HomeMy WebLinkAboutPermit Building 1995-05-05RINGFIELc,RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Olfice: 726.3759
LOCATION OF PROPOSED WOBK;
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
/ 5o /11-72
ESSOBS MAP:I z- 0{)n-4 I :+TAX LOT:o9€tt
BLOCK:I c)SUBDIVISIONLOT:
PHONE:
STATE:ztP
3OWNER:
ADDRESSI
CITY:
ADDrroN l/DEMOLISH OTHER
OESCRIBE WORK:
NEW- BEMODEL
EXPIBES PHONE
It
DDBESS
COcoAq6'+a
J 7
t1t?
It
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{ELECTRICAL:
MECHANICAL:
CONTBACTOR'S NAME
Xperueneu:D/>
NST,
NTBACTOR #
|PLUMBTNG:
USE -\t\\- OFFICE
I OF BDBMS:
Y OF UNITS:
LAND USE:
OCCY GFOUP:
ZONING CODE:
FLOOD PLAIN
WATER HEATER
r OF STORIES:SECONDARY HEAT:
SOUARE FOOTAGET
CONSTR. TYPE:
HEAT SOURCE:
BAiiGE:
OUAD AREA:
* OF BLDGS:
To request an lnspectlon, you must cail 726-3769. Th
macie the same worklng day, lnspectlons requested
ls ls a 24 hor.rr recordlng. All lnspections requested before 7:00 a.m. wlllafter 7:00 a.m. wlll be made the followlng work day,
l-l Temporary Electrlc
REQUIRED INSPECTTONS
ffi Rough Mechanlcal - prlor to.-H cover.
Slte lnspectlon - To be made
after excavatlon, but prlor to
settlng forms,
ffi Rough Electrlcal - prlor toY! cover.
f-l UnderslabPlumblng/Electrical/ r-yt
-
Mechanlcal - Prlor to cover. LAI Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
Flnal Mechanlcal - When all
mechanlcal work ls complete,
ffi Footlng - After trenches are
-
excavated.ffi Flnal Bultding - When ail..! requlred lnspecilons have beenapproved and bulldlng ls
completed.Masonry - Steel locatlon, bond
beams, groutlng,
ry
ry
ry
Framlng - Prlor to cover.
m Foundatlon - After forms are
erected but prlor to concrete
placement,
Other
Wall/Celllng lnsulatlon - prlor to
cover.
l-l Underground Ptumblng - prioru to fllllng trench.Drywall - Prlor to taplng.
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or docklng.
MOBILE HOME TNSPE TIONS
Wood Stovo - After lnstallatlon.
F
E
Post and Boam - Prlor to floor
lnsulatlon or decklng,lnserl - After flreplace approvql
and lnstallatlon of unlt.
Blocklng and Set.Up - When ailblocklng ls complete.
Floor lnsulatlon - Prlor to
decklng.Curbcul & Approach - After
forms are erected but prlor toplacomcnt of concrete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Sanltary Sewer - Prlor to fllting
trench.
Storm Sewer - Prlor to fllling
trench.
Electrlcal Connecllon - Whenblocklng, set.up, and plumbing
Inspectlons have been approved
and the home is connected tothe servlce panel.
Water Llne - Prlor to filtlng
trench.
Rough Plumblng - Prlor to
cover.
Streel Trees - When all requlred
trees aro planted.
Flnal - After all required
lnspections are approved andporches, sklrting, decks, andventlng have been lnstalled.E
74zY
7/r
,l
t(
ffi Flnat Plumblng - When ailLfJ plumbtng work ls complete.
ffi Flnal Electrlcal - When ail# electrlcal work is complete.
ry
E
tl
[-l Flreptace - prlor to faclng
-
materlals and franring lnsp.
[--l Slaewalk & Drlveway - After
-
excavatlon ls completc. forms
and sub-base malerial ln place.
l--l Fence - U/hen compteted.tt
E
Lot faces
Lot sq, ftg.
Lot coverage
Topography
Total helght
(
Lot T)pe,/*V rnt"rro,
-
Corner
__ Panhandle
-
Cul-de-sac
IS THE PROPOSED WOFIK IN THE .
HtsroRtcAL D|STR|C[, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcailon must be slgnedand approved by the Historlcal
Coordlnator prlor to permlt issuance.
APPROVED
DITIONAL COMMENTS
Z
PLUMBING PERMIT
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Slorm Sewer
Moblle Home
Mechanlcal Permlt
lssuance
State Surcharge
Total Permlt
J5+ 38
FEE
ioP
tso. a?
\ atg
d-
3 &,4p
3, e&
\ 5.q2
LO- !s
E
3
No
FT.
FT,
FT.
Plumblng Permlt
State Surcharge t.Bo + 3?
Total Charge (c)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan N0
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
\
(D)&6. s
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
--
ft
Curbcul
--
ft
Demolitlon
State Surcharge
Total Miscellaneous permits (E)
-p
VALIDATION:
RECEIPT NUMBEFI
DATE PAID
AMOUNT RECEIVED *8
PL.HSE GAR ACC
N 5
S 5
E
BUILDING PERMIT
VALUE
/orzt4-z:(w)
1.88 \ j?
432 ^ii :
(A)
Z*
f,l3,3 I
SQ. FT. XITEM
Main
Garage
Carport
$/SQ. FT.
5G,*
,2F.
^rt{ss-E
Pp[DtNG VALUE, PLAN CHECKAND BUILDING PERMIT
Thls permrt rs granted on the express condrilon that the saldconstruction shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprlngfleld, lncludlng theDevelopment Code, regulating the c-onstrucilon and use ofbulldlngs, and may be._suspended or revoked at any tlmeupon violatlon of adl-provisions of sald ordlnancEs,
,n.u
Revlewed By
gshs
PI I date
yieived B
Date Pald
Recelpt Number
Plan Check Fee
SYSTEMS DEVELOPMENT C if'p(s
#4r
HARG E
(B)
Systems Development Charge ls due on all undevelopedproperties wlthin tlre City llmits whlch are belr.:g lmproved,
By slgnature, I state and agree, that I have caref ully examlnedthe completed appllcailon and do hereby cerilfy that alllnformatlon hereon is true and correct, and I f urther cerilfythat any and all work performed shall be done in accordancewlth the Ordinances of the City of Sprlngfield, and the Lawsof the State of Oregon pertainlng to tho work descrlbedhereln, and that NO OCCUPANCy wlll be made of anystructure wlthout permission of the Bulldlng Safety Dlvlslon.I further certlfy that only contractors and employees whoare ln compliance wlth OFIS 701.055 wlll be used on thlsprolect.
I f urther agree to ensure that all requlred lnsp
requested at the proper tlme, that each address
from the street, that the permlt card ls located
of the property, and the approved set of plans
ections are
ls readable
at the front
wlll remalnon the slte at all tim durlng construcilon.
Slgnat
Date
TOTAL AMOUNT DUE (exctudlns etectricat) ._qQ:1-67(A, B, C, D, and'E'Comblned)RECEIVED BY
67
Total Value
Building Permit Fee
State Surcharge
Total Fee
C'TY OF OFEGO'V
Date /r2
ffio'ituo
ee*Sff*,tledh3slherqFe
S>dINGFIELE,
BI,;BGIT,ICAL PERHIT APPLICATION225 FIFTB STREET
SPRINGFIELD, oREGoN 97
INSPEGTI0N REQUEST: 726-3769
OPPICE: 726-3759
.lou uumuer 4 50't5 t
.00
.00
.00
.00
3 COHPLTTE FEE SCEEDT'I,B BELOV
A. Nev Residential-Single or
Multi-FamiIy per dwelling unit.
Service Included:Items Cost
E
12
I.EGALU.Sum
JOB
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if work is suspended for
180 days.
2 CONTRASTOR INSTALII\TION ONL B
Electrical Contractor
Ct ty hone
Supervisor L e Number
Expirat ion te
Cons tr tr. Number
Ex at ion Date
gnature of SuPervising Electric
Ovners Name E.ec,-,,D
(-n
Address qAO F)
3e,z.-Phone 14 t- 3831
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home. or
Modular 'Dve1ling
SerVice or Feeder
$ 85.00
s 1s.00
$ 40.00
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-
Over 1000 amPs/volts
-
Reconnect OnIY
Temporary Services or Feeders
tnsiallaiion, Alteration or Relocation
200 amps"or less $ 40'00
over 4bL to 600 amps I $ 80.00
over 600 "rp" or-iOOO *Tt" see rrBrr aF6
Branch Circui ts ; .'
New, Alteration or Extension Per Panel
one Circuit $ 35'00
i""f, aaaitional ; .'-
Circuit or with Service;;-r;;J.; Permit 4 $ 2'oo %
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/Outline Lighting-
Limi ted EnergY/Res
-
Limited EnergY/Comm
SUBTOTAL OT ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
./@"s s0.00
s 60.00
s100.00
s130.00
s300.00s 40.00
c
Ci ty
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.$40
$40
$20
$36Omers Signa
DATE:
5L-
RECEIVED
=
&
E?*r4-n .Srrz-r
B No. 15o45 t
CITY OF SPRINGFIELD SYSTEMS DE\TELOPMENT CHARGE
WORKSHEET
(CoMMERCIAL & RESIDENTIAL)
NAME OR COMPANY
,zJAM UEL L, B NOM
LOCATION:4'5o ^/. b+r! 5T /7 o z+tz-4 ol5oo
LAA Aoot T toNDEVELOPMENT TYPE:
BUILDING SIZE:
1. STORM DRAINAGE
IMPERVI0US SQ. FT.
2. SANITARY SEi.lER-CITY
NO. OF PFU'S
(See Reverse)
4ez
OT SIZ
x $0.209 PER SQ. FT.
X $43.26 PER PFU
a. Fr.
$
$
g -6-
5'zr4Vt\
1
3 TRANSPORTAT ION
NO OF UNITS X TRIP RATE X COST PER TRIP
Y
X
Y
E
x $436.19
x $436. 19
x $436. 19
4. SANITARY El^l R-Ml^lMC
5
(Use PFU Total From Item 2 Above)
Mt.lMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MI,JMC SDC
SUBToTAL (ADD ITEMS 1,2,3 & 4)
ADMINISTRATiVE FEES
BASE CHARGE (SUBTOTAL ABoVE) X .05
K p Burdick
-o
SDC Coordinator
Date:4, i5 TOTAL SDC S 4t219
FIXTURE UNIT CALCULATION TABLE: Number of Ncw Fixtur X Unit Equivalent :'Fixture Units
(NOTE: For remodels. ciliutate only t .lET additional fixturest. NUMBER OF
FIXTURE TYPE NEW FIXTURES
Bathtub-----
Drinking Fountain.-..
Floor Drain.
lnterceptors For Grease/Oil/Solids/Etc.
lnterceptors For Sand/Auto Wash/Etc...... - - -. - - -
Laundry Tub/Clotheswasher..... - -
Clotheswasher - 3 Or More.
Mobile Home Park Trap (1 Per Trailer)
Receptor For Refrigerator/lvater Station/Etc-..--...
Receptor For Commercial Sink/Dishwasher/Etc-.
Shower. Single Stall..2
Shower, Gang.........
Sink: Bar, Commercial. Residential Kitchen
Urinal, StatlAA/all...
Wash Easin/Lavatory, Single..................
Toilet, Public lnstallation..
Toilet , Private.....
Miscellaneous:
TOTAL FIXTURE UNITS
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred af ter annexation date in table,
calculate credits separates.
UNIT FIXTURE -.
EOUIVALENT UNTTS
2
1
2
6
2
6
6
1
J
2
1/H
2
..)
1
6
4
(
ead
4
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
1 983
1 984
1 g8s
$3.46
12Q
3.32
3.21
3.06
2-92
2.73
1 985
1 986
1 987
1 9BB
1 989
1 990
1991
.1993
$2.46
2.14
1 .'t7
1.37
o.97
0.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
X$
(Rate X Assessed Value)
XS
(Rate X Assessed Value)
CREDIT TOTAL $
t
1
.)7-/r- 7s
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'-/= / ----?y''ft*" --a2ta.-/--{,
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7- /2
7-t 7-7 s-4
INDIVIDUAL ACKNOWL EDGMENT
No. 5199
State of OREGON
SS
On this the 19 day ot JULY rP-5-, betore rne
County of LANE MARY BINGHAM
the undersigned Notary public, personally appearcd
C ECIL E MILTON ndS AMU LL BRANOM
! personally known to me
ffi proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) THEY -- subscnbed lo the
within and acknowledged that ___AE E_I_ __ execuled rt
WTNESS my and
I'IISSION ExPI RES: 02-06-98AfTENTION NOTARY: Althorgh trE hlorrnatEn req,rsled bdow is il co{-fd altactrnent ol ttrs ccrlrlcale to anolher docunent
tTitle or Type of
Number ol fuges oNE Dare of Documenr _-QZl9-95
Signe(s) Other Than Named Above
01992 NATIoNAI- llorARy AssocrAnoN .8216 Remmer Ave. canoga park. cA 91309.7r84
rs
THIS CERTIFICATE
MUST BE ATTACHED
TO THE DOCUMENT
DESCBIBED AT RIGHT:
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207 Q STREET . SPR|NGF|ELD, OH 97477 . pHONE (503) 726-5104 . FAX (503) 726_3895
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