HomeMy WebLinkAboutPermit Building 1994-08-18)fiazo= *< -> y'6fi l,ft zlSzt-t #?/a?/s
PRI FTELD
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726-3769
Offlce:726-3759
LOCATION OF PROPOSED WOFIK:
ASSESSOBS MAP:
LOT 1o)- z
h,
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97 477
TAX LOT
SUBDIVISION:
Z
BLOCK:
pb(K
ur)
ZIP:
Q.
e.7STATE:
PHONE:7 y7- (co 8
t
rtACITY:
ADD
REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW Z
Rt EXPIRES
{zro
CONST.
DDRESS
{L
PHO E
'ca I
CONTRA TOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
, OF BDRMSI Z * 7
SECONDARY HEAT:
SQUARE FoorAGE: ?;aZ-
2-
E
- OFFICE USE -
WATER HEATER
ZONING CODE:
FLOOD PLAIN:
RANGE:
r OF UNITS:
LAND USE:
2 QE,
-) .) 14
I w
wt+K-^;M2z2
OCCY GROUP:
* OF STORIES:
OUAD AREA:
* OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. wlll be
made the same worklng day, lnspectlons requested after 7:00 a.rn. wlll be made the followlng work day.
REQUIRED INSPECTIONS
E
tl
tl
R,
.E
N
Temporary Electrlc
Slle lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Underslab Plumblngl Electrlcal /
Mechanlcal - Prlor to cover.
Masonry - Steel locatlon, bond
beams, groutlng.
Underlloor Plumblngl Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulatlon - Prlor to
decklng.
Sanltary Sewer - Prlor to fllllng
trench.
Storm Sewer - Prlor to fllllng
trench.
Waler Llne - Prlor to filllng
trench.
Rough Plumblng - Prlor to
cover.
Rough Mechanlcal - Prlor to
cover.
Rough Electrlcal - Prlor to
cover,
lllrlnat Ptumbins - When an
-plumblng
work ls complete.
NT'lnal Electrlcal - When all
lectrlcal work ls complete.
[dfootlng - After trenches arelFexcavated.
E
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flreplace - Prlor to faclng
materlals and lramlng lnsp.
)<fFramlng - Prlor to cover.
Xl waltrC'elllng lnsulatlon - Prlor to
-cover.ffi Orywall - Prlor to taplng.
l--l Wood Slove - After lnstallatlon.
tl lnsert - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
are erected but prlor to
placement of concrete.
Sidewalk &
f{flnal Mechantcal - When alt.-rnechanlcal work ls complete.
f!'f-rtnat Bulldlng - When ail
7a+equlred lnspectlons have been' approved and building ls
completed.
l9Foundatlon - After forms areAL€rectect but prlor to concrete
placement.
pfunderground Plumblng - PriorHo fllllng trench.
,E
E
B
N,
w
E
k
and sub-base materlal ln place.
Fence - When completed.
Trees - When all requlred
rees are planted.
Other
MOBILE HOME INSPECTIONS
Blocking and Set.Up - When all
blocklng ls complete,
Plumbing Connectlons - When
home has been connected to
water and sewer.
Eleclrlcal Connection - When
blocking, set-up, and plumblng
inspections have been approved
and the home is connected to
the service panel.
Final - After all required
lnspectlons are approved and
porches, sklrtlng, decks, and
ventlng have been lnstalled.
tion
Af ter
forms
Drlveway -ls complete,
Qy' i :',
OWNER:
ruD,(
tl
E
..:. ,. ,i i,. r: *,i!r!i
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
ATZo4"
Z-z9ou
backs rS THE PFIOPOSED WORK tN THE -
HISTORICAL DISTRICT, OR ON
THE HISTOFIICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
PL.HSE GAR ACC'
N Eb
S /24
31
E /3
/3D4/3
,-, ^ r7l
+Ee(A) 5U-27
VALUE
{20 nT?
Stzz-
E
X $/SO. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT,
Main 2/ 7G
Garage
Carport
6za /4'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 tlme
ewed By
.2
i5
P F fu,rr
f any provisions of
Receipt Number:
Received
ordinances.
6<)
upon violation or
Plan Check Fee:
Date Paid:
Systems Development Charge ls due on all undeveloped
properties wlthin the City limits which are being improved.
SYSTEMS DEVELOPMENT CHAR
B)nnA
ITEM
Flxtures
Residential Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
afu t+l*z,t-tt
7/
3ZqP
FT.
FT.
ro
(c)
N" 2*/
GE (SDC)
"re-+k(B)
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent 2-
2@
/-&
/4,
(D)39/b
ero
No
3?o *)a7at.;-o-r
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
Je ?"/,3r/az
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed appllcatlon and do hereby cerilfy that all
lnformation hereon is true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the Clty of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
hereln, and that NO OCCUPANCy wlll be made of any
structure wlthout permission of the Buildlng Safety Division.
I further certify that only contractors and employees who
are ln compllance with OFIS 701.055 will be used on this
proiect.
I further agree to ensure that all required lnspections are
requested at the proper ilme, that each address ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remaln
on the slte at all times durln g constructlon
gnatu
Date
MISCELLANEOUS PERMITS
Moblle Home
State issuance
State Surcharge
Sidewatk 65 f t
Curbcut 3Z- tt
Demolitlon
State Surcharge
Total Miscellaneous Permits (E)
Z?.LS-_4__/4#
E>- *<y'z <z
41bs,
VALIDATION:
FIECEIPT NUMBER
DATE PAID
TOTAL AMOUNT DUE (exctuding etectricat)
(A, B, C, D, and E Combined)RECEIVED BY
--
iZ . AMoUNT RECEIVED
ADDITIONAL COMMENTS
c
I 2 r 4,o
'1
Lot Type
)C lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
t
FT.
ATTACHT4ENT BI
CITY OF SPRINGFIELD SYSIEIIS DEVELOPMENT CI-IARGE
I^IORKSHEET
(COMMERCIAL & RESIDENTIAL)
ilIA},IE OR COMPAI,IY:4
LOCATION:
DEVELOPHENT TYPE:
BUILDING SIZE:
xl(STORil NRAINAGF
IHPERVIOUS SQ. FT 2t8 I
SI . Ft.
x $0.209 PER SQ. rr ,o OG
s
2" to*tro*t sEwrR-CITY
NO. OF PFU'S
(See Reverse)
3z X $43.26 PER PFU s /284,' Z
3. TRANSpoRTATTON
NO OF UNITS X TRIP RATE X COST PER TRIP
e x /,o/ x$436.19
x x $436.19
x x $436.19
SUBTOTAL (ADD ITEMS 1.2, & 3) s 26ot, /7
4. SANITARY SEWER-}4I.IMC
NO. 0F PFU'S 32 x $17.19 PER PFU + $10 t"lI,{HC ADMIN'FEE
euse-iru Total From Item 2 Above)
l'[,{t4c CREDIT IF APPLICABLE (SEE REVERSE)--..
TOTAL.YII,IHC SDC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
f,Ao, oY
s 42. an
S rrF.or
$3 323.S6
5. ANMINISTATIVE FEES
BASLI (SUBTOTAL ABOVE) X .05 G6,tr
Date:r t _"7
g.P.
SDC i nator
$
Ha
82.SDC #ffi*47
TOTAI SDC s > 18?. 7f
.r,iE}sr'l,i':i:l 'r
'-" JoB NO. 14// 7 /
S 7a/. /o
,
FIXTURE UNIT CALCULAl ,JN TABLE: ruumuer of New Fixtures X Unit Equivatent = Fixture unirs
(NOTE: For remodels, calculate only the NET additional fixtures)
NUMBER OF UNIT FIXTURE
F]XTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub.....
Drinking Fountain....
Floor Drain
tnterceptors For Grease/Oil/So|idsiEtc.................
lnterceptors For Sand/Auto Wash/Etc..........-v-Laundry Tub/Clotheswasher. .. . .... .
Clotheswasher - 3 Or More
Mobile Home Park Trap (1 Per Trailer)......
Receptor For RefrigeratorflVater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Sta]|..........
Shower, Gang........
a
1
2
3
b
2
6
b
1
3
2
1
2
2
1
6
Sink: Bar, Commercial, Residential Kitchen
Urinal, StallflVall..:.............
Wash Basin/Lavatory, Single
Toilet, Public lnstallation.
Toilet , Private....
Miscellaneous:
Tz
T;T- 4
3.L
/Head
4
TOTAL FIXTURE UNITS
cREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in taole,
calculate credits separates.
Year
Annexed
Rate per $1,O0O
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
i 980
1 981
1 982
1-o83
1 984
1 985
$3.46
3.38
3.32ar1
3.06
,42
2.73
1 985
1 986
li,i,/
1 988
1 989
1 990
1 99i
1 993
$2.46
2.14
1.77
1.37
0.97
o.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
x $ /2. /1o 42jq
(Rate X Assessed Value)x $-
(Rate X Assessed Value)
3 .1A
CREDIT TOTAL = $42, od
rt)?
CTT
7
--'-T-
("
225 FIFTII STRI.:IIT
SPTUNGIIIELI)' OIII:GON
INSPIICf,ION REQUI'.ST :
oFPICE: 7?.6-3751)
72.6-3-t69 ''' *t'
1. LOCATION OI' INSTALLATI 0N0"'
- ;z-/
LEGAL DESCRIPTION
2
DE ON
Pcrnrits arc non-transferable and explre
iI vork is not started wlthin 180 days
of issuance or i[ vork ls suspended for
180 days.
2. CO}rI'RACTOR INSTALINTION ONLY
Tr"p tottowtng proloct ae submttterl h"-fi.lf,q$I"$f,t^L
97 47 7 rt ' ' and does not requiie opecific tarii ,se
PgRH IT APPLICATION
Ci ty Job Number
T'EB SCNBDULB BBLOV
Residential-Single or
Hu t -Fam ype r dvelling uni t.
Service Included:
Items Cost
5t'tllN(;l:tl:Lu
1000 sq.ft. or less
Each additional 500
sq. ft or portlon
tlrereof
Each Manuf 'd llome or
Modular Dr.,elling
Service or Feeder
raA
0i!
r-)za-
-')
.z-_-
Sum
lac"o@
3o*
$ 85.00
$ 1s.00
$ 40.00
$ s0.00
$ 60.00
$100.00
$130.00
s300.00
$ rr0.00
Ci ty I'hone Iar{-s lO8
supervisor License Ndnrbar ?*Z+ f
Iixpirat ion Date
Con:;tr Cotrtr. Number lob
Expiration Datc
Signature of Supcrvising Electrician
/
Ouners Nane //*tzdlr-,)r
A<ldress
OVNEN INSTALINTION
The installation is being made on
property I olrn vhich is not intended
for sale, Iease or rent.
ovners Slgnaturc:
- ---- - -:- -
DATE:
RIICEIPT il:
Services or Feeders
fnstaIlatlon, Alteratlons or
Rclocatlon:
200 amps or less
20L anrps to 400 amps _
401 amps to 600 amps _
601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Oniy
D
lilcc t ri
Adcl r:ess
cal Con
{n
t rac tor
6ix }e'\D
c Temporary Services or Feeders
Installatlon, Alteration or Relocation
200 amps or less S 40.00
201 amps to /r00 amps _ $ 55.00
over /r0L to 600 amps _ g 80.00
0ver 600 amps or 1.000 volts see ,8" above
Ci ty .2 ;d rnone 74 7-40.38;
D. Branch Circults
Nev, Alteratlon or Extenslon Per Panel
One Ci rcui t $ 35.00
Each Adcli t ional
Circui t or vi tlr Service
or Feeder Permit S 2.00
E. l'liscellaneous (Service/feeder not included)
-Eaclr installation
Plrmp or irrigation
Sign/0u tline Liglt t ing_
Limi ted Energy/Res
SUDTOTAL OT ADOVE
5/ State SurchargeT0TAL -. |a ,*,fo Loe
00
00
00
00
40
40
20
36
$
$
$
s
rUi(:riIVI.tr) llY:
5
2/ ez,a c
,t' t
Willamalane
Park & Recreation District
lob No.
SYSTEMS DEVELOPMENT CHARCE
WORKSHEET
,
NAME:
ADDRESS:
LOCATION OF FROPOSED BUILDINC SITE:
Stre€t Address if Known:
1
NO OF UNITS
B. Single Family - Attached
NO OF UNITS
C. Multi-FamilY Apartment
NO OF UNITS
D. Manufuctured Home Park
NO OF UNITS
Communiry Services Division
City of Springfield
;3/Q - ',-.-' 'ei srArE: &"z* 7y'7g
PHONE:7
Platt Name:Tax Lot Number:
DEVELOPMENT TypE (Chect appropriate dwelling(s). 5DC Calculations and dwelling type
aefinitions are on the back-)
A. Single Family - Detached
Single FamilY home Manufactured home not in a Park
X $400 PER UNIT =$
Z
- z 7r?5 7az(/o)
i;eX $370 PER UNIT =
X $277 PER UNIT =
X $280 PER UNIT =
rii
$
$
$
WPRD SDC
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet-
3. TOTAL WPRD NEf SDC ASSESSED (lf SDC reduced for Credit)
$
$
Date
;{r