HomeMy WebLinkAboutPermit Building 1995-05-24PHONE:
zlPSTATEI
OWNE
CITY:
ADD
OTHEFIHADDITION DFEMODEL
DESCRIBE WORK:
\-t-NEW
-PHONEBACTOB '|EXPIRESADDBESSNAME
L (o(frz
MECHAN
CONTR
G EN EBA
PLUMBING
ELECTRICAL:
lt t I
Dll
$f2-
,1J e
L L
SRre-
PE:
SQUARE FOOTAGE;llnQ3.
- oFFrcE usE -
SECONDARY HEAT:HEAT SOURCE:
RANGE:WATER HEATER:
LAND USE:
/ OF BDRMS:
ZONING CODE:
FLOOD PLAIN
* OF UNITS:
CONSTB. TYOCCY GROUP:
* OF STORIES:
QUAD AREA:
, OF BLDGS
-_a-
----
RESIDENTIAL
PERMIT APPLICATION
lnspections:726'3769
Office: 726'3759
SPrlINGFIELD
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Wood Stove - After lnstallation.
lnserl - After flreplace approval
and lnstallatlon of unlt.
93.rt"-ltoJOB NUMBEB
225 Flfth Street
Sprl ngfleld, Oregon 97477
LOCATION OF PBO
ASSESSORS MAP:
SED WORK:
TAX LOT:
LOT:BLOCK SUBDIVISI
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recording. All lnspectlons requested before 7:00 a.m, wlll be
made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
4
REOUIRED INSPECTIONS
[ftRough Mechanlcal - Prlor to Ir-.fFlnal.Plumbing.- When all
-
cover. J plumblng work ls complete.
[!-Rough Electrical - Prlor to flVFlnat Etectr]cal - When a1lJ cover. E electrlcal work ls complete.
lJlkErecrrrcar service - Must be El-l'::l[::l':l^"-?l - whon arrg
"i-p-r6riJ to irirGrn permanent J mechanlcal work ls complete.
electrlcal power.
ffuFlnal Buildlng - When alltJ requlred lnspectlons have been
approved and building ls
completed,
I-#ramtng - Prlor to cover'
lllAlall/Celling lnsulation - Prlor tolJ cover.
[-f,-ow*"tl - Prlor to taping.
MOBILE HOME INSPECTIONS
l--rl,Footing - After trenches aretJ excavated.
Temporary Electrlc
SIte lnspectlon - To be made
after excavatlon, but prior to
settlng forms,
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Masonry - Steel Iocation, bond
beams, groutlng.
Underground Plumbing - Prior
to fllling trench,
f-frfoundatlon - After forms aretJ erected but prior to concrete
placement.
f-!-tJndertloor Plumbing / Mechanical
Prlor to lnsulation or decking.
l-7}+ost and Bsam - Prlor to floorH insulatlon or decking.
[lJloor lnsulation - Prior totg decklng.
fl-€anitary Sewer - Prior to fillingtJ trench.
f)-Etorm Sewer - Prior to filling
-
trencn.
Ply*:;Line - Prror to rirrins
I ufRough Plumblng - Prlor to
- cover.
l-lf-€urbcut & Approach - AftertJ forms are erected but prigr to
placement of concrete.
[7f'sidewalk & Driveway - AfterlJ excavatlon is complete, forms
and sub-base materlal ln place.
l-l Fence - When compteted,
Slreet Trees - When all requlred
troes aro planted.
Other
Blocking and Set.Up - When all
blocklng ls complete.
Plumblng Conneclions - When
home has been connected to
water and sewer,
Electrlcal Conneclion - When
blocking, set-up, and plumblng
inspectlons have been approved
and the home ls connected to
the servlce panel.
FInal - After all requlred
Inspectlons are approved andporches, sklrtlng, decks, and
ventlng have been lnstalled.
a
tl
E
E
--
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght B
PL.HSE GAR ACC
N
S
E
Lot Type
-4nr"nor
-
Corner
-
Panhandle
-
Cul-de.sac
state surcharge tio/o
Total Fee
sl qI'
3ru.qa(A)
\\.\D
oo
X $/SO. FT. = VALUE
5\\r.2D to3 tfl+
n]tsroTotal Value
Bulldlng Permlt Fee
BUILDING PERMTT
ITEM SQ. FT.
Maln
Garage
Carport
\\33
'5\oC .l tqb
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt ls granted on the express conditlon that the saldconstructlon shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprlngfletd, lncluding theDevelopment Code, regulatlng the corlstructlon and use ofbulldlngs, and may be suspended or r:evoked at any ilmeupon vlolatlon of any provlsions of sald ordlnances.
Reviewed By DateP
Date Paid:
Recelpt Num
Recelved By:
sYSr E MS D EV E Lo P'
=
* r,rl *
^
-&!1?p Systems Development Charge ls due on all undeveloped
properties withln the City llmlts whlch are belng improved.
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
l3o/o
\\pEF
\10, 8D(c)
?DI
FT.
No \\ oD,9o
PLUMBING PERMTT
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
r33
co3
(D)A? 63
q C{)
4
Vent Fan
\\s.5C
rDg2
Mechanlcal Permlt
lssuance
State Surcharge
Total Permlt
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I f urther cerilfy
that any and all work performed shall be done ln accordance
wlth the Ordinances of the City of Sprlngfleld, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCy will be made of any
structure without permisslon of the Bulldlng Safety Divlslon.
I lurther certlfy that only contractors and employees who
are ln compllance wlth ORS 701.055 wlll be used on thls
prolect.
I further agree to ensure that all required lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the front
the property, and the approved set of plans wl
natu re
Date
no
the slte at all es durlng con.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
:fii:ffi;:
Demolltlon
Total Mlscellaneous Permlts (E)
\3 "p
S Su rge
TOTAL AMOUNT DUE (excludlng electricat)
(A, B, C, D, and E Comblned)
D
DATE PAID
VALIDATION:
RECEIPT NUM
AMOUNT REC
RECEIVED BY
q. lS THE PROPOSEO WORK tN THE
HISTORICAL DISTRICT. OR ON
rH E H tsrontcAL REGtsrERq=.[E_
lf yes, thls appllcatlon must be slgnedand approved by the Hlstorlcal
Coordinator prlor to permit issuance.
APPROVED
Plan Check Fee: _
FT.
FT.
N0
CITY OF OREGO'V
225 Frrm STBEBT apProval'
spRrNGprBtD, oREGoN gt47t zo,,ns VDL-'
INSPECf,ION RBQIIBSTI 726-3769 -. ^ .. -
OFPICE: 726-3759 o",*cZAAI-
1.OP
s0()
a )
Permits are non-traltsferable and expirelf vork ls not started vithln 180 days
of lssuahce or lf vork is suspended for
180 days.'
2. CO}IIBACf,OR INSTALT.ATION ONLY
Electrical Contractor
Address 1& S ur 3tsd .q{.
SPRTNGFIELO
The tollowing Proiect
zoning, and does not
as subrnitted has the
require specific lsnd m
EI,BCTRTCAL PERHIT APPLTCATION
Ci ty Job Number
li;eo Signatur" 3't"fSUPfTg PEE--SCBEDULE BELOg
A. Nev Resldentlal-Single or
HuIti-FamiIy per dvelling unit.
Service Included:Items Cost
_L- $ Bs. oo
1-. g 1s.oo
lrt 1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Hodular DveIIing
Service or Feeder
Services or Feeders
Insta1Iation, Alterations
or Relocation:
Sumb
3!-
B
$ 40.00
CI ty
Supe
phone /-{lS-,9Bq
rvisor License Number lAOb-S
Expiration Date
Constr Contr. Number
200 amps or less
201 amps to 400 amPs _
401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/volts
Reconnect 0nly
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Expiratlon Date
ture of Su t trician
Ovners
Address
Ci ty [Ol'[ot Phone
.v"*I;UALLATToN
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
Orners Signature:
DATE:
c.Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less $ 40.00
over 4b1 to 600 ambs
-
$ 80.00
0ver 600 amps or lbOOETis see rrB, a56iE-
Branch Circuits
Nev, Alteratlon or Extension Per Panel
one circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit
-
$ 2.00
E. Hiscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/OutIine Lighting-
Limi ted Energy/Res _Limited Energy/Comm
SUBTOTAL OP ABOVB
5Z State Sulch-arge
TETAL ?O'A
i D
s 40.00
$ 40.00
$ 20.00
$ 36.00
oo
+oto,l-RBCBIVED
5
\x\ 1l)
?5oozo
CTTY OF SPRTNGFTELD SYSTEMS DEVEI,OPMENT CHARGE
WORKSHEET
(c0MfiERCIAL & RESIDENTIAL)
NAME OR COMPANY:4av DEN Eu LR-fKt9e g fi,tc-
L0CATION: 9 o S. 7z ^tp Vt. lQoz-l az/o/5oo
u0
NL 9p<DEVELOPMENT TYPE:Ltz
1
BUILDING SIZE
STORM DRAINAGE
TMPERVIoUS SQ. FT.
2. SANiTARY SEl.lER -C ITY
NO. OF PFU'S
(See Reverse)
N.A
tg
X l,or X $436.19
SIZ
x $0.209 PER SQ. FT.
X $43.26 PER PFU
Zt
a. Ft.
$
$
s 3tq+9
"?
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
I
X
I,
x $436. 19
x $436.le
4 SANITARY SEI,IER-MWMC
NO. OF PFU'S Ig X $17.19 PER PFU + $IO MI'IMC ADM FEE
(Use PFU Total From Item 2 Above)
MI.IMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL -Mt,lMC SDC
SUBT0TAL (ADD ITEMS 1,2,3 & 4) $ t,tZ+z
ADMINISTRATIVE FEES
BASE CHARGE (SUBToTAL AB0VE) X .05
5
Kip Burd ck
4-
(
SDC Coordinator
oate, 5r/ze1rE
TOTAL SDC $1 5AB o4
. CALCULATFIxTuRe uYll';ur",i'," onrv thc
(NOTE: For remodels
ION TABLE: Nurnbcr of New fixtures
'-'I tiotttooal fixturcsl*"ao o,
NEW FIXTURES
FIXTURE TYPE
Bathtub--"-
O.i"ti"S Fountain""
Floor Drain'
i"iJ.""o."tt For Grease/oit/Sotids/Etc"-"'-'--"-
i"i".""oa".t For Sand/Auto Wash/Etc-""-'-":-'
Laundry Tub/Clotheswastrer"' -' -
Clotheswasher - 3 Or More"-'- "":""'-:--'
R"..pao, For Refrigerator/Water StationlEtc
Receptor For Commercial Sink/Distrwasher/Etc-'
'<Joit Equivatent - Fixturc Units
,oU[}I"*' [lI]T"
L
a,e
7-
TOTAL FI)ITURi_ UT']ITS
lf improvements occurred after annexa
b.4U x $,68 '?-d
2
1
2
n
6
2
6
6
1
J
2
1
2
2
1
Shower. Single Stall---.---"'/Head
Shower. Gang.-..-----
Sink: Bar, Commercial. Residential Kitct-ren'
L
L
---9-
Urinal, StatlAl/all -- -
Wash Basin/Lavatory, Single""""
Toilet, Public Installation
Toilet, Private--.-.-.-'
Miscellaneous
CREDIT CALCULATIO N TABLE:
calculate crcdits scParates.
Based on assessed value
Credit doi Parcelor Land Only lf Applicable
lmprovdment {if after annexation date}
6
4
I
(Rate X Assessed Value)
X$
(Rate X Assessed Value)
tion date in table,
29
z?
CREDIT TOTAL _ $26
Year
Annexed
Rate Jler $1,OOO
/rssessed ValueYear
Annexed
Rate pcr $1,OOO
Assessed Value
1 985
1 986
1 987
1 9BB
1 989
1 990
1 991
i 993
$ 2.46
2.14
1-71
1-31
o.97
0-61
o-44
o-15
1979 or before
1 980
1 981
1 982
1 983
1 984
1 g8s
$3.46
12Q
J.JL
3.21
3.O6
2-92
2-'13
+
2
I
I