HomeMy WebLinkAboutPermit Building 1992-02-05RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
SPrlINGFIELD
5? 4rz
JOB NUMBER I 756
225 Fifth Street
Springfleld, Oregon 97 477
LOCATION OF PROPOSED WORK:s"#s7/ s. 4zu sr
MAP:l8Dzo9 t z-TAX LOT:LtRoD
LU cer.ru rrleacor^rsBLOCK:SUBDIVISIONLO'I:
Eazz,
ZIP:
PHONE:e 86 -&z->6, 4T6si.
bt4
L4 lttort,-_ + ,(ss
lAr*Pr NG laoc
OWNER:
ADDBESS:
ADDITION DEMOLISH OTHER
DESCRIBE WORK:I lZa
NEW X- REMoDEL
k#o<
t(-e=ELECTRICAL:{)ltrzzc t-,N)
L
MECHANICAL:O4)4)k
CONTRACTOR'S NAME
GENERAL:
PLUMBING
ADDRESS
5oZz t*Lpt rte.
EXPIBES
4qs
PHONE
1&6-62>o
CONST.
CON'TRACTOR #
L"e 1L4lq Ll4,w"r.t-
&t-
QUAD ABEA:3R
E
_ OFFICE USE _
# OF BLDGS
RANGE:
OCCY GROUP:
# OF STORIES
WATER HEATER:
FLOOD PLAIN:
* OF UNITS:
LAND USE:
ZONING CODE:
'{ OF BDRMScoNSrR. r""=, - i//L"--=-
HEAr soun.., GW/ --SECONDARY HEAT
SQUARE FOOTAGE:
To request an inspection, you must call 726-3769. This ls a 24 hour recording. All inspections requested before 7:00 a.m. wlll be
made the same worklng day, lnspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
fi'"-oorarY Eteclric E Rough Mechanical - Prior to
cover.
tr
^K
lVFoundation - After forms are
F'Lierected but prior to concrete
placement.
Eframing - Prior to cover.
F(t yi:i:eitins tnsurarion - Prior to
E[ DrVwat] ;'Prior to taping.
ft *ooo stove - After instatlation.
Site lnspection - To be made
after excavation, but prior to
setting forms.
Underslab Plumbing I Electrical /
Mechanical - Prior to cover.
Footing - After trenches are
excavated.
Masonry - Steel location, bond
beams, grouting.
Underground Plumbing - Prlor
to filling trench.
Underl anical
- Prior or decking
Floor lnsulation - Prior to
decki ng.
Sanitary Sewer - Prior to filling
trench.
Storm Sewer - Prior to filling
trench.
Water Line - Prior to filling
trench.
Rough Plumbing -- Prior to
cover.
x
E,X*:l Etectricar - Prior to **
K,E
E.
Final Plumbing - When allplumbing worl( is complete.
Final Electrical - When all
electrical work is complete.
Final Mechanical - When all
mechanical work is complete.
Final Building - When atl
required inspections have been
approved and building is
cornpleted.
Other
MOBILE HOME INSPECTIONS
Blocking and Set.Up - When all
blocl<ing is complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrlcal Connecllon - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Electrical Service - Must be
approved to obtain permanent
electrical power.
Fireplace -- Prior to facing
materials and framing lnsp.
lnserl - After fireplace approval
and installation of unit.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Driveway - After
excavation i$ complete, forms
and sub-base material in place.
Fence - When completed
reet Trees -- When all required
are planted.
V Post and Beam - Prior to floor
,Jdinsutation or decki ng.
B,
E
Frr
K
K
mbi
CITY: EU q EN E STATE:9zYo <
,\
tl
E
Lot Type
V ,,,rc,io,
-
Corner
-
Panhandle
-
Cul'de'sac
P.L.HSE GAR ACC
N
S
E
E
.S THE PROPOSED WORK I N THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? _...-
l( yes, this application must be signed
and apProved bY the Historical
Coordinator prior to permit issuance.
VALUE
G-r7#
"y'/s
76s 87
34bN
30
3b3,eo(A)
X $/SQ. FT.
f(-,20
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
/ /2,"
5zS
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.
Reviewed v
Fleceipt Num
,D
Date Paid
Rec
Plan Check Fee:
SYSTEMS DEVELOPMENT C
(B)
HARGE (SDC) g4
# tszt-E
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
bo?o
Roo
Z
/6b,@(c)
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
N0
. FT.
ADDITIONAL CO MENTS
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent
ooo
3 /,{o
/2,oo
/.Es
-43P2
300
(D)
4aol:
\oo
Vent Fan
Mechanical Permlt
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
No3
By signature, I $tate and agree, that I have carefully examined
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springf ield, 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 Building Safety Division.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
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
natu reY-
Date ]5
th set of plans will remain
ction
of the property,
on the site at al
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk 75 t
curbcut ?O t
Demolition
State Surcharge
Total Miscellaneous Permits (E)3s1f
t zl.2.D-2/3f
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, O and E Combined)
Z.zo 2e
-5 -73D/{TE PAID
AMOUNT HECEIVED
BECEIVED BY
VALIDATION:
RECEIPT NUMBER
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total height
APPROVED:
/ ilti '.
SPrlIN FIELO
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'376S
Office: 726'3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
?2/7t6
?fr,
JOB NUMBER
225 Fifth Street
Spri ngf ield, Oregon 97 477
TAX LOT:
SUBDIVISION
ru
LoT: ----- BLOCK
- GZzOPHONE:
{ozz-
ZIP:
J IL
STATE:
ksrz e-o<OWNER
ADDRESS:
CITY:
NEW
--
REMODEL ADDITION DEMOLISH OTHEB
DESCRIBE WORK:
MECHANICAL: --
PHONEEXPIRESADDRESSCONTBACTOR'S NAME
ELECTRICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
RANGF_:
* OF BDRMS:
_ OFFICE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATER
Y OF UNITS:
HEAT SOURCE:SECONDARY HEAT:
SOUARE FOOTAGE:
QUAD AREA:
,T OF BLDGS
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
--
To request an inspection, you must call 726-3769. This ls a24hour recording. AII inspections requested before 7:o0 a'm' w
made the same working day, lnspections requested after 7:00 a.m. will be made the following work day'
ill be
REOUIRED INSPECT!ONS
fl TemporarY Electric
II
Rough Mechanical - Prior to
cover.
Final Plurnbing - When all
plumbing work is comPlete.
Site lrrspection - To be made
after excavation, but Prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is comPlete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
t []e n nt When allElectrical Service - M work is complete.
approved to obtai nen
el tri
Footing - After trenches
excavated.ing
Final Building - When all
required inspections have been
approved and building is
com pleted.mal S
Masonry - Steel location
beams, grouting.
d
Other
Foundation - After forms are
erectccj but Prior to concrete
placernent.
/Ceiling lnsulation - Prior to
covclr.
Underground Plumbing - Prior
to filling trench.l-l Drywall - Prior to taoing
MOBILE HOME INSPE TIONS
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.Wood Stove - After installation.
Posl and Beam - Prior to floor
insulation or decking.lnsert - After f irePlace aPProval
an<i installation of unit.
Blocking and Set'UP - When all
blocking is comPlete.
Floor lnsulalion - Prior to
decki ng.Curbcul & APProach - After
forrns are erected but Prior to
placement of concrele.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanilary Sewer - Prior to filling
trench.Etectrical Connection - When
blocking, sei'uP, and Plumbing
inspections have been aPProved
and the home is connecled to
the service panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & DrivewaY - Afte r
exiavation is comPlete, {orrrts
and sub-base materiai in Place.
Water Line - Prior to filling
trench.
Streel Trees - Wlren aii required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
ventinO have been installed.Rough Plumbing - Prior to
cover.
(
"7d@9
E
E
E
tl r
tl
tl
E
tl
E
l--] Fence - When comPleted.
E
L_lT
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-- Panhandle
---- Cul-de-sac
Set ks
P.L.HSE GAR ACC
N
S
lu l-HE PROPOSED WORK lN THE
HISTORICAL DISTFTICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved bY the Historical
Coordinator prior to permit issuance.
APPROVED:E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition tltat the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Coclc, regulating the construction and use of
buildinqs, and may be suspended or revoked at any time
upon violation of any provisions of said ordinatrces.
Plan Reviewed By
/4#i-
J3
Date Paid
Fleceipt Number:
Recei
/D4 S7
Plan Check Fee:
-7-
(A)
7S z
VALUE
/? "sz
X $/SO. FT.
tz.*
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
Systenrs Development Charge is due on all undeveloped
propertles within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)*e97
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
No
Wood Stove/ lnsert/Fireplace Unit
Dryer Vent
MECHANICA!. PERMIT
(D)
N0
Mechanical Permit
lssuance
State Surcharge
Total Permit
Fu rn ace
Exhaust Hood
Vent Fan
By signature, I statc atrd agree, that I have caref ully examined
the completed application and do hereby certify that all
in{ormation hereon is true and correct, and I f urther certify
that any and all work performed shall 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 Building Safety Division.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
I f urther agree to cnsure that all required inspections are
time, that each address is readable
qil>0Date
nates
FG,snu,u,."
requested at the
mit card is located at the frontfrom the street, th.
set of plans v'rill remainof the pro
tructionon the
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut -- ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
AB
,o/laz
2?z -tg
DATE PAID
AMOUNT HECEIVED
RECEIVED BY -,-
VALIDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
z/2.'3
I
,/rO ,-73
/lAfo7p/53,st
.
JOB NO.
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
}IORKSHEET
(C0MMERCIAL & RESIDENTIAL)
NAME OR COMPANY:
LOCATION:
DEVELOPMENT TYPE:LD?tf roN
BUILDING SIZE: /A*
"c. 1xc-t-,,pes Arc: \OT SiZ
1. STORM DRAINAGE
TMPERVIoUS SQ. FT.4 L x $0.203 PER SQ. FT
X $42.08 PER PFU
COST PER TRIP
$424 .3 1
$424.3 I
$424.31
$
$
$15.125 PER PFU + $10 Mt^lMC ADM FEE $
TOTAL-MWMC SDC
SUBToTAL (ADD ITEMS 1,2,3 & 4)
sQ. Ft.
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X
x x
x_x
x_x
4. SANITARY SEt,lER-Mt,lMC
NO. OF PFU'S Y
(Use PFU Total From Item 2 Above)
MI,IMC CREDIT IF APPLICABLE (SEE REVERSE)
5 ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL ABoVE) X .os
K p Burdick
SDC Coordinator
TOTAL SDC $ ,g er-?d\6.^n',t tr/+ /qt
FIXTURE UNIT,CALCUL.AI .-l TABLEI Number of New Fixtures X
For remodels, calculSte only the NE additional fixtures)
NUMBER OF
FIXTURE TYPE NEW FIXTURES
Equivalent = Fixture Units illOTE:
UNIT
EOUIVALENT
FIXTURE
UNITS
Drinking Fountain...-..
Floor Drain..
lnterceptors For G rease/Oil/Sollds/Etc'.." " " " " ""
lnterceptors For Sand/Auto Wash/Etc.
l-aundry Tub/CIotheswasher.
Clothes,walher - 3 Or More.--
Mobile Hdme Park TraP (1 Pe r Traiter)................
Receptor For Refri geratorflVater Station/Etc--..- "'
Beceptor For Commerclal Sink/Dishwasher/Etc"
Shower, Single'Stall..
Shower, Gan9...........
Sink, Bar, Commercial
Urinal, Stall/YVall....
Wash Basin/Lavatory, Single...-...
Water Closet, Public lnstallation.-
Water Closet, Private.........
Miscellaneous:
TOTAL FIXTURE UNITS
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
/Head
2
1
L
J
6
2
6
6
1
3
2
1
2
2
1
6
4
Credit for Parcd or tand Only lf Applicable
tmprwement (rf after annexation date)
x$
(Rate X Assessed Value)
$
x $-
(Rate X Assessed Value)
CREDIT TOTAL
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
1981
1982
19&3
1984
1985
$s.21
3.13
3.08
2.96
2.42
2.68
2.51
1986
1987
1988
1989
1990
1991
1992
$ 2.24
1.93
1.57
1.18
0.79
o.44
0.28
tMPERVlous AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
TY OF OREGO'U
225 FIFTE STRBEf, :
SPRINGFIELD, OREGON 97477
INSPBCUON REQUBSTI 726-3769
oFPICE: 726-3759
st,ruNGFrELu
ELESTT.ICAL PERHIT APPLICATION
Job Number 2/7Se
1. LOCATION OP INSTALI,ATIONz
IJGAL DESCRIPTION AD
JOB DESCRIPTION5,.F,fu,
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COT.IIT,ACTOR INSTALT"ATION ONIY
ty
FEE SCHEDULE BELOS
Nev Residential-Single or
MuIti-FamiIy per dvelling unit.
Service fncluded:
Items Cost
r0p
4[rr It] ,.
A
(}-l* tt
cokpLetr
L000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
/> $ 8s.00
2 $ 1s.00
Sum
_ZSZ
30
Electrical Contrac tor TllV,4ml ET*i
tddress /Ii> ,YFtCpc bT
ciry friZ'gn & Phone 3y'2'Eg4{
Supervisor License Nrimber < a./7,,
Expiration Date
Bxp iration Date
Signature of Superv ctrieian
Ovne rs Name
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 40.00
0ver 401 to 600 amps _ $ 80.00
0ver 600 amps or L000 volts see rrB'r above
D. Branch Circuits
New, Alteration or Extension Per Panel
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 1000 amps/vo1ts
Reconnect 0nly
One Circui t
Each Additional
Circuit or with Service
or Feeder Permit
B
$ 40.00
$100.
$1 30.
$300.
$ 40.
$ 3s.00
s 2.00
ss0
$60
00
00
00
00
00
00
/,
Address
Ci ty Phone
OIINER INSTALI,ATION
The installation is being made onproperty I ovn vhich is not intendedfor sale, lease or rent.
Ovners Signature:
DATE:
Miscellaneous (Service/feeder not included)
-Each installation
Prrmp or irrigation S 40,00
:lglagytl ine Li_ghting- $ 40.00l,rmr ted Energy/Re"
=
$ 20,00Limited Energy/conm
=
$ :O.OO _
,,
.<z-r/z? 7s
E
5
RECETVED B Y;
fr{"1:sf.li:H"
TO?AL
Constr Contr. Number 4Z-S<-A
SPFI. - - iIELEl
%
225 YIYTfl STREET
sPRrNGrrELD, oREGON 97477
itrsprctrox nrouest z 726-3769
OFFICB: 726-3759
Eleetrical Contractor
Citv Phone
Supervisor Licen,se Number
Expiration Date
EI,BCTRICAL PERHIT APPLICATION
City Job Nunber Z 7
3. COHPI,ETE PEE SCffiDtILB BBLOV
Nev Residential-Single or
Hulti-FamilY Per dvelling unit'
Service Included:
I tems Cos t
$ 8s.00
$ 1s.00
$ 40.00
B Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
iOi .rb" to 400 amPs
-401 amps to 600 amPs
-
601 amps to 1000 amPS-
Over 1000 amPs/vo1ts
-
Reconnect 0nlY
$ s0.00
$ 60.00
$100.00
$130.00
$300. o0
$ 40.00
$ 2.00
c.TemporarY Services or Feeders
in"i"ff"iion, Alteration or Relocation
LPQ
1 A
I,EGAL DESCRIPTION
2_
DESCR]
Sum
"U"r"
).S
1000 sq.ft. or less
Each additional 500
sq. ft or Portion
thereof
Each Manuf'd Home or
Hodular Dvelling
Service or Feeder
permits are non-transferable and expire
ii ,ott is not started vithin 180 days
;i i;;;.tce or if vork is susPended for
180 days.
2. CONTRACf,OR INSTALI.ATION ONLY
:2
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
0vners Name
Address 22
city EL/4 Phone
p
t
OVNER INSTALI"ATION
e installation is be
operty I ovn vhich i
or sale,ease or ren
DATE:
200 amps or less -r-"f 19'00
zOi "*'p. to 400 amPs
-
I ::'00ov"r +br to 6oo amps
-
$ 8o'oo
Over 600 amPs or fbOO voTIs see I'B"
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
s;"h aaaitional
Circuit or vith Service
or Feeder Permit
-
$ 3s.00
z>o
ing made on E.Miscel]aneous(Service/feedernotincluded)
s not intended $ 40.00
$ 40.00
$ 20.00
$ 36.00
SIETOTAL OP ABOVB
5Z State Surcharge
TOTAL
oo
D
(
Th
r -Each installation
Pump or irrigation
Sign/0utline Lighting-
Limited EnergY/Res
-
Limited EnergY/Comm
5
RECEIVED
L-
t
-73 M
7*1 -q 3
4Q
SPRINGFIELE,
Zonin
225 PTYIE STRBET L ,'.3./KA4
SPRTNGFTELD, 0REGON 97477,
rNsPECf,roN BEQUEST -. 726-
OPFICE: 726-3759
1.TION OF ,TION
ELECTRTCAL PERHIT APPLTCATION
Ci ty Job Nunbe, C1 Al )sb
3. COHPLETE FEE SCffiDUI.,E BELOU
A. Nev Residential-Sing1e or
HuIti-FamiIy per dwelling unit.
Service fncluded:
I tems Cos t
s 8s.00
$ 1s.00
$ 40.00
B Services or Feeders
Installation, Alterations
or Relocation:
L %
1 I
IJGAL DESCRIPTIONl?02 r)qt h4O nf\
PTIONL
Permits are non-transferable and expire
if vork is not started vithin iEO <iaysof lssuance or if
180 days.
is suspended for
#srt I 23'1
2. CONTTRACTOR INSTALI^ATION ONLY
Electrical Contractor
Address$asq 3td Or
Ci ty I Phone 6+r-orf b
Supervisor Licens e Number 5Qq-Jttr
Expiration Date /o*)- 7r
constr contr. Number 3tF l Vb Cce:
Expiration Date lo-l* ?c-l
Signature of Supervising ElectricianY s. d*-
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
0ver 1000 amps/vo1ts
Reconnect 0nly
Sum
c Temporary Services or Feeders
Installation, Alteratlon or Relocation
s s0.00
s 60.00
s100. 00
$ 130. 00
s300. 00
$ 40.00
s 3s.00
s . 2.00
00
00
00
00
200 amps or less $ 40.00
201 amps to 400 amps
-
$ 55.00
Over 401 to 600 amps
-
g 80.00
Over 600 amps or 1000 vorts see ttgrr
"f,f,lf-
O'*rners N
Address
cit
7
ca
L , f ,l Phone *f rr+-7oS I
#{il,0n
S rt,
D. Branch Circuits
Nev, Alteration or Extension Per Panel
OVNER
One Circui t
Each Addi tional
Circuit or vith Service
or Feeder Permi t
The installation is being made on
property I ovn which is not intended
for sale, Iease or rent.
Ovners Signature:
DATB:L
E. Hiscellaneous (Service/feeder not included)
-Each installation'
Pump or irrigation
Sign/OutIine Light ing-
Limited Energy/Res
-Limi ted Energy/Comm
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
6o.ao
s 40.
$ ao.
s 20.
S 36.
C'TY OF SPF'N'GF'tr{,tr $flFGCf,.'
RBCBIVBD
5
_-._ctO4at, .
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Eacir Hanui'd iiome or
-Hodular Duelling
Service or Feeder
l^D.c)'c./, r^o
,a OREGO'U
225 PIFTE STRBEf,
SPRINGFIEI,D, ORBGON 97477
INSPECTI0N RBQITBST. 726-3
:t
as submitted h af IEGIIBil,GAL
r;rqriro scecific land uee
PERilIT APPLICATION
City Job Wu A", ?,U 7 9O
HuIti-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.oo
s 1s.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocat ion:
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
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less S 40.00
201 amps to 400 amps _ $ 55.00
Over 401 to 600 amps _ $ 80.00
0ver 600 amps or 1000 volts see rrBil above
D. Branch Circuits
Nev, Alteration or Extension Per Pane1
Bi :"!n a:.
769
Jlr '' !trv,ltq p'nlect
l..r ilng.i il0t
sa'rrtN(;FrELl,
.ne Ci.rcui t ./
Each Additional
Circuit or vith Service
or Feeder Permi I Z
SI.,BTOTAL OF ABOVE
5Z State Surcharge
TOTAL
OFFICE: 726-375
1. LOCATION OT
9 Zoning.
D,., i.0_:,1'L-P. CoHPLETB FEB SCBEDULE BBLog
ll'gneturoMsingle or
IJGAL DESCRIPTION
JOB DESCRTPTIONl)i fu,, (' , Zb PAl <,F,.€ed.
Permits are non-transferable and expire
lf vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COIiITRACTOR INSTALT,ATION ONLY B
Electrical Contrac tar 7nr44a) t&-f,
Address ,/{Z ,VAtaxs 467
Ci ty Eu4.phone 3y'2 -gb4si
Supervisor License Number ? Ol: r
Expiration Date 'o
constr contr. Number 4ZS-gO
Sum
Exp iration Date
Signature of
Ovners Name
s s0.00
s 60.00
$100. 00
$130.00
$300.00
$ 40.00
00
00
00
00
/-, J ..Z,or<- ,' 6rae ,
Address
Ci ty Phone
$ 3s.oo 5g-
$ 2.oo _#
3-
4r1qS
OVNER INSTALI^ATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DArE: f ol I
RECEIPT *:
E. Miscellaneous (Service/feeder not included)
-Each installation
Prrmp or irrigation $
Sign/outline Lighting- $
Limi ted Energy/Res S
Limited Energy/Comm $
39,n
40.
40.
20.
36.
5
---f-v-RECEIVED B
lar.
\-r-
JOB NO.lzr 15 t-
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(C0t'lt'IERCIAL & RESIDENTIAL)
NAME OR COMPANY
LOCATION:8t t s. 4cU gr ls ozo9tz - 41oo
DEVELOPMENT TYPE:
BUILDING SIZE:
L3? - Ktew 9f"-
sQ. Ft
I STORM DRAINAGE
IMPERVIOUS SQ. FT.
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
OT SIZ
'Lt oo x $0.192 PER SQ. FT
tg X $39.78 PER PFU
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
o-o 5 x $40r.05
x $401.05
x $401.05
X $
$
SUBT0TAL (ADD ITEMS i,2, & 3)$ l|Zze:
ADMINISTRATiVE FEES
BASE CHARGE (SUBT0TAL ABoVE) X .0s
TOTAL - C ITY sDC S 1511
5. SANITARY SEt^lER-MWMC
NO. OF PFU'S ts $13.62 PER PFU + $10 MhlMC ADMIN. FEE s 255Y
(Use PFU Total From Item 2 Above)
Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE)
l-J-TOTAL-Ml^lMC SDC
Kip Burdick
SDC Coord'inator
I x {,
X
4
+3
\9
2
-2.o)-
22402
TorAL spc s lozz*2
u
/l
rit Equivalent = Fixture Units (NOTE:
FXTURE UNIT CALCUIA' .?I TABLE: Number or New Fixtures )
l.rr"r""aas,catcutatJi"r'in"lgadditionalrixtures) IE$T,['[',
UNIT
EQUIVALENT
z-.zt
-$b\
FIKTURE
UNITS
r3
1?
FIXTURE TYPE
Bathtub----.-.
Drinking Fountain"""
Shower, Single Stall-."""""'
Shower, Gang...--......
Sink, Bar, Commercial
Floor Drain.
i ;;;il For G rease/oiu.?,orllsf :
Interceptors For Sand/Auto Wasn/trtu"""""""""
Lunary Tub/Clotheswasher"""""'
Clotheiwasher - 3 Or More"""""""""'"""'
f.ll'"Oif" Horne Park Trap (1 Per Traiter)" "'':"""""
neceptot For Ref rigeratorAVater Station/ Etc" " " "
n"""pr", For Commercial Sink/Dishwasher/Etc"
2
1
2
3
6
2
6
6
1
3
2
1 /Head
2
2
1
6
4
I
U rinal, StallflVall....
Wash Basin/Lavatory, Single"""""
Water Closet, Public lnstallation"
Water Closet, Private.."""'
Miscellaneous:
CREDIT
calculate credits
?-
a-
7.7x $l,o
(Rate X Assessed Value)x$
TOTAL FIKTURE UNITS
CALCUT-AT.oN TABLE: Based on assessed varue. rf improvements occurred after annexation date in table'
Credit for Parcel or Land Only lf Appticable
lmprovement (if after annexation date)
2
(Rate X Assessed Value)
CREDIT TOTAL
RUNOFF COEFFICTENTS FOR STORM DRAINAGE
Year
Annexed
Rate Per $1,000
Assessed ValueYear
Annexed
Rate Per $1,000
Assessed Value
1985
1986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0.25
0.87
0.50
0.16
1979 or before
1980
1981
1982
1983
1984
$2.83
2.76
2.71
2.60
2.46
2.33
IMPERVIOUSAREA:TOTALLoTSIZEXRUNOFFCOEFFICIENT
+
2
L
I
b
I6
I