HomeMy WebLinkAboutPermit Building 1995-05-22t
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
ASSESSOBS MAP:
LOT:
o .{ . Or, q?7&
JOB NUMBER
225 Fifth Street
Sprlngf leld, Oregon 97477
TAX LOT:
BLOCK:SUBDIVISION
? 7?PCITY;ztPSTATE:
OWNEB:PHONE .726-/?,ar
ADDRESS:
Atlret*+Len q,/4i' (-.r*s_ Sa- S *),
t/
JcrstDESCRIBE WORK:
ADDITION DEMOLISH OTHERNEW- REMODEL
CONST.
CONTRACTOR 'YADDRESS EXPIRES PHONE
dr,^l ne.r-
odne f
PLUMBING:(l t t--t r1.Q ,.
MECHANICAL;
ELECTRICAL:
CONTBACTOR'S NAME
GENERAL:u\ 11-€ r-
CONSTR, TYPE:vp-E OF UNITS:
WATER HEATER:
HEAT SOURCE:
RANGE:
- OFFICE USE -
LAND USE:QUAD
ZONING CODE:
FLOOD PLAIN
I OF BLDGS:
SECONDARY HEAT:
SOUARE FOOTAGE:
, OF BDRMS:
-
OCCY GROUP:
I OF STOBIES:
__t
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. wl1 be
made the game worklng day, lnspectlons requested after 7l0O a.m, wlll bo made the followlng work day,
REQUIRED INSPECTIONS
Temporary Electrlc Rough Mechanlcal - Prlor to
cover.F
Slte lnspecllon - To be made
after excavatlon, but prlor to
settlng forms.
[--l Underslab P]umblng/ Electricat/
'J Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumbing - Prior
to fllllng trench.
Underlloor Plumblng/ Mechanical
- Prlor to lnsulatlon or decklng.
Sanltary Sewer - Prlor to fllling
trench.
Storm Sewer - Prior to fllllng
trench.
Water Llne - Prlor to filling
trench,
ffi Wall/Colllng lnsulatlon - prlor to.{>J cover.
[X. orv*"tl - Prlor to taplng.
Rough Electrlcal - Prlor to
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Framlng - Prlor to cover.
Wood Stovo - After lnstallatlon
ffi Flnal Electrlcal - When ailtJ electrlcal work ls complete.
ffi flnat Mechanlcal - When ail$l mechanlcal work ls complete.
ry Flnal Buildlng - When all
requlred lnspectlons have been
approved and bullding is
completed.
ffi otn"'
MOBILE HOME INSPECTIONS
[-l Alocking and Ser.Up - When ail.J blocklng ls complete.
Flnal Plumbing - When ailplumblng work ls complete.
Plumbing Connectlons - When
home has been connected to
water and sewer,
m
ffi eost and Beam - Prlor ro floor+ lnsulatlon or decklng,
lYl ftoor lnsulatlon - Prlor toL# decklng.
[--l lnsert - After ftreplace approval
-
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior to
placemont of concrete,
Sidewalk & Drlveway - After
excavatlon ls complete, forms
and sub.base materlal ln place.
|_-l Fence - When compteted
Slreel Treos - When all requlred
treeg are planted.
Electrlcal Connection - When
blocklng, set.up, and plumbing
lnspections have been approved
and the home ls connected to
the servlce panel.
N Rough Plumblng - Prlor to
cover.
Flnal - After all required
lnspectlons are approved andporches, sklrting, decks, and
ventlng have been lnstalled.
?Qc t rz-
(),e
o^*M lrrl
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typ
.__ lnterior
-
Corner
-
Panhandle
=- Cul.de-sac
P.L.HSE GAR ACC
N
S
E
Set I lS THE PROPOSED WORK IN THE.HtsroFilCAL DtsTFlCr, oR oNTHE HISTORICAL REGISTER?
-
lf yes, thls appllcailon must be slgnedand approved by the HistoilcatCoordlnator prlor to permlt lssuance,
APPROVED:
BUILDING PERMIT
VALUE
7r
6
c.d_4Uad,- g"g
AS
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
3.t3+ 32
(A)
_6se9_
F Clt)
6-1,€e
SO. FT. X $/SO. FT.Py.[D_tNG VALUE, PLAN CHECKAND BUILDING PENruIir
Thls permit is granted on the express condrilon that the sardconstruction shall, ln all respects, conform to the Ordlnanceadopted by the City of SpiingffefJ, inctudtng theDevetopment code, regurating ine Jonitiiciron and use ofbulldlngs, and may be suspended or revoked at any tlmeupon vlolailon of any provislons of sald ordln"n"r".
ewed By
R
3tlh"=
By:
G3
Date Paid
Recei pt Number
Plans
Plan Chcck Fce
DEVELOPMENT CHARGE (SDC)
(B)$ qt, F,f
SYSTEMS
Systems Development Charge ls duo on all undevelopedproperties wlthln the City limlts whlch are being lmproved,
DITIONAL COMMENTS
Wood,Stove/ lnsert/ Flreplace Unit
Dryer Vent
PLUMBING PERMIT
FEE
(D)
No
FT.
FT.
FT.
(\,)
\5. Er-
Mechanlcal permlt
lssuance
Sta16 Surcharge
Total Permlt
r i, (,J?3I b.-*-l-E
l.
\6.€
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
Vent Fan No
Plumblng permlt
State Surcharge
Total Charge
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Slorm Sewer
By slgnature, I state and agree, that I have carof ully examlnedthe completed application and do hereby cerUfy that alllnformatlon hereon is true and correct, and I f urther certlfythat any and all work performed shall be done ln accordancewlth the Ordlnanccs of the Clty of Sprlngfleld, and the Lawsof the state of oregon perrarnrng to tho work descrrbedhereln, and that NO OCCUPANCy will be made of anystructure wlthout permission of the Bulldlrrg Safety Dlvislon.I further certl,y that only contractors and employees whoare ln compllance wtth OFIS 7O1.OSS wlll be used on thlsprolect.
I further agree to ensuro that all requlred lnspecilons arerequested at the proper ilme, that each address rs readabrefrom the street, that the permlt card ls located at the frontof the property, and the approved set of prans wilt remarnon the slte at all times durlng construcilon.
Z'Z _<
Slgnature
Date
2a'42'fn'
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk _ ft
Curbcut _ ft
Demolitlon
State Surcharge
Total Miscellaneous permits (E)
VALIDATION:
BECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEDTOTAL AMOUNT DUE (exctudtns elecrricar) ._ [1.{,5S(A, B, C, D, and E'Comblned)RECEIVED BY
2-
)\-)
Moblle Home
J..'\ $+Ti.."
225 FTP"IH STREET
SPRINGFIELJ, OREGON 974l7d' ----Fif?\
INSPECTTON REQUEST: 72fr,37'6Q"r
OFFICE: 726-3759
1. LOCA TTON OF INSTAILA ON
I,EGAL DESCRTPTION
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 INSTALLATION OMLY
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Signature of Supervising Electrician
Address
city 1y'?4--r-Ynone V-6 /7/f
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE:
RECETPT
RECEIVED
ELE TRICAL PERHIT APPLICATION
Job Nunber
3. COHPIJTE FEE SCffiDT'I^E BELOIT
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Incl-uded:Items Cost
1000 sq.ft. or less S 85.00
Each additional 500
sq. ft or portion
thereof s 15.00
Each Manuf'd Home- or
Hodular Dve1ling
Service or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations
or Relocation:
SPF|IELO
5. SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
l: :,fJ:"#l % HJE ?UXP$:1 #'' "'x':
l:;*' "
a;:proval. I \J{4-
Z
Sum
200 amps or less
201 amps to 400 amps _401 amps to 600 amps _
601 amps to 1000 amps-
Over 1000 amps/volts
Reconnect 0n1Y
$ s0.00
s 50.00
sr.00.00
s130.00
$300.00
$ 40.00
Exoiration Date
Constr Contr. Number
Temporary Services or Feeders
Installation, Alteration or Relocation
Exoiration Date 200 amps''or less
201 amps to 400 amPs _0ver 401 to 600 amps
Over 600 amps or 1000-volTs
D. Branch Circuits
0vners Name
C
s
$
$
s
40.00
55.00
80.00
Nev, Alteration or Extension Per Panel
One Circuit t--- $ 35.00 )6-e
Each Additional
Circuit or vith Service
or Feeder Permit / $ 2-00 Lto
E. MisceLlaneous (Service/feeder not included)
ee rtBrt a6ove
-Each installation
Pump or irrigation $
sign/outline Lighting- S
Limi ted Energy/Res $
Limited Energy/Comm S
40.00
40.00
20.00
36.00X- -: - '
C;|TY OF OREGO'U
a?
/- ^ g/ {3 ofua-
JOB DESCRIPTION*83-d - ,' z*r'
3-r
ATTACHMENT 81 raB N0.?ta/ F2
CITY OF SPRINGFIELD SYSTEMS DEVELOPMEIfI- CHARGE
WORKSHEET
(COHMERCIAL & RESIDENTIAL)
C(INA}4E OR COHPANY:
-4LOCATiON{; 5.
DEVELOPMENT TYPE
BUILDING SIZE:
f. ilryimTffi
IMPERVIOUS SQ. FT
(SUB ABOVE) X .05
SIZ a. Ft
x $0.209 PER SQ. rr.
2. . SANiTARY SFWFR-CITY
NO. OF PFU'S
(See Reverse)
2 x $43.26 PtR PFU
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x
-
x $436.19
x
-
x s436.19
x
-
x $436.i9
SUBTOTAL (ADD ITEMS i.2, & 3)s trL.5 Z
4. SANTTARY SEWFR-MWMC
NO. OF PFU'S $17.19 PER PFU + $10 }4l^l|,lc ADMiN.FEE s
(Use PFU Total rom item 2 Above)
HI,It,lC CREDIT iF APPLICABLE (SEE REVERSE)
TOTAI -HWMC SDC
SUBTOTAL (ADD ITEMS 1.2,3 & 4)$
5. ANMINISTATIVE FFFS
il
$
$
KtzaPez
2-27- 2 f
Ha
S
82. SDC
r
r
i
i
P
o
g.
natrd
6, t2
Date
TOTAI SDC $ 7O.8s-
FlxTuRE UNIT CALCUIATION TABLE: Number of New F'^'es X Unit Equivatent = Fixture Units
(NIOTE: For remodels, calculate on ,e. NET additional fixturesl
NUMBER OF
NEW FIXTURES
UNIT
EOUIVALENT
FIXTURE
UNITSFIXTURE TYPE
Eathtub.
Drinking Fountain............
I:loor 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 FlefrigeratorMater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall
Shower, Gan9.........
Sink: Bar, Commercial, Residentiat Kitchen...
Urinal, Stalll}Vall..l
Wash Basin/Lavatory, Single..
Toilet, Public lnstallation.
Toilet , Private....
Miscellaneous:tTl4t mz's *.,tt
Tolt ET /45A/JED ,fto t4PEtmtr /.r/4 B" rtCStutSo
2
TOTAL FIXTURE UNITS 2
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
ad/He
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
1 980
1 981
1 982
1 983
1 984
1 985
$3.46
3.38
3.32
3.21
3.O6
2.92
2.73
1 985
1 986
1 987
1 988
1 989
1 990
1 991
1 993
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation datel
x s_
(Rate X Assessed Value)x$
(Rate X Assessed Value)
CREDIT TOTAL =$
a
----4-
I
Permit #:
Address Z
Issued by:Date:2 2-
Statemeht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before abuilding permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exemptfrom registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 3B:
l. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3.A.. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
38. I will be my own general contractor
t If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correctand thatl have
Notice to Property Owners about ConstructiogBesnonsibilities on
*42,2 f' 'z' '
OR
read and do understand the Information
the reverse side of this form.
(Signature of permit applicant)
(White copy to issuing agency perrnit file,
pink copy to applicant)
(Date)
Ntr
,X