HomeMy WebLinkAboutPermit Building 1999-09-13CITY
SPF!NGFIELD
225 North Fifth Street
Springfi-e1d, OR 97477
Location of Proposed Workz 2274
Assessors Map #: a7021-943
Lot: Block:
RESIDENTTAL PERMIT APPLICATION
CITY OF SPRINGFIEI,D
COMMT'NITY SERVICES DIVISION
BUILDING SAFETY
Page 1
ilob Number: 990592
7 26 -37 59
726-3'7 69
1?,
.4
ST
Office
l-nspectr_on !r_ne
Tax Lot #: 03000
Subdivision : AMBLESIDE
Owner: TOM WIRFS
Address : P. O .BOX 23'7
Describe Work: S.F.RESIDENCE
Phone #: 747-8704
ciry/state/zip: sPLFD oF., 9747L
NEW
ContracEor
TOM WIRFS 0032947
1.275 S 2ND SPRINGFIELD OR 97477OOOO
BMC PLUMB]NG O1O48O5
PO BOX 292 TERREBONNE OR 977600000
MARSHALLS OO2579O
4110 OLYMPIC ST SPRINGFIELD OR 9747
B]LLS ELECTRIC 0073452
3170 W. 11TH EUGENE OR
Const.
Contractor #Expires
06 /28 / ee
o3/1.3/00
t2/23/ee
1-O/04/ee
Phone
141-8704
548-7510
747-7445
3 41, - 8426
T,titicaiior,
General:
Plumbing:
Mechanical
Electrical
QUAD AREA: 3RNC
OCCY GROUP: R3
HEAT SOURCE: FG
SQ FOOTAGE: 2444
-- oFrrcE usE --
LAND USE: 1111
CONSTR. TYPE: VN
RANGE: G
To requests an inspection, call the 24 hour recording at 726-3769.
A11 inspections requested before 7:00 a.m. will be made the same working day,
inspections requested after 7:00 a.m. will be made Lhe following work day.
--- REQUIRED TNSPECTTONS ---
SITE - To be made after excavation but prior to sett.ing forms.
FOOTING - After trenches are excavated.
FOITNDATION - After forms are erected but prior to concrete placement
IINDERFLOOR PLIIMBING - Prior to insul-ation or decking.
ITNDERFLOOR MECHANICAL - Prior to insulaLion or decking
ROUGH cAS - after line is instaLl-ed and capped if not
appl iance
POST AND BEAM - Prior Lo floor insulation or decking.
INSULATION - Fl-oor; prior to decking Wal1/Ceiling;
WATER LINE - Prior to flIIing t.rench.
SA.MTARY SEWER LINE - Prior to filling trench.
STORM SEWER LINE - Prior to filling trench.
T NDERFLOOR DRA,fN - Prior to cover or placement of conc
ROUGH PtITMBING - Prior to cover.
ROUGH MECHAIiIICAL - Prior to cover.
ROUGH ELECTRTCAL - Prior To Cover.
ELECTRICAL SERVICE - Must be approved to obtain permanent power.
SHEAR WALL NAILING - Before covering sheathing with finish materials.
FRAI{ING - Pri-or Lo cover.
INSULATION - Fl-oor; prior to decking Wa11/CeiJ-ing; Prior to cover
DRYWALL - Prior to taping.
CURBCUT - After forms are erected but prior to placement of concrete.
SIDEWALK - After excavation is complete, forms and sub-base material
in p1ace.
# OF BLDGS: 1
# OF BDRMS: 3
INSUL PATH: P1
.SPRIi&GFIELD
.fob Number: 990692
CITY SPruNGFIEU',
Page 2
FINAL PLTMBING - When all plumbing work is complete.
FINAL MECHAIIICAL - When all mechanical work i-s complete.
FINAL ELECTRICAL - When all el-ectrj-ca1 work is complete.
cAS SERVICE - After line is installed and }ine has been connected to a
minimum of one appliance. Pressure test done at this point '
FINAL BUILDING - When all required inspections have been approved and
the building is compfete.
Lot Faces: E
Topography: 2
House
Garage
Setbacks
SW
5
5
Lot Sq. Ft.: 9240
Total Height: 22
Lot Coverage: 25.5 Z
Lot Type: INTERfOR
E
18
N
5
Item
Main
Garage
PROCH
TotaL Value
Building Permit Fee
Surcharge/admin
TOTAL FEE
..- BUILDING PERMIT
Square Feet x
18 54
649
84
$/Sguare Feet
69 .64
18 .34
15
(A)
Value
129, 113 . 00
11, 903 . 00
1, 260 . oo
L42,276.00
529
42
75
38
572.L3
--- PLUUBING PERMIT ---
Item
Residential Bath(s)
Plumbing Permj-t
Surcharge/admin
TOTAL CHARGE
2
Fee
150.00
150.00
12.80
L7 2 .80(c)
.-- MECHANICAL PERMIT ---
Furnace
Exhaust Hood
Vent Fan
Dryer Vent
GAS LINE & W/H
GAS F. P.
Mechanical Permit
Issuance
Surcharge/edmin
TOTAL PERMIT
3
5.00
4.50
9.00
3.00
5.00
4.50
(D)
32.00
10.00
2 .56
44.56
--- MISCELI,A}iIEOUS PERMITS
Surcharge/admin
Sidewalk
Curb CuL
PLAN REVIEW FEE
WILLAIVU\LAI{E SDC
CITY SDC
Wa<nr
TOTAL ITTISCELLA.I\IEOUS PERMITS
0.00
60.00
60.00
344.34
1, 000 . 00
2 ,5LL .57
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. SPFIIIiGFIELO
ilob Nurnber: 990692
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Page 3
(Excluding Electrical )
unless oEherwise noEed
- - - TOTAL A.MOI'NT DUE -. -
(A, B, C, D, and E combined)
tltob 3D
08.70
--- BUILDING VALUE, PLA}iI CHECK AI{D BUILDING PERMIT ---
This permit 1s granted on the express condition that the said construction
sha11, in all respects, conform Lo the Ordinance adopted by the City of
SprlngfieJ-d, including the Development Code, regulat.ing the construction and
use of buildings, and may be suspended or revoked at any time upon violation
of any provisions of said ordj-nances.
Received By:
Pfans Reviewed By: DON MOORE Date: 07/23/99
Building Site Reviewed By: BOB BARNHART
-.- ADDITIONAL COMMENTS
PATH 1; SEPARATE ELECTRICAL PERMTT ]S REQUIRED
REAR OF PROPERTY IS IN WETLANDS AREA.
DRIVEWAY REQUIRED TO BE PAVED
2 STREET TREES REQUIRED
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that alf information hereon
is true and correct, and I further certify that any and all work performed
shal1 be done in accordance with the Ordinances of t.he City of Springfield,
and Lhe Laws of the State of Oregon pertaining to the work descrlbed herein,
and that NO OCCUPANCY will be made of any structure without permj-ssion of the
Community Services Division, Building Safety. I further certify that only
conLracLors and employees who are in compli-ance with ORS 701.055 will be
used on this project.
I further agree to ensure that all- required inspectj-ons 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 Lhe approved set of plans
wi-ll remain on the s e at al-l- times during construct.ion
Si-gnature Dat
--- VALTDATTON ---
Receipt Number
Date Paid
AmounL Received
Received By
- CITY OF SPR OREGO'U
225 TIFTE STREET
SPRTNGFTEIJ, OREGON 97477
INSPECTI0N REQIIEST:. 726-3769
OFFICE: 726-3759
I.,EGAL DESCRTPTION
JOB
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
STALLATT ON ONLY
EI;ESTRICAL PERHIT
Ci ty Job Nuruber
3. COMPIATE FEE SCMDUI,E BELOIT
A Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
a
ia
06 L000 sq. f t. or l-ess
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home- or
Modular Dvelling
SerVice or Feeder
Sum
a666
t included)
.00
.00
.oo
.00
t/- g 85. O0 A5
,+ s1s.oo A
2.. CONTRAC:IOR IN
Electrical Contra
Address
Ci ty
/k 4/c tor
D
Pn,""S// ffz6
$ 40.00
B Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amPS
-
401 amps to 600 amPs
-
601 amps to 1000 amPs-
0ver l-000 amPs/voIts
Reconnect Oniy
c
D
E. Miscellaneous (Service/feeder no
-Each installation
Pump or irrigation $40
ign/Outline Lighting--s40
imi ted EnergY/Res $20
imited EnergY/Comm
SUBTOTAL OF ABOVE
52 State Surcharge
32 Administrative Fee
TOTAL
Supervisor License Number ?r a5.
7
$ s0.00
s 60.00
s100.00
s130.00
$300.00s 40.00
Expiration Date
consrr conrr. Number 2 o F' " c-Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
:?
ef pervi tricianSu
Owners Name
Add
ci Phone
200 amps''or less t/ S 1q.00
201 amps to 400 amps
-
S 55.00
over 4b1 to 600 amps
-
$ 80.00
Over 600 amps or 1000-voFs see rrB,
tu
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
The installatio s being made on1
p
f.
roperty I ovn
or sale, Ieasq-gg
0vners Signa
DATE:
RBCEIVED
not intended
$36
OO
a
SPFlTNGFIEL.,
,-'yxfl4rr'W',yr
'1. tja
EXPIRE
JOURI','JoB No . ffioGq z-
ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME OR COMPANY
LOCATION z* AJ 3?rar)
DEVELOPMENT TYPE SFD
BUILD]NG SIZE 244+OT SIZ
1 8(4)
x $0 227 PER sQ. FT. t-1O3.-1O
x $47.14 PER PFU s f,,? s .t"t
\$
$ 211,4
$ 2'3.20
<$
$ 10.00
TOTAL-MI^JMC SDC s 7tz"b+
sZ97z.o1
$tt1(D
F SQ. Ft
STORM DRAINAGE .? _ \----- --z*++ + z (!t?) t
IMPERVIOUS SQ. FT ZIOC
2. SANITARY SEWER-CiTY
NO. OF PFU'S
(See Reverse Side)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x r.ot x$475.32
x $475.32
4. SANiTARY SEI,JER-MhIMC
A. REIMBURSEMENT COST
NO. OF FEU'S X 277l.+ PER FEU
B. IMPROVEMENT COST
NO. OF FEU'S X
"5,2O
PER FEU
MI^JMC CREDIT iF APPLICABLE (SEE REVERSE)
1'4i,ll'4c ADMINISTRATIVE FEE
SUBTOTAL (ADD ITEMS 1,2,3 & 4)
ADMiNISTRATiVE FIES:
BASE CHARGE (SUBTOTAL ABOVE) X .05
Mtt--
SDC Coordinator
ATTACH'A. WPD
X
5
Date: a /z lz7
-r-TOTAL SDC $Lel,l.G
n
$ 4tu,o7
FIXTURE UNIT CALCUI ^-^\N TABLE: Number of New Fix tJnit Equivatent = Fixture units
(NOTE: For remodels, calculate only the NET additional fixtureslrra* O, UN,T FTXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub 11
Drinking Fountain.....
Floor Drain..........................................
lnterceptors For Grease/Oil/Solids/Etc......
lnterceptors For Sand/Auto Wash/Etc......
-C-
-'-7rr-'z>
--a-2
+
-v-
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
b
4Toilet, Private.......
Miscellaneous:
TOTAL FIXTURE UNITS
CREDIT CALCULATTON TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
x$-
(Rate X Assessed Value)
X$
(Rate X Assessed Value)
CREDIT TOTAL $
Year
Annexed
Rate per $1,O00
Assessed Value
Year
Annexed
Rate per $1,OOO
A,ssessed Value
1 989
1 990
1 991
1 992
1 993
1 994
., . 1995
1 996
1 997
$1.98
1.55
1.15
0.96
0.83
0.67
o.52
o.38
o.21
1979 or before
1 980
1 981
1982
1 983
1 984
1 985
1 986
1 987
1 9BB
$4.27
4.18
4.12
3.99
3.83
3.68
3.48
3.18
2.82
2.42
RUNOFF COEFFICTENTS FOR STORM DRAINAGE
(For Estimating Purposes Onlyl
Residential.
Commerica1...............
lndustrial
Governmental
o.4
0.9
05
0.5
FIXUNIT.WPD IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
I
Laundry Tub/Clotheswasher......
Clotheswasher - 3 Or More.....
Mobile Home Park Trap (1 Per Trailer)......
Receptor For Refrigerator/Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Sta11..........
Shower, Gang......,..
Sink: Bar, Commercial, Residential Kitchen....
Urinal, Stall/Wall...
Wash Basin lLavatory , Single........
-Toilet, Public lnstallation.
7//
I
Willamalane
Park & Recreation District Job. No.
PHONE: JtI_At o'{
STATE: Dt..t7 tZIP: a1
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:q.i-\
ADDRESS:
LOCATION OF PROPOSED BUILDING S
Street Address:&&r .{{\
ITE:
\q
Plat Name:
1. DEVELOPMENT TYPE
ype detinitions are on the
Tax Lot Number:C)3 5-cro
(Chgck appropriate dwelling(s). SDC calculations and dweiling t
back.)
A. Single-Family Detached
h Single namiiy homd
NO. OF UNITS I
Manufactured home not in a park
X $1,000 per unit = $
ci01c<_o ---
B. Single-Family Attached
NO. OF UNITS X $924 per unit = $
C. Multi-Family Apartment
NO. OF UNITS X $692 per unlt = $
D. Mant{actrrred Home Park
o0
NO. OF UNITS X $699 per unlt
WILLAMALANE SDC $
2. SDC CREDIT (tf appncabte) SDCAayermus{ ruo{6str proof of
Wllamalane Credit approvat. Seo SOC Credit Wortcsheot. $
3. TOTAL WILLAMALANE NET SDC ASSESSED
(lf SDC reduced for Credit! $
D nt
City of Springfield
nt Date l3_,
a
,NGFIELD
rrt lD: SPRA103
Voucher lD :
Handling Code:
City of Springfie /
Voucher
00028096
RE
Vendor Number:
Voucher Date :
lnvoice # :
Approver:
Operator:
Gross Amount:
Proi/Grant
0000005876
Feb 06, 2001
02-06-2001
Puent,David
wtLS5940
750.00
Amount
750.00
Tom Wirfs Construction
P.Q. Box 237
Springfield, OR 97477
Description
.ree deposit refund
Account Fund Og SubClass BY
215500 821 2001
'omments:
ree deposit refund for job numbers 99-00689-01 ($s00.) and 99-00692-01(g2so.)
aTtc. ?6+ i zzl.f 3>/J-
This permit is required for any sit€ activity in the flood plain and everywhere sito alteration consists of
fifty (5O) cubic yards of material or more and/9r it a drpinageway is affected, within City limits and .
This Side To Be Filled Out by Applicant
[Digof Springfietd
CitV
N 33vo\
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6-L -qf lPermit Eipiration Date:
z
22-74
Property Owner
, Springfield, Oregonress
Pnane:7 4
Date of Application
Address
Site Add
(ozq /-,; w,.r4
Journal number applicable Land Use Appllcatio
tu*Lotr@tr UGB Tax Map No
JuQ o{/u,oo t-Source Location
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FILL, Ouanti
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I Project Supervi s6t:
Supplier
Destination:
MaterialeaGRADING, Ouantity
EXCAVATION, Ouan
Supplier
Address
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SITE PLAN Required Data:Ouantity of material, Property lines and descriptions, Tax map and
lot number, Site address, Existing contour lines, Pro'postird contour lines, Exisling drainage
wavs, Prooosed drainaqe wavs, Siqnificant trees and foliaqe, Ground cover, Soil types,
Bui(dihgs,iseptic systeirs, SriwersiAreas subject to floodi-ng, Utilities, Areas subject to land
slides, Proposed site improvements.
sotLs & GEOLOGY PLAN,. , .' .
,,
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
ADDITIONAL INFORMATION,
REPLANTING PLAN
COMPANY NAME:_ ,
PROJECT SUPERVISOR:
PHONE
CITY STATE
PHONE
CITY STAT
ADDRESS:
COMPANY NAME:
PROJECT SUPERVISOR:
ADDRESS:
MoBILE PHoNE: g1J0!? , EMERGENCY
FAX7V7 7F2f
PHONE: 3l r X77 E
ZIP: 47vz? OFFICE PHONE 7 q7 g7o c/
CIIY:ADDRESS
Registration Number:Expiration Date
CONTFACTOR NAME:
PHONE oPROJECT SUPERVISOR
STATE: 0a
I understand that I or my successors may have future plana for my property which may b6 anticipated or unanticipatod at
this time. I understand that such future plans may requiro permits and developement approvals from the City of Springfield
I understand that notwithstanding any approval of this Land and Drainage Alteration Permit (LDAP), that at the time of
application of luture permits or approvals the City may review and reconsider all actions which I or my successors have
undertaken persuant to this LDAP. I understand that tho.City may as a condition of any future approval, require the
undoing, changing, or modification of any actions which I have undertaken as a result ol the City's approval of this LDAP.
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By signature, I state and agree, that I haVe carefully exainined the completed application and do hereby cortify that all
information herein is trus and correct, ahd I further certify that any and all work pqrformed shall be done in accordance
with the Ordinances of the City of Springfield. applicable City Standard specificatione ahd Drawings, and the laws of the
State of Oregon pertaining to the work described herein..l further.c6rtify that only conractors and employees who are in
compliance with ORS 701 .055 will be used on this project.
The City may inspect the work site described in this pormit at any time during a on6 year period following the receipt by
the City of notice of completion of the deccribad work and rpcclfy, !t th6 City's solc dasecration, any additlonal rostoration
work required to return the sits to a standard acceptable to the City. The p€rmitteo wiU be notified in writing of any work
required and will have thirty (3O) days from the date of the notice to compl6t6 the work. Work not completed at tho end of
the thirty days will be performed by the City and the costs will be billed to the permlttee.
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I further agree to ensure that
the street, and the
Signature
all required inspections
s€l of plans will remain
bi that tsaddress fromreadablearo.requesied
allsiteattheon
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: ?o-237
DRAINAGE, 0 Storm, Q Ditch, E Culvert, 0 Natural
zone: L , FEMA community eanetNo.:41ffiZ OZ\7O(-
tr FLOODWAY, FEMA Community Panel No.:
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Date
FLOOD PLAIN,
WETLANDS, Descripti o;n ZSt
s20.00
$ 30.00
$40.00
$40.00 For the lirst 10,000 cubic yards, plus
$20.00 for each additional 1 0,000 cubic yards or fraction thereof
5220.00 For the first 100,001 cubic yards, plus
$20.00 for each additional 1O.000 cubic yards or fraction ther€of
$340 For the first 200.001 cubic yards, plus
$6.00 for eagh. additional 14,000 cubic yards or fraction thereof.
$3Q.O0 For the first 1O0 cubic yards, plus
.$14.00 for each bdditional 100 cubic yards or fraction thereof '
$156.00 For the f irst 1,000 cubic yards, plus
912'.OO for each additional 1,000 cubic yards or fraction thereof .
$264.00 For the first 10,000 cubic yards, plus
$54.00 for each additional 1 0,000 cubic yards or fraction thereof
$750.00 For the first 100,001 cubic yards, plus
$30.OO for each additional 10,000 cubic yards or fraction thereof
Estimated VoJume
Ptan check r"", QZO . 0O
Y.7.Received By 6n.N
t
b Date g
+/
100,001 To 200,000
$30.00
Received by:
Date:
Receipt No
Date:
PLAN CHECK FEES:
UP TO 1OO CUBIC YARDS
101 TO 1,O00 CUBIC YNRDS
1,001 TO 10,000 cuBlc.YARos
1O,OOO TO l OO,OOO CUBIC YARDS
2OO,OO1 CUBIC YARDS OR MORE
GRADTNG PERMIT FEES:
UP TO 1OO CUBIC t'ARDS
1O1 TO 1,OOO CUBIC YARDS
1,001 ,To 10,000 cuBlc YARDS
10,000 To 100,000 cuBlc YARos
1oo,oo1 To 200,000
?. ..
Grading Permit fee:
Receipt Nub5OZO out"|llTtfi
AMBLESIDE MDADOWS SUBD.
This prope(y is located in an area ofheary clay
soils (expansive clays). A Iiccnscd cngineer shnll
vcrify tho stobility ofthe soils in thc proposcd
building area and make any recommendations
necessary to assure lhe continued slability of thc
soil. A copy ofthe engineer's rcport sh:rll be
subnritted to tho lluilding Ollicial prior to
beginning construction of the structure.
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Maintenance
Building
Engineering
Plannin
Date:
Date
Date:
Date:
lssued by:_.__DatePermit Number
Reqrrired Final lnsfrectiohs'
Maintenance:
DatePlanning:
Engineering:
Building:
Date
Date
Date
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5 L.and and Drainage. activity as outlined in this permit has been completed in accordance with
the p.rovrstons ot thrs permrt.
Lald ^qqd_Dlalrla-ge_ a-qtlvrly a-s-_o-ullined in this permit has not been completed in accordancewtth the provtstoTls ol this permit.
tr Land and Drainage activity was performed prior to application for this permit.
Accepted by:-__ Date:
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1/6/1998
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tr DRAINAGE, 0 Storm, Q Ditch, E Culvert, O Natural
zone: L , FEMA community panet No.: 4lffiZ OBTE-
tr FLooDWAY, FEMA Community Panel No.:
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d FLOOD PLAIN,
WETLANDS, Descriptibn ZSI
s20.00
s 30.oo
$40.oo
$40.00 For the f irsr 10,000 cubic yards, plus
920.00 for each additional 1 0,000 cubic yards or fraction thereof
S220.00 For the first 100,001 cubic yards, plus
$20.00 for each additional 1O,000 cubic yards or fraction thereof
$34O For the first 200,001 cubic yards, plus
$6.00 for each additional 1Q,000 cubic yards or fraction thereof .
t$30.00
$3q.OO For the first lO0 cubic yards, plus
S14.OO for eachhdditional 100 cubic yards or fraction thereof.
$156.00 For the first 1,000 cubic yards. plus
912'.00 for each additional 1,000 cubic yards or fraction thereof.
S264.00 For the f irst 10,000 cubic yards, plus
$54.00 for each additional 1 0,000 cubic yards or fraction thereof
$750.00 For the first 100,001 cubic yards, plus
$30.00 for each additional 1 0,000 cubic yards or fraction thereof
GRADING PERMIT FEES:
+?n.00
K,7,
om.oo
?..'
lEEN
100,001 To 200,000
2OO,OO1 CUBIC YARDS OR MORE
Estimated Volume
Plan Check Fee
Received By:
Grading Permit fee:
Received by:
UP TO 1OO CUBIC t'ARDS
101 TO l,OOO CUBrC YARDS
1,001,TO 10,000 cuBrc YARDS
1O,OOO TO l OO,OOO CUBIC YARDS
1oo,oo1 To 2oo,ooo
Receipt No
Date:
PLAN CHEQK FEES:
UP TO 1OO CUBIC YARDS
101 TO 1,000 CUBIC YARDS
1,001 TO 1O,OOO CUBIC,YARDS
1O,OOO TO l OO,OOO CUBIC YARDS
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AMBLESIDE MEADOWS SUBD.
This property is located in an area ofhcavy clay
soils (cxpansive clays). A liccnsed engincer shall
verify tho stobility ofthe soils in thc proposcd
building area and make any recommendations
necessary to assure the continued stability ofthe
soil. A copy oftlre enginccr's rcport shlll bc
subnrittcd to thc lluilding Ollicial prior to
beginning oonstruction of thc structure.
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Maintenance:
Building:
Engineering
Planni
Date:
Date
Date:
Date:
Engineering:
Building:
Maintenance
lssued by:-__Date
Date
Permit Ntrmber_-
Reqrrired Final lnsfrectiohs'
Date
Date:
Lrate
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5 L.and and Drainage. activity as outlined in this permit has been completed in accordance with
the provrstons ot thrs permlt.
Lald-qqd DJaiqage aqtlVity as ou.tlined in this permit has not been completed in accordancewrth the provrsroTrs ot tnls permit.
tl Land and Drainage activity was performed prior to application for this permit
Accepted by:-__ Date:
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1/6/1998
Date:_
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