HomeMy WebLinkAboutPermit Building 1994-03-315?'l tz.
RES!J ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
SP,lINGFIELO
JOB NUMBER
225 Fifth Street
Spri ngfield, Oregon 97 477
ftL.,)1 s, 4U t0l-
ASSESSORS MAP:r9 n os i?-TAX LOT:O1 M
LOT lo,BLOCK:SUBDIVISION
OWNER:
ADDRESS:
CITY:
PHONE:
o^STATE:ztP
/a7ta *
77(
ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW X REMODEL
ADDRESS EXPI RES PHONECONTRAGTOR'S NAME
GENERAL:
PLUMBING
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
G
"3PEo,
WATER HEATER:
HEAT SOURCE:
FIANGE:
ZONING CODE:
* OF BDRMS:
- OFFICE USE _
CONSTB. TYPE:
FLOOD PLAIN:
SECONDARY HEAT
SQUARE FOOTAGE:
OCCY GFIOUP:
* OF STORIES:
QUAD AREA:
* OF BLDGS:
LAND USE:
# OF UNITS
To request an insoectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspections requested before 7:00 a.m. wlll be
made the same working day, lnspections requested after 7:00 a.m. wlll be made the following work day.
REOU!RED INSPECTIONS
ffiT".porary Eteclric
.t K
K
Rough Mechanical - Prior to
cover.lXfrlnrt Plumbing - When ail
l--plumbing work is complete.
Site lnspection - To be made
after excavation, but prior to
setting forms.
Rough Electrlcal - Prior to F
E
Flnal Electrical - When all
electrical work is complete.cover,
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
'NZf a,""rricat service - Must belAapproved to obtain permanent
electrlcal power.
Final Mechanical - When all
mechanical work ls complete.
ffi Footing - After trenches arefr excavated.Fireplace - Prior to faclng
materlals and framlng lnsp.
[Vt Finat Building - When att
f\-required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.K
K
tr
Framing - Prlor to cover.
X Foundation - After forms are
erected but prlor to concrete
placement.Wall/Ceiling lnsulalion - Prior to
cover.
Underground Plumbing - Prlor
to filling trench.Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
tr.
K
Underlloor Wood Stove - After lnstallation.- Prior to I no ng.
Post and Beam - Prior to floor
insulation or decking.lnsert - After flreplace approval
and lnstallatlon of unit.
Blocking and Set.Up - When all
blocking is complete.
ffi1t""*1'rsulation - Prior to K Curbcut &Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water€nd sewer.
aKSanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
IVT Storm Sewer - Prior to fillingJAtrench.
l\7 SiAewalk & Driveway - After
LAexcavation is complete, forms
and sub-base materlal in place.
K Waler Llne - Prior to filling
trench.
Fence - When completed
Trees - When all required
Final - After all required
inspections are approved and
porches, skirtlng, decks, and
venting have been installed.llfnougtt Plumbing - Prior totrov€r.trees are planted
q L+ oz34
I
iltt
Olher
-
Lot faces
Lot sq, ftg.
Lot coverage
Topography
Total height
Tao?
StPu
z2%o:;'
Lot Type
)L tn,",io,
-
Corner
-
Panhandle
-
Cul-de-sac
i rS THE PROPOSED WORK lN TH:.
HISTORICAL DISTRICT, OR ON
THE HISTOFIICAL REGISTER?
-
lf yes, this application must be signed
and approved bY the H istorical
Coordinator prior to permit lssuance.
APPBOVED
P.L.HSE GAR ACC/lN/4
S 7
/a
E 3z
BUILDTNG 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
3
1,3*i
v
eq l.bq
Beceipt Numbe
By:
Date Paid:
Plan Check Fee:
Rec
luttD
(A)
9)I
Main 11<,
Carport
$/SQ. FT.
=t ?4
Total Value
Building Permit Fee
State Surcharge
Total Fee
)Db,<)1
Zd,gt,7f' 'zzf(m
BUILDING PERMIT.'
ITEM SQ. FT. X VALUE
6tX,4Otc
,Garage <) b
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC) #(B) E rlilg
ADDITIONAL COMMENTS
I+
ITEM
Fixtures
Residential Bath(s)
Sanltary Sewer
Water
Storm Sewer
Mobile Home
FEE
/At,ao
,/6 b-""(c)
FT.
FT.
FT.
No2
8.*
PLUMBING PERMIT
Plumblng Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
2'73o
/,3E
(D)
6*s " i ul/H
1 0,oo
38,?e
Vent Fan
Oo
G,oo
4€oq,q
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood
Noj
5,o,o
By signature, 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 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 ls located at the front
approved set of plans will remain
ct f
Date
of the property, and
on the slte at all during con
)(,nn.,u,u
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewark 7€ t
curbcut )Q ,,
Demolition
State Surcharge
z/,2f,
Total Miscellaneous Permits (E)
lo
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
^ 4^27 "zo
c6
OFEGO'UCITY OF
225 FTfrg STRBEf,approval.
SPRTNGPIEI,D ,ORBGON 97477 Zonl
INSPBCTION REOIIEST:
OPEICE: 726-3759
1 OF
I.AGAL DESCRIPIION
The followlng Proicc't
zoning, and does nor iequire sPecific
L {L
as subrnltted h6 ns
A.
land use
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Hodular DveIIing
Servlce or Feeder
Services or Feeders
InstaIIation, Alterations
or Relocation:
SPrlI'{GFIELO
BIJCTRTCAL PERT{IT APPLICATION
7268A69'\l-q q ciOdo;1 't '
rrrnorueasrc.t il* P 'K 3' eelt?ttfB
E
FEE SCEEDTILE BBLOII
Nev Residential-Sing1e or
MuIti-Family per dvelling unit.
Service Included:Items Cost Sum
/ $ Bs.oo tr
n g ls.oo -€permits are non-traisferable and expire
if vork is not started uithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONIRACTOR INSTALI.ATION ONLY
Electrical Contractor
Supervisor License Number
Bxp iration Date
Slgnature of Supervlsing Electrician
Ovners Name
Address
Ci ty
O9NER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
Omers
DATE:
$ 40.00
B
Address
cl Phone
Exoiration Date
Constr Contr. Number
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amPs_
0ver 1000 amps/volts
Reconnect 0nly
200 amps or less e/'-
201 amps to 400 amps _
over 401 to 600 amps
-0ver 600 amps or 1000ETIs
$
$
$
$
$
$
s
$
$
s
50.00
60.00
100.00
130.00
300.00
40.00
ee I'Bu aEove
_*40.00
55.00
80.00
i D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Addi tional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/OutIine Light ing_
Limited Energy/Res
Limi ted Energy/Comm
SUBTOTAL OP ABOVB
5f State Surcharge
TOTAL
$ 40.00
s 40.00
$ 20.00
$ 36.00
/,
RECEIVBD
tu
3 ?E,D
ry Job ttu V", ? /Ofr 7
Permit No:
Address:
Issued by
ry
ate: 7'V/^2
R OFFICE USE ON
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board tosign the following statement before the building permit can be issued. This state.ment is required for residential b_uilding, elecfrical, mechanical, and plumbingpermits. Licensed Architect and Engineer applicants, exempt from registratioiunderORS 701.010(7), need not submit this statement. Thib statement will befiled with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
1
2
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is soldor offered for sale before or upon completion.
My general contractor is---
Contractor registration numbe
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the construction contractors Board.
3. B. W I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that t have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side is form.
3
3 A
sig nat t lican te
WHITE @PY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
a
OR
W.dt^eglelens
fob No.
SYSTEMS DEVELOPMENT CHARCE
WORKSHEET
NAME:
ADDRESS:
LOCATION OF PROPOSED BUILDING
Street Address if Known:
Platt Name:
S srArE:W^rgrug
PHONE:
,'l ,@
Tax Lot Number:
{De?
$d
(
1
Community
PEVETOPMENT TYfE ,
(Sheck appropriate dwelling(s). SDC Calculations and dwelling typedefinitions are on the back.)
A. Single Family - Detached
tL single Family home Manufactured home not in a park
NO OF UNITS]X $400 PER UNIT =$
B. Single Family - Attached
NO OF UNITS X $:ZO PER UNIT =
C. Multi-Family Apartment
$
NO OF UNITS
D. Manufactured Home Park
X $277 PER UNIT =$
NO OF UNITS X $280 PER UNIT =$
c{)
WPRD SDC
2. SDC CREDTT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAT WPRD NET SDC ASSESSED (lf SDC reduced for Credit)
$
City of Springfield
ron Date
$,7)
t
,oB No . a4 ozl*
CITY OF SPRINGFIELD SYSTEI'IS DEVELOPMENT CHARGE
T.IORKSHEET
(C0MMERCIAL & RESIDENTIAL)
JNAME OR COMPANY:
LOCATI0N: Bts-l 5..Lc"r-B Sr. tloz o€, \L - c^1Q2OO
DEVELOPMENT TYPE : I tP-- rt vvr 9? g-
BUILDING SIZE:
I. STORM D RAINAGE
IMPERVIOUS SQ. FT.bt
SiZ
-1 -1 x $0.203 PER SQ. FT.
sQ. Ft.
NO. OF PFU'S
(See Reverse)
X $42.08 PTR PFU
3 TRANSPORTAT ION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X
\-o x $424.3i
x $424.31
x $424.31
$
$
4 SANiTARY SEl,lER-Ml,lMC
N0.0F PFU'S tA x $15'125 PER PFU + $i0 Mt,lMC ADM FEE
(ijie PFU Total From Item 2 Above)
Mt.lMC CREDIT IF APPLICABLE (SEE REVERSE)
t5s ZAz
t.t
ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL AB0VE) X '05
TOTAL-MWMC SDC
SUBT0TAL (ADD ITEMS 1,2,3 & 4)$ob1 o b
5
Kip
sDc c
Burdi ck
oordi nator
.{+-12
51+3
rl2bb
TOTAL SDC $2 \1L +8
2. SANITARY SEWER-CITY
t
FIXTURE UNIT,CALCUL
For remodels, calculAte only the Nlfl
FD TURE TYPE
Drinking Fountain.....-.. .
Floor Drain.-
lnterceptors For Grease/O il/Sol ld s/Etc" " "" " "" "'
lnterceptors For Sand/Atno Wash/Etc. " " " " " ""--'
l-aundry Tub/Clotheswasher- -. -. -- -. -...
CIotheswaqher - 3 Or More-
Mobite Hdme Park TraP (1 Per Traiter)
.ON TABLE: t'tumoer of New Fixture: nit Equivalent = Fixture Units (NoTE:
additional fixtures)
NUN1BER OF
NEW FIXTURES
z
UNIT
EOUIVALENT
FIXTURE
UNITS
2
1
2
J
6
2
6
6
1
3
2
1
aL
Z
1
L
Receptor Fbr RefrigeratorAVater Station/Etc""""
Receptor For Commerclal Sink/Dishwasher/Etc"
Shower, Single'Stall..
Shower. Gang...-..-.-.-
Sink, Bar, Commercial
z
Urinal, StaltflVall....ZWash Basin/Lavatory, Single----.----.
Water Closet, Public Installation.-.'-
Water Closet, Private.....-Z ---6--
Miscellaneous:
TOTAL FIXTURE UNITS t8
CREDIT CALCULATIoN TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits
b,zt x$\b.1'.++r{
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
(Hate X Assessed Value)
/Head
2
6
4
xs
(Rate X Assessed Value)
CREDIT TOTAL
r4
$*q
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,0OO
Assessed Value
1 9B6
'1987
19BB
19&9
1990
1991
1 992
$ 2.24
1.93
1.57
1.18
0.79
4.44
o.2B
1979 or before
19BO
't981
't982
1983
1984'19&5
s.21
J. IJ
3.08
2.96
2.82
2.68
2.51
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Residential....
Commercial..
lndustrial-..
Governmental.
0.4
0.9
0.45
0.5
IMPERVIOUS AREA : TOTAL LOT SIZE X RUNOFF COEFFICIENT