HomeMy WebLinkAboutPermit Building 1995-05-03t/
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office:726-3759
ASSESSOBS MAP:
SPrlIr.lGFIELE,
Lof LNE
" ,ou NUMBER 7ft YzS
225 Fif th Street
LOT:
-
BLOCK: _
rlngf leld, Oregon 97477
,ry77.-*"EZ
IAX LOT:
SUBDIVISION:
A,74
t
STATE:ZIP:/q>/>>
N E:
OWNER:
ADDRESS:
CITY;
ADDITION DEMOLISH OTHER
DESCRIBE WORK
NEW X REMODEL
PHONE
ELECTRICAL:
CONTBACTOB'S NAME
EXPI RES
?^
MECHANICAL;
PLUMBING:
GENERAL:
CONST.
CONTRACTOR ,
L.
l-qL
l.26{ t za€F-
u)fl,
I
/^J
,t(
- OFFICE USE -
r OF BDFIMS:
BANGE:WATER HEATEB
LAND USE:
SECONDARY HEAT:
SQUARE FOOTAGE:
QUAD AFIEA:
E OF BLDGS:
FLOOO PLAIN:
ZONING CODE:
CONSTB, TYPE:
HEAT SOURCE:
# OF UNITS
To request an lnspecilon
made the sanre worklng
, you must call 726-376g. Thls ls a 24 hour recordlng. Allday, lnspections requested after 7:00 a.m, will be made
lnspections requested before 7;00 a.mthe following work day,
wlll be
Sile lnspectlon - To be madeaner excavatlon, but prior tosetUng forms,
U.nderslab plumblng/ Electrical /Mechanlcal - prloi to cover.
X!f:*"- Arter trenches are
[-l ruasonry - steel tocatlon, bond.J beams, grouting,
X:,"":l*'t* ; #l:: J:[;,?"
Underground plumblng _ priorto fllllng trench,
una".lto@vMechanrcal
- pilor to lnsulatlon or c,ecklng.
Posl. and Beam - prior to floorrnsutailon or decklng.
Floor lnsulailon - prior tooecKt ng.
Sanltary Sewer - prior to flillngtrench.
Storm Sewer - prior to fllllngtrench.
Water Llno - prlor to filllngtrench.
Rough plumblng - prlor tocover.
REOUIRED INSPECTIONS
,X.lf"';r Mechantcat - Prior to
Xi;;"t: Electrtcat - Prror to
X "'r,",xJ: fl .:";rij ; #;:," ff ,olectrlcal power.
F,lreplace - prlor to faclngmaterlals and framlng lnsf
Framtng - prlor to cover,
Final Plumbing - When ailprumbtng work ls complete.
F.lnal Eleclrlcal _ When allerectrlcal work ls complete.
flla] rUgchanicat _ When ailmecnanical work ls complete.
Flnal Building _ When ailrequlred.lnspecilons have beenapproved and bulldinq iscompleted.
"x
X
K
X
x
E
K
{all/Celllng lnsulatlon _ prtor tocover.
Drywall - prlor to taplng
K
X
X
X
X
K
R'
l-l Wood Stovo - After lnstailation
lnsert - After flreplace approvaland lnstallailon of unlt.
Curbcut & Approach _ Afterrorms are erected but prior topracomcnt ol concrete.
Sldewalk & Drtveway _ Afterexc.avauon lg completo, formsano sub.base materlal in place.
Fence - When completed,
MOBILE HOME INSPECTIONS
I Blocking and Ser.Up _ When ail< blocklng ls compleie.
lqTUinS Connecrtons - Whennome has been connected towater and sewer.
Eleclrical Connection _ When
P^l:gftig, ser_up, and ptumbin-srnsp€cilons have been approvedand the horne ls connected tothe service panel.
@x;;t [";F,"Yhen arr requrred
Flnal - After ail requiredtn-spections are appioved andg-oj9,nosl sklrilng, decks, andvenilng have been lnstalled.
LOCATION OF PBOPOSED WOFK:
,€-2
I
I
lllr
OCCY GROUP:
E OF STOFIIES:
fr"^o"rarv Erecrrtc
[-l ourer
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
a/24
42%
Lot Typ.
-y' ,n,J,,o,
-- Corner
_- Panhandle
-
Cul.de-sac
P.L,HSE GAR ACC
N n
S q
/5 /S
E 25
IS THE PROPOSED WORK TN THE.
HISTOFIICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcailon must be slgnedand approved by the Historlcal
Coordinator prlor to permlt issuance.
APPROVED:
/ez. /4 . ', z:Vza >z
state surcharse 11O,9Sa1P,t/
BUILDING PERMiT
VALUE
Total Fee (A)
6?fr>,/
6Fv-x-la
X $/SO. FT.ITEM
Main
Garage
Carport
SO, FT,
/D22
Total Value,
Building Permit Fee 2Aado
-,JrsL-+'
-.%21vaz?a
BUILDING VALUE, PLAN CHECKAND BUILDING PERMTT
Thls petmlt ls granted on the express condltion that the saidconstruction shall, ln all respects, conform to the Ordlnanceadopted by the City of Springfleld, includlng theDevelopment Code, regulatlng the constructlon and use ofbulldlngs, and may be suspended or revoked at any tlmeupon vlolation of any provislons of sald ordlnances.
Recelpt Nu^be,,fu
a
-/*9r-
v:
4-- $r
DatePewe
Date Pald
Recel
Plan Check Fee:
SYSTEMS DEVELOPMENT C
(B)
HARGE (SDC) +i
fl zto+'9tP
Systems Development Charge ls due on all undeveloped
propertles wlthln tlre City limits which are being lmproved,
o-
ITIONAL COMMENTS
a
c0
ITEM
Flx tu res
Besldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
./bo.oo
/ ZpobY *4,8o 17"2:(c)
FT.
FT.
FT.
No 2-
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Oryer Vent
4,*
3,Oo
7tt2,/ 5,oo
./o.a o
zo/
-t,r 20.2.(c).
Vent Fan
Mechanlcal Permlt
I ssu an ce
State Surcharge
Total Permlt
,?f r,4-f
(D)
MECHANICAL PERMIT
Furnace
Exhaust Hood
No'e
By slgnature, I state and agree, that I have caref ully examlned
the completed applicatlon and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordlnanccs of the Clty of Sprlngfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure wlthout permission of the Buildlrrg Safety Dlvislon.
I further certlfy that only contractors and employees who
are ln compllance wlth OBS 701.055 wlll be used on thls
prolect.
I further agree to ensure that all requlred inspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the f ront
of the property, and the approved set of plans wlll remaln
on the slte at all tlmes durlng constructlon.x,/ Slgnature
Date
ftr" A;r.^l*
s- ] - ?<
M ISCELLAN EOUS PERM ITS
Moblle Home
State lssuance
State Surcharge
Sldewalk - tt
-Curbcul
-
ft
Demolitlon
State Surcharge
Total Mlscellaneous Permlts (E)
VALIDATION:
HECEIPT NUMBER
DATE PAID
,h-
AMOUNT RECEIVED
TOTAL AMOUNT DUE (excludlng electrical)
(A, B, C, D, and'E Comblned)
%?]z
RECEIVEO BY
qa
5z
2
CITY OF SPR OFEGO'V
oFPrcE: 726-3759 Ar a":itJ siSnatu'a--'['l
3- aoHPLEfE
Jl:,1o_,lo-yi1 g, p:.oiact as $L, bm [roo has rhe f oi ! :. vringzonrng, and Coes not requit.e si,eLlfic lano iiseaprproval.
zo,,ins LDfu--*-*.- BLECtRTcaL pgRt{rr AppLrcATroN225 FTFTE SIREET
1.ON INST
I^EGAL I fae
JOB DESCRIPTION
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 INSTALI.,AITION ONLY B.
ELectrical Contractor
Address
Ci ty hl ehone 724 45ZO
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signa
0vne
SPFlI}tG.FIELO
ty Job Nunber
FEE SCffiDTIIJ BETOV
A- Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost Sum
Address / Og 4D 5t
ciry 1aft pno"" 7y'422?
OIJNER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE:
C. Temporary Services or Feeders
Installation, Alteration or Relocat
200 amps"or less / z. $ 40.00
201 amps to 400 amps ----- $ 55.00
0ver 401 to 600 amps
-
$ 80.00
Over 600 amps or i000 volTs see "B"
D. Branch Cireuits
-Each installation
Pump or irrigation S
Sign/Outline Lighting- $
Limited Energy/Res $
Limited Energy/Comm $
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E Miscellaneous (Service/feeder not included)
L000 sq.ft. or less
Sach additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
-Modular Dvelling
Sertice or Feeder
Services or Feeders
InstalIation, Alterations
or Relocation:
200 amps or less
20i. amps to 400 amps _
401 amps to 600 amps _
601 amps to 1000 amps_
Over 1000 amps/vo1ts
Reconnect 0n1y
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Admini.strative Fee
TOTAL
s 8s.00
$ 1s.00
$ 40.00
s s0.00
s 60.00
s100.00
s130. 00
s300.00
s 40.00
10n
#3 o
a6oiil
r e
40.00
40.00
20.00
36.00-->
6O
RECEIVED B
5
OO
r B NO.150*zq
LL
CITY OF SPRINGFIEI,D SYSTEMS DEVEI,OPMENT CHARGE
WORKSHEET
(C0MHERCIAL & RESIDENTIAL)
NAME OR COMPANY:n 6Ru TON
- /45oo
LOCATION:ods
DEVELOPMENT TYPE:LDP il e*v 9FP
Ft
BUILDING SIZE:
1. STOBM DRAINAGE
IMPERVI0US SQ. FT.
SIZ
54o x $0.209 PER SQ. FT-Z
2 SANIT ARY SEt,lER -C ITY
NO. OF PFU'S
(See Reverse)
I X $43.26 PER PFU
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
A
X
t.x $436.19
x $436. 19
x $436. 19
$
4. SANIT ARY SEI,IER -Ml,jMC
NO. OF PFU'S 18 X $17.19 PER PFU + $10 MWMC ADM FEE
(Use PFU Total From Item 2 Above)
Mt^lMC CREDIT IF APPLICABLE (SEE REVERSE)
SUBTOTAL (ADD ITEMS 1,2,3 & 4)
ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL ABoVE) X .05
4z
$3tq
79
t5Zoo
5
Burdick
Coordi nator
obZ6
K
Date:
TOTAL SDC $ ZI O+VL
I
$
+/a,
FIXTURE uruIr }ALCTLATTON TABLE: Number or Ncw Fixturc
(NOTE: For remodet., tuttltut. only 1 .ET additionat fixrures). NUMBER OF
FIXTURE TYPE NEW FIXTURES
'Unit Equivalent :-Fixture Units
UNIT FIXTURE -.
EOUIVALENT UNITS
z-
Bathtub-.-.-2
Drinking Fountain..-.1
2
6
2
6
6
.I
3
2
1
2
')
1
o
4
I
I
Floor Drain.
lnterceptors For Grease/Oil/Solids/Etc_ - -... - _ - - - - - -.. -
lnterceptors'For Sand/Auto Wash/Etc... -. -... -,... -..-
Laundry Tub/Clotheswasher....'-...-..... -'. - --,.. - -..- - ----:.',.
Clotheswasher - 3 Or More..-..
Mobite Home Park Trap it p"r trailer)
Receptor For Refrigerator/lvater Station/Etc
Roceptor For Commercial Sink/Dishwasher/Etc..
Shower. Single Stall....-...-.
Shower, Gan9......... ................
,
Sink: Bar, Commercial. Residential Kitchen
Urinal, StallflVatl...
Wash Basin/Lavatory, Single.?-2-
Toilet, Public lnstallation.-E-Toilet , Private
Miscellaneous:
L
TOTAL FIXTURL UNITS l8
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
4-
-----:--
b
lHead
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $ 1,OOO
Assessed Value
1979 or before
1 9BO
1 981
1 982
i 983
1 eB4
1 985
$3-46,)ro
.) a.)
3.2.t
3.O6
2-92
2.73
1 985
1 986
't 987
1 9BB
1 989
1 990
1991
1 993
s2.46
2.14
1.-17
1-37
o.97
0.61
o-44
o-15
Lfu- x $I 9.s3_b179Credit for Parcel or Land Only lf Appticabte
lmproVement (if after annexation date)
(Rate X Assessed Vatue)x $_
(Rate X Assessed Value)
CREDTT TOTAL _ $b5y
Willamalane
Park & Recreation District
l}gtl, 'D' "fr
fob No.
qtkt' nAq
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
,
PHONE:NAA4E
ADDRESS:
LO-CATION OF FROPOSED
Stre€t Address if Known:
1
BUILDI
Plaft Name:
NO OF UNIrS I
B. Single Family - Attached
*)
Tax Lot Number:
Manufactured home not in a Park
X $400 PER UNIT -=.
tr.
$
$
srArE: @. =r,
q1 441
$ \tn.a0
$
$
$
,00
DEVETOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back-)
A Single Family - Detached
I Single Family home
NO OF UNITS X $370 PER UNIT =
C. Multi-FamilyApartment
NO OF UNITS X $?77 PER UNlr =
D. Manufactured Home Park
NO OF UNITS X $280 PER UNIT =
WPRD SDC
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet
3. TOTAL WPRD NET SDC ASSESSED (lf SDC reduced for Credit)
, '^it r (nn rirnr Datc
$ Llw"ta
stuw
illd0
AJ-r6
CITY OF SPRINGFIELD.OREGO'V
225 FIVTE SItsEEf,
SPRINGSIELD, OREGON
INSPECTTON REQIIEST:
oFFICE: 726-3759
SPFTTTIGFIELD
The lollowing project as submltlecl has the follolving
zoning, and does not roquiro rpecilic latrci use BIJCTRICAL pERl{IT A3pIJCATION
sTrfr^t'v72 City Job Nunber
aotu ?9- 4(3. COHPI,ETE FEE SCEEDTILE BELOIIp
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
1.
\rz?ry:"nOF
Sum
3_gu tf)0 o
Permits are non-transferable and expire
if vork is not started vithin L80 days
of issuance or if work is-suspended for
180 days.
Signature trician
s Name
Addre
Ci ty
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Eome or
Modufar Dvelling
Service or Feeder
B. Services or Feeders
Ins tallation, Alterations
or Relocation:
t--- $ eS. OO. ES
z s 1s.00 \o
$ 80.00
see rrBfr aE6lE
$ 40.00
2. COI{TRACf,OR INSTALI,ATTON ONLI
Electrical contractor (i ,il fkdn-
Address P0 0r>r t0lo1
ci rl Phone U" -1 03
Supervisor License Number Lbl l5
Expiration Date io l,lqr-,
constr contr. Number b5b6l Temporary Services or Feeders
Installation, Alteration or Relocation
c
Expiration Date zlzx lqb
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
200 amps or less
201 amps to 400 amps
-Over 401 to 600 amps
0ver 600 amps or 1000Tofts
Branch Circuits
00
00
00
00
00
00
50
60
100
130
300
40
s
$
$
$
s
$
$ 40.00
$ ss.00
*/ttdrCqt4tua,
D
INST
The installation is being made on
property f ovn which is not intended
for sale, Iease or rent.
Omers Signature:
' 'T1n-, tsna*-
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Misce.llaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0ut1ine Light ing-
Limited Bnergy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
oo
ne
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5qDATE:
LO