HomeMy WebLinkAboutPermit Building 1993-10-18SPRINGFIELE,
RESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSE n
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97 477
TAX LOIASSESSORS MAP:lr/,D,3+
LOT:BLOCK:SUBDIVISION
STATE:
OWNER
ADDRESS:
CITY:
PHONE
ZIP:
REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
*.* K
ADDRESS EXPIRESNE
GENERA
MECHANICA
CONTRACTO
PLUMBING
E
CONST.
CONTRACTOR #
il&o
/Ll
(/
dRUJ - OFFICE USE _
CONSTR. TYPE:
WATER HEATEFI:
HEAT SoURce, Q-A,>. fuZ/
RANGE:€s
r OF UNITS:
LAND USE:
g OF BDRMS:
SECONDARY HEAT:
SOUARE FOOTAG
FLOOD PLAIN:
ZONING CODE
OCCY GROUPT
* OF STORIES:
QUAD AFIEA:
* OF BLDGS:
To request an lnspectlon, you must call 726-3769. This is a 24 hour recording. All inspections requested before 7:00 a.m. will be
made the same working day, lnspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
femporary Electric w
a
Rough Mechanical - Prior to
cover.
Final Plumbing : When all
plumbing work is complete.
Site lnspection - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to a Final Electrical - When all
electrical work is complete.cover.
Underslab Plumbing/ Electrical/
Mechanical - Prior to cover.Electrical Service - Must be
approved to obtain permanent
electrical power.
a Final Mechanical - When all
mechanical work is complete.
w Footing - After trenches are
excavated.a Final Building - When all
required inspections have been
approved and building is
completed.
Fireplace - Prior to faclng
materlals and framlng lnsp.
Masonry - Steel locatlon, bond
beams, groutlng.w
w
Framing - Prior to cover.a Foundatlon - After forms are
erected but prlor to concrete
placement.
Other
Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.W) Drywall - Prior to taping.
MOBILE HOME !NSPE TIONSw
a
a
w
w
w
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.Wood Stove - After installation.
Post and Beam - Prior to floor
insulation or decking.lnsert - After flreplace approval
and installation of unit.
Blocking and Set-Up - When all
blocking is complete.
Floor lnsulation - Prior to
decki ng.w Curbcut & Approach - After
forms are erected 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.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Water Line - Prlor to filling
trench.
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.d :;*tt Plumbins - Prior to A
.a
\
E
E
E
E
Lot faces
Lot sq. ft,
Lot coverage
Topography
Total height
O-*d
Lot Type
-
lnterior'\1
'\ corner
-
Panhandle
-
Cul-de-sac
ks .IS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL FIEGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
A.PPROVED:
P.L.HSE GAR ACC
N /a
S /&{
/a
E ?e 26
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.
Plan Check r".' - 7?O'?/
Receipt Number:-
/a-6-23
Dateewed
v:
Date Paid
Recei2/.69
(A) {/8. //
/o7.€
BUILDING PERMIT
Total Value
Building Permit Fee
State Surcharge
Total Fee
ITEM
Main
Garage
Carport
Systems Developtnent Charge is due'on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHA nce rsoo aF+Ab+(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
/8.2. ua
/ az,yz
FT.
FT.
FT.
?./z
(c)
No 2X ,./. 2a
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fi replace Unit
Dryer vent 2 X7
-dS
/.?<
ae2?
?8.2f(D)
7.*
6 *'6
./a.*
MECHANICAL PERMIT
Mechanical Permit
lssuance
State Surcharge
Total Permit
Fu rnace
Exhaust Hood
Vent Fan
?.r /- sa
No 4rf3-
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 contraclors and employees who
are in compliance with ORS 701.055 will be used on this
project.
I f urther 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 is located at the front
of the property, and the approved set of plans will remain
on the site at I times during construction.
Signature
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
sidewatk /28 n
curbcut {2 n
€€neu!.oa- l(4<34aq/7€
State Surcharge
Total Miscellaneous Permits (E)
7?..b
,/4.??
?/e.ao
7"a22
/hl6.b'{
/25 20
2,AMOUNT BECEIVED
RECEIVED BY
DATE PAID
VALIDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
g*ze,€z
ffi.##Iffi
tw
^'q'"'' - -v/6w
]OB NO .qbt+rz
CITY OF SPRINGFIELD SYSTEI-IS DEVELOPMENT CHARGE
}IORKSHEET
(c0t'lt'IERcIAL & RESIDENTIAL)
Sr AI c ENTT De. P*u LNAME OR COMPANY:
l*o z 1 tu{or-l LL. C-n1sr. t -1Ob-7-bb 'f - Oo.looLOCATION:
LDE Nlew D dPLElDEVELOPMENT TYPE:
BUILDING SIZE:
I. STORM DRAINAGE
IMPERVIOUS SQ. FT.
2. SANITARY SEt^lER-CITY
NO. OF PFU'S
(See Reverse)
62
2z
\.ot x $424.31
x
---
x $424.31
LOT SiZ
x $0.203 PER SQ. FT.
X $42.08 PER PFU
sQ. Ft.
3 TRANS PORTAT I ON
NO OF UNITS X TRIP RATI X COST PER TRIP
2x
$
x $424.31
ZL $15.125 PER PFU + $IO MI,IMC ADM FEE s ?+';19
$X
4. SANITARY SEt,lER-Mt,lMC
NO. OF PFU'S
(Use PFU Tota'l From Item 2 Above )
MltlMC CREDIT IF APPLICABLE (SEE REVERSE)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBToTAL AB0VE) X -0s
,-L
K p Burdick
Coordinator
TOTAL-MWMC SDC
SUBT0TAL (ADD ITEMS 1,2,3 & 4)$2qto o-1
tq
bz+53
B5-l9
6Zz
*bq:
sDc
Lo 7
TOTAL SDC bo 61c
't Equivalent = Fixlure Units (NOTE:
FIXTURE UNIT CALCULA] - N TABLE: I'IUMUET Of NCW FiXIUTES X
ior r",J"ls, catculAiJonry tn" Ng aJ-aitional fixtures)
NUMBER OF
FIXIURE TYPE NEW FIXTURES
2
UNIT
EOUIVALENT
FIXTURE
UNITS
Floor Drain.-
interceptors For G rease/Oil/Sollds/Etc" " " "" """'
lnterceptors For Sand/Atrto Wash/Etc"" " " " " "-"'
l-aundry Tub/CIotheswasher""" ""
Clotheswaqher - 3 Or More"""""'
Mobile Hdriie Park Trap (1 Per Trailer)""'-
Receptor For RefrigeratorAVater Station/ ttc" " " "
n"""p,ot For Commerclal Sink/Dishwasher/Etc"
Bathtub...----
Drinking Fountain...--."'-"'
Shower. Single'Stall--
Shower, Gang-.--.------
Sink. Bar. Commercial
Urinal. StallAvall-.--
Wash Basin/t vatory, Single""""'
Water Closet. Public lnstallation"
TED Yz,4,zt x
(Rate
(Rate X Assessed Value)
2
2
z
Z
oo
$ lz.q
x$
2
1
2
J
6
2
6
6
1
3
2
1
2
2
'l
/Head
Water Closet, Private--.-...""""'
Miscellaneous:
TOTAL FIXTURE UNITS
cREDlr CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table'
calculate credits
6
4
6 .{ot?
Credit for Parcd or LaM Only lf Applicable
lmprovement (rf after annexation date)
X Assessed Value)-{olaCREDIT TOTAL $
Year
Annexed
Rate per $1,000
Assessed ValueYear
Annexed
Rate Per $1.0O0
Assessed Value
1986
1 987
1988
1989
1990
1991
1992
$ 2.24
1.93
1.57
1.18
0.79
0.44
0.28
'1979 or before
1980
1981
1982
1983
1984
1985
s.21
3.13
3.08
2-96
2.82
2.@
2.51
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
IMPERVIoUSAREA=ToTALLoTSIZEXRUNOFFCoEFFICIENT
JI
--r+--
d
z
I
ZZ
Willamalane
Park & Recreation District
SYSTEMS DEVELOPMENT CHARCE
WORKSHEET
PHONE
STATE:
fob No.
P
NAME:.Ju L\norfl.b U.Dn .(
ADDRESS:'lDScc"5cucn {fia.(Y,,
T
LOCATION OF PROPOSED B
Street Address if Known:fltilff'le HO+ ,.--o I o*nr- 7 ,/LtBf'
r'l4}9aWPRD SDC
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAT WPRD NET SDC ASSESSED (lf SDC reduced for Credit)
1
Platt N Tax Lot Number:
DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.)
A. Single Family - Detached
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
NO OF UNITS
X $400 PER UNIT =$
X $370 PER UNIT =
X $277 PER UNIT =
X $280 PER UNIT =
co
$
$
$
$
$
Community Services
City of Springfield
ca)
l0r-\$rq3
Date
)
RE3IDENTIAL - COHIIERCIAL
SIDEI]JALK / CURBCUT
AFPLICATIOhI / PER-1IT
SPrlINGFIELE,
2?5 NORTI] FIFTI{ gTREET
gPRlh{G,F IELD, OREGON 31411
=NG
INEERING D IVI 5 IOI.IGlcE No. 126-71>3
IN9PECTION LINE: -]26-3169
JOB ADDRE99:l4o.t Gl1 i;
rl'A5eEgrcRs rAp No.^ l'Z - c,'> - J 6 3 c{- lAx Lol
9JBDrvl9loN:
OJ,h.iER:<-.,'5\Urvtcr.^'r b
ADDRE99' ?O: ->. L€-^ecLl clTYtfol,g-rtl-
STATE, cfu Zlp, a1-rc{(-:-7_Pl{otlE No. :B4S Oti(iS
RECETPTNo: o il5+-=
CA9+{
CHECK
*
CHECKED FOR DELNAUENCIES
I
9I6NED:Zrt L-
DATE,z--3 -2+
ujORK
I,IJORK TO tsE FERFORIIED EY:
CON;RACTOR*
cr.l,
SlDEllALK: CURB S|DE
-
9ETBAC<
-
GURS-CUT, x REgtDEhiTlAl- _ coHMERtCAt_ _
g=COND DRI\EIIJAY ( gEE TRAFFIC )
R=aUlR=9 APPLlcATlol.l FOR A fcoND DRI\€IIJAY(T-4.1a)
OR A COIJNTY APPLICATION FOR FACILITY P=B1IT (C AE.2O3)
lF tN Tl.+E UGB.
DA1E G APPLICATION
X oul'{ER CO}.ITRACTOR
*RSGIgTR,ATION NO.EXPIRES,
Arrr<,99 Pi-lONE,
PROCEDUFE FOR IN9PECTICI.I REOIIE9T:
ClLL 12b-3169 (FEcO@ER ) STATE YOUR CITY DESIGNAT=D JO3 Nt,j].13=R, JOg ADDRES9;IYPE OF
INSPECTIO.{ GAUESTED A\D tlrriEN YOil IUILL 3= READY FOR lNgP=CrlON, CONTRACiOR9 OR Otl}{ERg NA:1E A\D
Pi-'lohlENI&"19ERREaU=STS RECEI\ED B=FORE 1zo@ /J1 TUILL BE l'iAD= rHE 9SlE DAY,REaUEgrg #iE?1too
AI'1 IUILL BE I1ADE TIIE NEXT TIJOR<INC DAY
EXIgTIhtG tsUILDIN6 PEB1IT NO. ( IF AFPLI cAtsLE,) q3i4\'2-
*YOUR CITY DESIGNATED Joa No. tSr5EE BOOK
reAUIRED INSPECTIOhIS SIDEIUALK / DRI\GiJJAY
rcR ALL CONCRETE PA\1ING IUITIIIN
THE STREET RIGHT OF IIJAY, TO 3E
l,lAD= AFTER ALL EXCAVATING
l5 coi'lPLETE AID FoBl r,ucR<
AID 5LJ3-BA9E I.IATERIAL 19
IN PLACE
CU@ / APPROACI{ APROl\l,
AFTER rcRJis ARE ERECTED
BUT PRIOF? TO POURING
CONCRETE.
FEE9, 9IDEUJALK5 cuRE-cuT IUALK x
rlO.OO + lO.lb/LF.( X )
OF UJALK
*
ilO.OO+'O.\>/LF.(X)
COI-IIIERICAL DRI\€IIAYS SHALL
HA\€ 5'TO A'FLAIRS
3'. O'' sTA\DARD
z/b ?zTOTA FEFIIIT FEE,
I .]A\G CAR=FJLLY EX*1INED THE COi-IPLETED APPLICATION FOR PEBIIT, A\D DO I-]EREBY CERTIFY TI{AT ALL
INTB1ATION {-]ER=ON 19 TR.]E AND CORRECT, A\D I FURTHER CERTTFY'iFiAT ANY AND ALL LT,OR< PERFOS.I=D
5I.]ALL 5E DONE IN ACCORDANCE I.UITII THE ORDINANCES G TI]E CITY OF SPRING,FIELD, AID THE LAIll9 G T}-]EgTATE OF OREGON PERTAINING TO TI{E I].JON4 PEU"RISED I.{EREIN, A\D TI.]AT NO OCCUPANCY I.IJILL BE I,1ADEd ANY STR"JCTURE IUITI-.IOJT PEB1I95IO}I OF T}..lE tsUILDING DIVISIO}.I I FURTI]ER CERTIFY TI-]AT ONLY CONTRACTORSAD
DATE
q
oo 4a3
W
f
I]J{-.{O ARE IN COHPLIANCE IUITH OR' 1@IO'> II,,ILL BE USED ON THIS PROJECT.
CITY OF OREGO'V
225 rTWE SITEBT
sPBrNGrrELD, ORBGoN 97477
INSPBCTION RBOI ESTz 726-3769
OFPICE: '726-3759
1
SPRI^lGFIELc,
ELBCTRICAL PERHIT APPLICATION
Ci ty Job Nunber
3. COHPI.ETE FEE SCEEDTILB BELOS
A New Residential-Sing1e or
MuIti-FamiIy per dvelling unit.
Service Included:Items Cost Sumtc1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each l'lanuf 'd Home or
Modular Dwel}ing
Service or Feeder
&
A,$ 1s.oo
$ 8s.00
$ 40.00
s s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Permi ts non-transferable and exPire
if work is not started vithin 180 days
of issuance or lf vork ls suspended for
180 days.
2. COIITRACTOR INSTALI.ATION ONLY
Electrical Contrae wrI{F, ELWWT !-
Address
city Efi&0fu6 Ptron
Supervisor License Number
81 - 511o
=filzS
Expi tion Date (r-- q4
of sing trician
s
Address
Cl ty Phone
OTINER
B. Services or Feeders
InstaIIation, Alterations
or Relocation:
200 amps or less
201 amps to 4OO amps
-401 amps to 600 amps
-
601 amps to 1000 amps-
Over 1000 amps/volts
Reconnect 0niy
e
Expi ration Date l0- \ -q5
constr contr. r.rumuer €H$'ffi t9Zoo
Temporary Services or Feeders
Installation, Alteration or Relocation
t
a6ove
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit
-
$ 2.00
MiscelLaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
$ 40.00
l,iili ted Energy/Res
-
$ 20.00
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
200 amps or ]ess I $ 40.00
201 amps to 400 amps -- $ 55.00
over 4b1 to 600 amps
-
$ 80.00
Over 600 amps or 1000 voTIs see rrB'r
The installatioh is beirig made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Onners Signature:
E
DATE:
RBCEIVBD
5
+Dgri
c.