llll.
Cutt to b. polYmrrlzrd cract ulcd lor llnal ln.pcctlon.
Mlnlnum 2'crurhrd rock l'mlnur.
010
020
02r
o22
023
024
026
026
o27
028
029
030
03t
032
933I
Mlnumun 4' cbrrlncr !t rny polnt. rwing'rwry'
concr.ta mlnlmurn 4' dlpth, 3,ooopoi'
Tranch to bt 'T' out. t
N.rdt St!t. / CountV Pcrmlt.
No rbovr ground rnclorlngt ln ,ld!w!lk o. hlndlclp rlmpt'
Dlcmond clt A.C./Concruta vrlur boxcr to grrda'
Froh Oll rlgnr / Gradcd.
Comply wlth Atn.rlcln. wlth Oltlbllltilt Act.
Concntl rlrbr, 72hrr cudng tlrnc, 4500psi.
Concntr rlcbr rlgulrc lolnt rcal m!t.rhl.
Drlvrwry rrquhrr dowrlr lvcry t8'.
Submlt trclllo control plan ptlot to rxclvltlon,
Notlly Tr.lflo Dlvhlon bcforc cxcavatign'
Corc drlll mrln llnc, lntcrt tcc, 2% min. gradc.
Murt comply wlth th. provlalonr ol ORS 757'641 to 757.671.
8' Clrculrr iolo/H2O-Vrc.
Commants:t
I
rHE LANE urL#iE6'Ub"6HbifltfhN-c qQU NgrL's
''ONE cALL NUMBER" 1-800-332-2344
48 HOURS BEFOBE DIGGINO
!
INSPECTIONS:'tr
ftU[Bg^';AtP'fl,',tr#Hit'Ji3T3$"':+]!J3P'i^?33.&13i1'f{,1-iJt'e',-itBilE[ffi]-f,il.ilEiEipy ren --iNsiicfibl.i;CitliiRAaiotrSbnbmen,s nln/le AND pHoNE NUMBER. REouEsrs RECEIVED BEFoRE 7:0o A.M. wlLL BE
MAOE tHE SNME-OAi, iECiUESrS-ArrEN Z:OO A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CA'UrECi rN AriEN CXCAVETIOI'IS ANE MADE AND FORM WOBK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
Q seruraRy sEwER, sToRM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
7248741.
SIGNATURE:
I have
'2.
and
allthat I
plans
a
Dato I
are
Et
yoar
anc6
I furthor agroo to
and tho ap:proved 8ot
5,e
that project address ls readable from tha street,
7>- 7,
RECEIVED BY:
AMOUNT RECEIVED:
VALIDATION:
Slgnature
F
DATE PAID:
RECEIPT NO:
f,l rnernc REVTEWED BY:
-+
[-] uarrureNANCE:
fi penur rssuED BY:.----
FOR SIDEWALK AND CURB CW PEBMITS PI.ACE A COPY (COMPLETED) IN PERMIT DRAWER.
I DATE:
ivrrMe oF coMPLErtoN:
OATE:
I
WORK IN PROGRESS DATE:
DEPOSIT BETURNED:
DATE:
DATE;
DATE:
DATE:
DATE:
DATE:
INSPECTION:
INSPECTION:
I elretrueEntNc REVTEWED BY:
thle
[ltr..1-,'-iE 1,1:fi E 541 : Itf,i riEnr,lEH I Hr:5F'Ftr trEi.r. :rEF:F,.UJ
ffirffiffi#ffiffiffiffi
Jr,ne 22, 1998
Tcrry Travess
Creat Western l{omes
5tt24 Main Street
Sr,rringfield, OF.97477
i(E: ENG NEERED FII,L INSPECTION
551 S. Sth Street
Springfield, Oregon 97 477
BP # 980592
flear N{r. Travess
Geomax inspected the engineered fill at the above location on June 22, 1998" The filldepth varies
fronn 0" to 4'-0". Springfield Quarry supplied the 1-1/2" cnrshed roek. The rock w'as reportedly
p)aced in 4" lifts and compacted with a 3 ton vibrating roller compactor.
I he rock as placed will meet or exceed the soilbearing capacity of 1000 p.s.L as required by the
1997 Oregon Structural Specialty Code Table 18-1-A.
Yours Truly,
f-,eOmax, [nC
PROFESSIONAL ENGINEERS
LAND SURVEYORS
BUILDING DESI Chll-:llS
BD6 N Nlt'lTH 5lREET COTIAGE GRDVC. OHLUUllr,:'4.1 I
iEt EPHONE i1A- ,9a)-(,'t26 FAx r5.i'. 9-i: r', . ,
f,Za
Jr:ff van den Eikhof, EIT
Froject Engineer
cg.Bob Barhart, City of Springfield Building Ofiicial
,&"
\,:rrr
f'
N,^O
r,,.1 i:_ ::
E \WPl)OC.S\Geomax Documents\98 Files\9 8 I 3 9.*pd [).,i]i,icS: e-lat hg
CITY OF OREGON
uos
JO,VS/"(
Anhorlzgd
225 FITTE
SPRINGFTELD, OREGON 97477
INSPECf,ION REQUEST: 726-3769
oFPICE: 726-3759
1
torOD
Permi ts are -transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTAII,ATTON ONLY
Electrical Contractor
Address /o(z 7&,*
Phone 7Z? -/€oo
Sr.-TNGFIELD
Nev Residential-Single or
Multi-FamiIy per dvelling unit
Service Included:
I tems
.;I;rcvai
A
Cos t
s 8s.00
s 1s.00
s 40.00 uy
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home. or
-Hodular Dvelling nSertice or Feeder O(
Ci ty
Supervi-sor License Number 7f 5* s
Expiration Date ft [zq
-T
constr conrr. Number '631>Z BO
Expiration Date / z{qs
Signa ture of S upervising Electrician
0vners Name
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
20L amps to 400 amps
-401 amps to 600 amps _601 amps to L000 amps_
Over 1000 amps/volts
Reconnect Only
200 amps''or less
201. amps to 400 amps
-Over 401 to 600 amps
0ver 600 amps or 1000 voTt
-Each installation
Pump or irrigation
Sign/Outline Lighting-
Limited Energy/Res
-Limited Energy/Comm
Services or Feeders
Installation, Alterationsor Relocation:
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
B
C
s s0.00
s 60.00
s100.00
s130.00
$300.00s 40.00
$ 40.00
s ss.00
s 80.00
Ad
Ci
d s
s see ttBu a6ffi
D. Branch Circuits
E
New, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service^ A &)or Feeder Permit I g 2.oo Clf
Miscellaneous (Service/feeder not included)
pnone?l oLlll
The installation is being made on
property I ovn vhich is not intended
for saIe, Iease or rent.
0rners Signature:
DATE:(
s 40.00
$ 40.00
s 20.00
s 36.00
RBCETVED
g-5
€e Willamalane
Park & Recreation District
.t
t.
Job. No.
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:PHONE:
ADDRESS:STATE:IP:
LOCATION OF PROPOSED BUILDING SITE:
Street Address:
Plat Name:Tax Lot Number:
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwelling t
ype definitions are on the back.)
A. Single-Family Detached
Single Family home
-LManufactured
home not in a park
No. oF UNTTS x $1,000 per unit = $ lllDACD
B. Single-Family Attached
NO. OF UNITS X $924 per unit $
C. Multi-Family Apartment
NO. OF UNITS X $692 Per unit
D. Manufac,tured Home Park
NO. OF UNITS X $699 per unit
WILLAMALANE SDC
2. SDC CREDTT (if applicable) SDCaayer must fumish proof of
Willamalane Credit approval. See SDC Credit Woksheet.
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
$
$
$
$
$
6
00
D pment
City of Springfield
Date
lmo.@
CITY OF SPB"VGFIELD, OPEGO'V
SPRINGFIELED
D EVELOP M ENT S ERW C ES DE PARTM E NT 225 FIFTH STREET
SPRINGFIELD, OR 974N
(541) 726-3753
FAX(541) 726-3689MANUFACTURED HOME LAND USE AGREEMENT
As required by the City of Springfield Development Code,
permits, one of the following be
Springfield, Oregon, CitY Job Number
Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed
floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12
feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to
have an exterior thermai *r.top" meetin; performance standards which reduce heat loss to levels
equivatent to the performance standards required of single family dwellings constructed under the State
Specialty Codes.
Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area
of not less than 500 square feet, that has a nominal roof pitch of 2 feet in height for each 12 feet in width
and that has no bare metal siding or roofing'
The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6
percent slope within 10 feet of thi perimeter enclosure. The perimeter foundation wall surrounding the
home shall be constructed of stone, brick or other masonry materials, and with no more that24 inches of
the enclosing material exposed above grade'
I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60
days of the date of issuance of the manufactured home set up permit' These requirements may include' but
are not limited to the items listed below. Specific land use riquire-et'ts regarding your parcel are noted on
yourapprovedsetupplansand/orpermitandyourpartitionapprovalifapplicable:
o Street Trees
o Paving DrivewaY
. Minimum 32 square foot storage sffucture
o Completion of partition approval
o Removal of any existing ,t uttuttt as noted on your partition approval
o Signing and recording o.f any required partition, easement, improvement agreements, etc.
o Final lot grading
. Clty Sidewalk and curbcut installation
o Any outside agency approval as required i'e', Division of State Land approval'
Bymysignaturebelow,Iagreetocompletetheabovementionedlanduserequirements.
Owner Date
/ -rr -7y
J,:ffi""r"1{,tt"iB:"8ffr giiaY,
Date
V a D
BACKFILL MATERIAL TO BE UTILTZED:
PERIOD OF USE OR TIME OF CONSTRUCTION:
' Q Rt-ltts (Two sETSI ATTAcHED
AREAI LENGTH:
TYPEOFWORK: CUT:
IillDTH:
OTHER:
EXISTING SURFACE MATERIAL:
FROM EATE:
TO DATE:
DEPTH:
BORE:
BACKFILL MATERTALI
TIMEI
TIME:
HElGHT:
D
PERMIT NUMBER:
DATE ISSUED:
aPit,loalt..o226FIFTH STREET
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE '
APPLtpATtoN DATE:
FNCROACHMENT PERMTT
NUMBER:
SPRINGFIELD, OREGON 97477
ENGINEERING DTVISION
oFFtCE TELEPHONE (5031 726.3753
ZlPt
ON
CITY:STATE:
SITE ADDRESS:
APPLICANT
SUBDIVISION:
OWNER:
ADDRESS:
CONTRACTOR:
CONTRACTOR REGTSTRATTON NOI
PROJECT SUPERVISOR:
TAX MAPI
TAX LOT:
STATE: Eif ,rr.
EXPIRATION,DATE:
ADDRESS:PHONE:\ . \rarF
PHONE:
hBPEcTlONS nEOUnrDr APfIJCANOil FCt
'
OEFOSIf ACCOUilTNOT
REOUESTED PERMITS:
tr ENCROACHMENT PERMIT NO: .........,,..,,,.,,,,,,,,,,,',,,
vALp FOB SIXTY tro, DAy! |ROM OAT! OF BSUATCG
QcursrBEEr E BoRE OoTHER
E C20.00 I _
Eo
Q ousr coNTRoL (wpE oF coNTRou
E-trrtrr
Er
or
Q asrxaur DEpos[..........
tr Q 010.00+t.l6/FT..
tr E 910.00+g.tE/FT.
fr
EI xew E] REMovE / REPAIB EI PAVE PLANT STRIP
Q'serarcx Qcunasroe ELENGTHllsPF "hN' QIDEWALU oBrvEwAY-Fo_n A+ coltcf,tr! ?AvrNo wrHrN TH! grReET NoHr oF wAy, To !EMAoE
^FrEn ^LL
ExcAvArNo E coMpLErE. iro ronra iiii,ii eno suaaesi iueiiiri'r-ir aeca .
SANITARY SAATER CONNECTION pERMtT! ................
VALD FOi $XTY lrot o^y8 rnou oAT! Ot |SSUA|C!
'|X aa,& r
Q ro srua O MAIN UNE (EASEMENT.B/WI B oTHERE sronru sEwER coNNEcnoN pERMrr:E 05.00 /vaD toi 30(Tv ltot o^ya tiolt oATt o, ESU }lct
Q cercx BAstN , BuBBrrR E sruB Et MANuNE
PRooF O,F INSURANCE: $600,000 MINIMUM
Q arncxeo tr REOUIRED AMOUNT TOTALDUE: C
TOTAL DUE WTH PERMIT I
DESCRIPTION OF P BOJECT:
ITAPPLICATION
SURFACE REPLACETVTNT MATERIALS TO BE UTILIZED:
TYPE OF OUST CONTROL TO BE UTI!-|ZED
NAME OF OTHER UTILITIES tF THIS IS A JO]NT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advrncr rnd work ronc to ba ln Gomplhnc.wlth thr Mrnurl on Trrglc Control Orvtcor tMUfcOt.DESCRIPTION:
WORK SHALL COMPLY WITH CHAPTERXARTICI."E6OF
REVTSTONS U24r9t FOEU ' ttt
THE CTTY CODE COIITRACTOR TO COMPLY WIT}I II'UTCD.
I
.LOCATION OF WORK
4T?^427*
EI-o_
TYPE OF SECURITY NEPOSIT
ftaulxersunEryaoNo esunnweoxo OcasxrcHEcK
-
RE1'IEW COMMENTS
BFiIBXfiB"I#Bfd^?fd[tl,'5ld#?hv$8H['FUdff.
EXISTING CITY CODES ANI.*.I 6tMPUANCE WITH CURRENT
001 Erctflll ldth I'mlnul roch
OO2 Comprct cvcry 18'loor drPth.
003 Rrqulnr comprotlon wlth . ilr.l rolllrr.
0O4 A.C. to mttah tht gr.rtlr ot .xlrtlne dlpth or 4'.
0Ol AI our rrrlcd lor tlnd lmpcctlon.
OOO . T.mpottty gttoh mry br urcd tt th. lnd of th. d!y.
OO, glgnlne rnd ZonJ Prorctlon to oomply wlth MUTco
008 Cut ooncrcr only on tcor. llncr ot cold lolnr.
OOg Sldrwrllr rnd ddvrwryr mln 3,000pr[
OtO Cudlng mln 3,!0oprl I No pltchwort hr thrn 3'.
011 Mait mh. nqulnmmtr on fl6 outr, 8pld. ood.,
Ol2 Rrrtor. pltnttd.rn[. Spld. codr 20C.3.06
Ol3 Spcc. to 8on I Jrct f No A.C. cnb.
014 Mcchrnlcalcomprctlngnqulrrd.
016 No pltchwo* rllowrd.
010 utard our to hrv. aonttol dlndty fln.
017 Cur to bc polymcrlzrd arrct ulrd lor llnrl lnrpcctlon.
0tg Mlnlnwr 2'cuhod rock I'mlnur,
Comments:
0le
020
02t
o22
023
024
026
020
027
028
020
030
031
032
933
343
Mlnrrnum 4' chtrrncc .t.nY polnt, rwing'rwcy.
Concnr mlnlmum 4' dcpth. 3,0o0pcl.
Trinch to ba 'T' out. t
Nmdr st!t. / County Pcrmlt,
No rbovr Otound .nclotlngt ln lldcvrllk or hlndlcap rumpr'
Dbmond art A.C./Cohcrct. vrluc boxcr to grudc.
Frcrh Oll llent , Ortd.d.
Comply wlth Arn.rl$n. wlth Olttblllti.! Act.
Concrrr rlrbr, 72hn. oudng tlmc, 4600ps1.
Concrata rlrbr rrqulrc lolnt lcal mctcrhl.
Drlvrwry nqultta dowrlr lvlrY 18'.
Submlt tnlllo control pltn prlor to cxcavrtlon,
Notlly T?rtlla Dlvltlon bcforc cxcavatlgn.
Corc ddll mrln !lnl, lnlrrt tr., 2% mln. gradc.
Murt comply wlth th. provlelona ol ORS 757.641 to 757.671.
6' Clrculrr iolctH2O.Vrc.
t.
THE LANE
"ONE
YOU ARE BEOUIRED TO CALL
UTILITIES COORDINATING COUNCIL'S
CALL NUMBER" 1 -800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
.I..I cuns ctir exo SIDEWALK INSPECTIoNS CALL 72e87}g (RECOROER) STATE YOUB DESIGINATED C]TY JOB- NuiiiaEilFinriltrNuMsen. JoB ADDRESS, TypE oF rNSpEcnoN REouEsrED, ANq wHEN You wlLL BE READY FoR
iHspecriol.i, ccJrurnAEiors on owNER,s NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:OO A.M. WILL BE
MAbEixE deMe DAY, REoUESTS AFTER 7:OO A.M. wILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALUo tN AFTER ExcAVATtoNs ABE MADE AND FoRM woBK rs tN ptAcE BUT PRIoR To PouRlNG coNcRETE.
SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECT]ONS CALL C]TY MAINTENANCE AT
72A.3761,tr
SIGNATUBE:
4
and
all
,t
Slgnaturc,Dato
a16
at
I furthor rqrcc to
and the ap:proved 8et
I
atnot
and
oyees
5,@
I have
, that project address ls readabla from the str6et,
/) -7>-?
RECEIVED BY:
AMOUNT RECEIVED:
i
DATE PAID:
RECETPT.NOI
VALIDATION:(/
E rnnrnc REVIEwED BY:
Q uarHreNANcE :..-......._
E penur lssuED BYi
FOR SIDEWALK AND CURB CW PEBMITS PI-ACE A COPY (COMPLETED) IN PERMIT DRAWER.
ATTIME OF COMPLETION:
ELEVEITTTI MONTHI DATEI
I
WORK IN PROGRESS
I rucrrueEnrNc REVTEWED BY:
DEPOSIT BETURNED:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
ar8
thla
t
' INSPECTIONT
'tHSPeCTtOtt: