HomeMy WebLinkAboutPermit Building 1997-11-05OTTOF
SPFIrlGFIELE,
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMT'NITY SERVICES DIVISION
BUILDING SAFETY
Page 1
ilob Nurnber: 97L523
225 North Fifth street
Springfield, OR 97477
Location of Propoeed Work: 1001 S 45TH ST
Assessors Map #: 1-8020524
Lot:55 Bfock:
office:
Inspection Line:
'726-3759
726 -37 69
Tax Lot #
Subdivision
05900
LUCERNE MEADOW
Owner: RICIIARD BITRROUGHS Phone # : 7 47 -227 5
Address: 1001 souTH 45rH STREET City/StraLe/Zip: SPRINGFIELD, OREGON 97478
Describe Work: GAZEBO & STORM SEWER CONN ADDITION
QUAD AREA: 3RSC
-- OFFICE USE --
LAND USE: 1111
To request an inspection, cal-l- the 24 hour recording aL 726-3769.
A11 i-nspections requested before 7:00 a.m. will be made the same working day,
inspections requested after 7:00 a.m. will be made the following work day.
--- REQUIRED INSPECTIONS ---
FOOTING - After Lrenches are excavated.
FRAIIIING - Prior Lo cover.
FINAL BUfLDING - When all required inspections have been approved and
Ehe building is complete.
Total Height: 12
Lot Type: CORNER
Setbk From NPL: 12 Solar Approved: Y
Item
Main
Garage
GAZEBO
Total Val-ue
Building Permit Fee
surcharge/aamin
TOTAI, FEE
--- BUILDING PERMIT
Square Feet x
1,44
$/Square Feet
(A)
Value
0.00
0.00
2,358.00
2,358.00
38.50
3.09
41.59
--- MISCELLAIIEOUS PERMITS
Surcharge/admi-n
PLAN REVIEW FEE
TOTAL MISCEI.TANEOUS PERMITS
0.00
25.03
(E)'rylory/
- - - TOTAL AI'IOITNT DUE
(Excluding Electrical) (A, B, C, D,
unlese otherwise noted 6/ru/
(
and E combined)
/or'?/tr
I 13,7 3
56 .62
5/ L (s'nfi/"r)7z t4
--- BUftDING VALUE, PLAN CHECK Atr{D BUILDING PERMIT ---
This permit is granted on the express condition that the said construction
shall-, in all respects, conform to the Ordinance adopted by the City of
Springfield, including the Development Code, regulating the consLruction and
use of buildings, and may be suspended or revoked at any time upon violation
of any provisions of said ordinances.
4L
SPFIXGFIELE'
Job Number: 971523
CITY OF
Page 2
Received By:
Plans Reviewed By: DON MOORE
Building Site Reviewed By: LISA HOPPER
Date: Lo/27 /97
--- ADDITIONAL COMMENTS ---
SEPARATE ELECTRICAL PERMIT IS REQUIRED FOR SPA (]F NOT ALREADY OBTAINED)
By signature, I stat,e and agree, that. I have carefully examined
the completed applicatsion and do hereby certify that all- information hereon
is true and correcL, and I further certify that any and all work performed
shal1 be done in accordance with the Ordinances of the City of Springfield,
and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCUPANCY will be made of any structure without permission of the
Community Services Division, Building Safety. I further certify that only
contractors and employees who are in compliance wj-th ORS 701.055 wiLl- be
used on this project.
I further agree Lo ensure Ehat all required inspections are requested at the
proper time, that each address is readable from the streeE, that the permit
card is located at the front of the property, and the approved set of plans
will remain on the site at all t,i-mes during construction.
//s=?7
Signature Date
--- VALIDATION ---
Receipt Number:
Date Paid:
Amount Received:
Received By:
z72r z
,u,/r,/s z
/')
RESIDENTIAL
PERMIT APPL'CATION
lnspections: 726-3769
Office:726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
SPRINGF TELI)
fufr,
JOB NUMBER
225 Fifth Street
Spri ngfleld, Oregon 97477
TAX LOT:a
SUBDIVISION:
-?2PHONE:
ZIP:STATE:CITY:
ADDRESS:
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
ADDRESS EXPTRES :. PHONECONTRACTOR'S NAME
GENERAL:
ELECTRICAL:
MECHANICAL:
PLUMBING:
CONST.
CONTFIACTOR #
- OFFICE USE -
ZONING CODE:Y OF UNITS:
RANGE:
QUAD AREA:
I OF BLDGST
SECONDARY HEAT
SQUARE FOOTAGE:
LAND USE:
OCCY GROUP:
* OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726'3769. Thls is a 24 hour recordlng. All lnspections requested before 7:00 a.m. will bemade the same worklng day, lnspections requested af ter 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
l--l Temporary Electrlc Rough Mechanical - Prior to
cover.
Slte Inspectlon - To be made
after excavation, but prior to
setting forms.
Rough Electrical - prior to Final Electrlcal - When ail
electrical work is complete.cover.
Underslab Plumblng/ Electrical /
Mechanlcal - Prior to cover.Electrical Service - Must be
approved to obtain permanent
electrlcal power.
Final Mechanical - When all
mechanical work is complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp.
Flnal Building - When all
required lnspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.
l-_l Framlng - prior to cover.
E Foundatlon - After forms are
erected but prlor to concrete
placement.
Other
Wall/Celtlng lnsulatlon - Prlor to
cover.
Underground Plumbing - Prior
to fllling trench.l-_] Drywall - Prtor to raping.
Underlloor Plumblng/ Mechanlcal
- Prior to lnsulatlon or decklng.
MOBILE HOME INSPE TTONS
Wood Stove - After lnstallatlon.
Post and Beam - Prior to floor
lnsulatlon or decklng.lnserl - After flreplace approvql
and installatlon of unit.
Blocking and Set.Up - When altblocklng is complete.
Floor lnsulation - Prior to
decking.Curbcul & AJrproach - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water ancj sewer.
Sanitary Sewer - Prior to fllling
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspectlons have been approved
and the home is connected tothe servlce panel.
W Slorm Sewer - Prior to fllling
trench.
Sidewalk & Drlveway - After
excavation is complete, forms
and sub-base malerial in place.
f--l Water Llne - Prlor to fiilingH trench.[l Fence - lvhen ccnlpteted
$lreel Trees - When all required
trees are planted.
Final - After all requiredinspections are approved andporches, skirting, decks, andventlng have been installed.
Rough Plumbing - Prior to
cover.
LOT
-
BLOCK:
# OF BDBMS:
--
WATER HEATER:
FLOOD })LAIN:
fl
fl
l--l final Ptumbins - When ail
'J plumbing worl< is complete.
tl
tl
E
tl
tl
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK TN THE .
HISTORICAL DISTFIICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved bY the Historical
Coordinator prior to permit issuance.
APPROVED:
ACCP.L.HSE GAR
N
S
VALUE
(A)
Total Value
Building Permit Fee
State Surcharge
Total Fee
'.t
X $/SQ. FT.
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is granted on the cxpress condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plans Reviewed By Date
Receipt Numbe
Date Paid:
Received By:
Plan Check Fee
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within tlre City linrits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
N0
<5>7-5_-
FEE
FT.
FT.
(c)
fr:%ZZ'€
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/Flreplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certify that all
information hereon is true ancl correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinanccs of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure without perrnission of the Buildirlg Safety Division.
I further certify that only contractors and enrployees who
are in compliance with ORS 701.O55 will be used on this
proiect.
I further agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
Signatu re
Date
on the site I times during ctlon.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
--
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Perrnits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
VALIDATION:
RECEIPT NUMBER
DATE PAID z *6-?B
AMOUNT RECEIVED
RECEIVED BY
aa?
E
FT.
PrtINGFIELTTRESIDENTIAL
ASSESSOBS MAP:
JOB NUMBER
I
225 Fifth Street (11 t921
Springfield, Oregon 97477
I
)
RK:a
t o TAX LOT:6eq n
SUBDIVISION: -LOT:BLOCK:
PHONE:
STATE ZIP:
6
Bqur^\rtOWNER:
ADDRESS:
CITY:
DEMOLISH OTHEB
DESCRIBE WORK:
NEW- REMODEL ADDI
ADDRESS EXPIRES PHONECONTBACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTBICAL:
CONST.
CONTRACTOR ,
:i$\),.-
LAND USE:
OFFICE USE -
, OF BDBMSCONSTR. TYPE:
HEAT SOURCE:
RANGF.:WATER HEATER
SECONDARY HEAI --
SQUARE FOOTAGE
E OF UNITS:
.'rolN
OUAD AREA:
I OF BLDGS:ZONING CODE:
)le-
OCCY GROUP:
r OF STORIES:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour rccordlng. All lnspections requested beforc 7:00 a.rn. wlll bemade the saftte worklng day, lnspectlons requested after 7:00 a,m. wlll be macle the following work day.
R UIRED !NSPECTIONS
l-l Temporary Electric Rough Mechanlcal - Prlor to
cover.
Flnal Plumbing - When allplumblng worl( ls complete.
Site lnspectlon - To be made
after excavation, but prior to
settlng forms.
Rough Electrical - Prior to Final Electrlcal - When ail
electrical work is complete.cover
Underslab Plumblng/ Electrical /
Mechanlcal - Prior to cover.Electrical Servlce - Must be
approvecl to obtaln permanent
electtrcalDolrer. , - i<= .'. :
FlreEFce - Prlor to faclng
matgftals and framing, lnsp.f rl .r
Frantlng ,.- .Pilor to cover.
al Mechanical - When all
mechanical work ls complete.
Footlng - After trenches are
excavated.Final Buildlng - Whqn ail
required inspectlons have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng,
Foundatlon - After forms are
erected but prior to concrete
placement.
Other
Underground Plumblng - Prior
to fllllng trench.
Wal(lCelling-tnsulatlon - Prtor to
covdU't*
Drywallfr flior lo taplng.X r r-,,-itrl:
alt
Wood Stov-1-{f ter lnstattatton.
Underlloor Plumblng/ Mechanlcal
- Prior to lnsulatlon or decking.
MOBILE HOME INSPE TIONS
Post and Beam - Prior to floor
lnsulation or decking.
rn
lnserl - After fireplace approval
and lnstallatf oD..pf unlt.
[-_l Alocking and Ser.Up - Wtren ail.J blocklng ls complete.
Floor lnsulalion - Prior to
decki ng.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.
Storm S€wer - Prior to fllllng
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Electrical Conneclion - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Water Line - Prlor to filling
trench.
Fence - When completed
Final - After all required
inspections are approved andporches, sklrting, decks, ancl
venting have been lnstalled.
\oo 1 Llc+a
tl
E
E
E
tl
E
tlr
Etl
tl
E
tl
tl
E l:.:gn Plumbins - Prior to fl I,l::, r1ee,s ; when ail required
-
cover.
-
trees are planted.
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
'Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
PL.HSE GAR ACC
N
S
E
IS THE PFIOPOSED WOFIK iN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTEB?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
BUILDING PERMIT
ITEM SO. FT,x $/so. FT.VALUE
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee (A)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
Date Paid
Becei pt Number
Received By
Plans Reviewed By Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City linrits which are being improved,
PLUMBTNG PERMIT
ITEM
Fix tu res
Resldential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
N0
FT.
FT.
FT.
Plumbing Permit
State Surcharge
Total Charge (c)
ADDITIONAL COMMENTS
MECHANICAL PERMIT
Furnacc
Exhaust Hood
Vent Fan No
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent6ok
Li n-r tt
(3
Mechanical Permit
lssuance
Stale Surcharge
Total Permit
ls
I I
(D))b. x
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther certi(y
that any and all work performed shall be done in accordance
with the Ordinances of the City of Sprlngfield, and the Laws
of the Stalc of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without perrnission of the Buildirrg Safety Division.
I further certily that only contractors and employees who
are ln compliance with ORS 701.055 will be used on this
proiect.
I further agree to ensure that all required inspections 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 the approved set of plans will remain
on the site at all times during construction.
Q slsnutu,e I
! or,"
L-
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
--
ft
Curbcut
--_
ft
Demolition
Slate Surchargg
Total Miscellaneous Perrni ts (E)
VALIDATION:
BECEIPT NUMBER 7
DATE PAID -6-
AMOUNT RECEIVED
RECEIVED BY -K")
I &
TOTAL AMOUNT DUE (exclu<ling clectrical)
(A, B, C, D, and E Combinc<J)
226 STREET
SPRINGFIELD, OREGON 97477
ENGINEERINO DIVISION
oFFtcE TELEPHONE (5031 726-3753
aritxo?laLD
ENCROACHMENT PERMIT
NUMBER:
INSPECTION LINE SEE INSPECNONS ON BACr SIDE '
PERMIT NUMBEP(. q 7/ 123
APPLI9ATION DATE - z/-DATE ISSUED: ,-, ,-
.LOCATION OF WORK
EXPIRATION.DATE:
PHONE:
NE
ZlPt
ADDRESS:
€7o r )
nrL
-G_^ 09-
PHONE:
a-+f
aA-
APPUCANT
'oo/SITE ADDRESS:
CITY:STATE:
ADDRESS:
TAX MAP:
TA)( LOTr
PHONE:
CONTRACTOR REGISTRATION NO:
PROJECT SUPERVISOR:
CITY:_ STATET_ t Zt?t
SUEDIVISlON:
OWNER:
CONTMCTOR: 0;, .,,4+ -
REOUESTED PERMITS:fig?tcTtotrt itouitDt Ar?uc^Ttoil m,oEffoStT ACCOUilTNOT
Q erucnoAcHMENT pERMtr No:g t'zo.oo Iv^tD ior 3Xw tcot o yt riora oAtt o, lauArct
QcursrREET EBonE CIoTHER
,Er
Q ousr coNTaoL lTypE oF @NTiou
n_Er
Er
Er
Elr
fl esrxllr
TYPE OF SECURITY DEPOSIT
ft aunrsrsuREryBoND 0 suflny BoNo
t.
E casx, cHEcK
fl cuna cur pEBMlr No!.............,......ff._tr_
IrT rnDi ro io(,RtMt ooNcsEra [ 010.00+t.l6/FT.u!lEqD0&,CUa!, A??8oAC8 AFrrn Foen! Aru EEgItD
--{t erconii[f sneweu
vAtD ioi tto oAYa ?iou oATtoFBSU NCE.
ONUAA'AY ISEE SEPARATE
PERMIT NO3....................E 0to.0o+C.lE/FT..({
vAtD IOi rtooAvtrior oATr or lru r{ca
El xew Sffieuove, REPATR O peve
Qieruecr ecunasoe OuNorlt
PTANT STRIP
tr
lllStEtrllo&llDEw^LU oRlvlw^Y^foi 4+ coltctgt! t^vhto wrHil nfi ITREET &oHt or w^y, To rEr'l ot
^FTCn ^tl txc^v^rr{o r coun-crt.-^rp-roii, iiiirr- elo itiiinii iruidiiii'r'ir'neca
SANITABY SEWER CONNECTION PEBMIT:E 05.0b /va^D 7oB tDcy oot oAyt tiora o Tt ot [tuAtEr
Q ro sruo o MAIN UNE (EASEMENT-R/W
I srcinrvr sEWER coNNEcrtoN pERMrrr
O orHER
vAlD ?ot Elxty ttot o^va nou oAtt o, lsu llct
Q cerer BAstN , arsetEn O sruo Et MAINuNE
pRooF oF INSURANCE: IEOO,OOO MINIMUM
E t5.oo /
. flrrrecxso e neouneo AMoUNT_TOTALDUE
'
q
I TOTAL DUE WrH PERfiilT I
DESCRIPTION OF PROJECT a
PEFUOD OF USE OB TIME OF CONSTRUCTION:
Q ruHs (Two sETst ATTAcHED
BACKFILL MATERIAL TO BE UTILIZED:
SURFACE REPLACEIdENT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE
NAME OF OTHEB UTILITIES IF THIS IS A JOINT
WARNING OEVICES TO BE UTILIZED:
DESCRIPTTON:
Advrnct r[r&rg wo* ton. Drot.otton to Ur tn
WOBT SHALT COMPLY WT}I x
oomdlrnct wlth tlrr on U.Ctorm
FROM DATE:
TO DATE:
T!ME:
TIME:AREA: LENGTH:JilIDTH:
TYPE OF WORK: CUT: eAEEo
OTHEB:
EXISTING SURFACE MATERIAL:
DEPTH:
BACKFILL MATER}AL:
HEIGHT:
aEu8t0N3 u2.nt ionrl rttt
60F cnY coDE,CONTRACTOR TO COMPLY WI}I MUTCD.
(MUTCOt.
APPLIGATION
-
BEVIEW COMMENTS /
8Ffl I,BXfrB'JIltrBldo?ihtl,
INSTRUCTIONS:
,t$EtF$ ^' ffiff[tt [6ff. En8ilNo crrY coDEs ANt'tN gTMPIJANCE WITH CURBENT
00t Srctllll wlth l'mlnw rocl.
002 Comprct lv]y 18'loorl drPth.
OOit Rrqulnr oomprgtlon wlth t ttrll tolll.r.
0ol3 A.q. to mttdt tht gr..t.t ol rxlrthe drPth or 4'.
00C Ai ostt rrrlcd lor flnrl lnrprodon.
Ooc . Trmponry p*oh mry br u..d tt thl tnd ol tho dry.
OO7 Slgnlng md Zonrr probctlon to oomply wlth MUTCo
008 Cut ooncrct. only on tcot lln.. oc oold tohtt.000 Sldrwrltr rnd ddvrwryr n*u 3,000p*
010 <tu mln 3,l00prl I No prtctrwort hr thln 3'.
011 Mrit mh. rcquhrmrnb on oult ol4r, 8pld. codr.
012 Errtm pbnrd.rnu,Spfd. codr 20C.3.06
Ol3 Spro. to 8on IJrcl lNo A.C. outa
014 Mrahrnlocl cmrprchg nqulnd.0tC No prtchwort rlowrd.
olC bt.nl autt to h.y. oontrol drnrlty llfi
01, Cuo to br polymcdrrd cruct ubd lor lhcl lnrpcctlon.
018 Mlnlnum 2'cuhrd roct l'mlnur.
Commcnts:
010
020
02l
o22
023
o24
026
020
o27
028
020
030
03r
032
933
343
Mlnunun 4' cllmnct rt rny polnt, rwlne'rwry.
conarata tr**ilm 4' dlPthr 3,000Pr1'
Tnndr to D. T ou. l
N..dt 8bt. I Csuntl prrmh,
No rbwr gouttd mdodml ln rldcwrll or hrntllccp rlmpr.
Dbmorld al AC.IConortt vtlul boxrt to gt.d..
Frrfi Oll rlenr I Ondrd.
Comply wlth Amrlc.nr wlth Dltlbllltl.t Act.
ConcnE drbr,72In anlrg tlnr. 460opd.
Concrrtr rlrbr nqr,lr lolttt rrl mrtcdrl.
Ddvrwry rqt*rt dowrlr rvrrY t8'.
Submh tnllh omttol plln ptlot to crclyttlon.
Notlly Tnllh DMtloo bclorr rxcavctfn.
Co?a drlt mtr Inr, hrrt rr, 2tl mln. grudr,
Murt oomety wlth thurovhlonr ol OFS 767.541 to 767.87'1.
C' Chculrr holr/H2OVrc.
YOU ARE REOUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S"oNE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
INSPECTIONS:
'E cunE cdr aHo sTDEWALK rNspEgnoNg cAlr 726+i7a9IREcoBDERt srATE youn DEsTcTNATED crw JoB
NUMBERNERMIT NUMBER, JO8 ADDRESS, TYPE OF INSPECTION REOUESTED, AND WHEN YOU WLL BE READY FOR
INSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REOUESTS RECEIVED BEFORE 7:00 A.M. wlLL BEI MADE THE SAME DAY, REOUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALLED lN AFTER EXCAVATIONS ARE MADE ANO FORM WOBK. tS tN PLACE BUT PRTOR TO POURING CONCRETE.
I serureny sEwER, sroBM sEwER, ENcRoAcHMENT pERMrr AND orHEB tNspEcfloNs cALL ctry MATNTENANcE AT
72e8741,
SIGNATURE:
t fu.rthor sgrcc to-onsurg that all lpqulrcd Inrpqctlonr arc rgqu&tcE r-t th. proper timr, that project addre$ lc rcadable from the Etrcct,
and thr ap-proved set of plrru wlll rbpain ori tho ritc at all timec durlng cohstruction.-
'a
I have
-')
.2
and
DateSlgnature,
olathlr
t
tho and
to
onarg
7 7
-)-qy)c qS
RECEIVED BY:
AMOUNT RECEIVED:
RECE]PT NO:
'-)i
DATE PAID:
VALIDATION:
Q n,tlrrurENANcE : _
E pennar tssuED BYi
FOR SIDEWALK AND CUBB CW PERMITS PUCE A COPY (COMPLETED) IN PERMIT DRAWER.
DATE:
I
DATE:
. WORK IN PROGRESS DATE:
ATTIME OF COMilEflON: DATF:
ELWS{TH M0MHI DATE
tE eHerHeERrNG REVTE\I/ED BY:
I rnernc REVTEWED BY:
OEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
INSPECTION:
.INSPECTION:
I
CITY OF CNRINGFIELD SYSTEMS DEVEI NPMENT CHARGE
WORKSHEET
NAME OR COI.IPAI'IY
LOCAIICN
DEVE|-OPMENI TYPT
BUILDI.NG SiZE )i.-!rL.
1. SIOP|4 DRAii'l,lGi Boer AEEA - /c, / t7 =
IMPER'/IOUS S0 F r +X $C.22b ?l? Sa. :r $ e6,7o
Z SANITARY SEr^iEe -C i-i-'/
NO. OF PFU,S o I $J5.86 PEi ,DF.J so-
(See Rever"si Si oc.
3. IRANSPCR;,r i ICi\j
NO CF UNIIS X TR.IP R,iTE X CCST PTR TRIP
x_x$47249 $ --a--
X
4. SANiTAR'/ SE,,ltel-f,lfit'4c
NO. OF FEU'S
MI^J[.,1C CREDIT IF APPLICABLE (SEE REVERSI)
PER FtU + $10 Mlr.jMCiADM FEE $
TQTAL-MtJl,lC SDC
SUBTOTAL (ADD ITEMS 1.2,3 & 4)
$
$
$
$ LE,7O
$ s.4+
X x $472 49
x $472.49
X
5. ADMINISTRATIVE FEES
BASE CHARGT (SUBIOIAL ABOVE) X .05
SDC Coordinator
Date lD-ZZ4 7
TOrAL SDC $ 72, t1
(