HomeMy WebLinkAboutPermit Building 2007-05-30Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007
APPLIEDz 0312112007EXPIRES: 11/3012007VALUE: $ 840,000.00
SITE ADDRESS: 470 S 2ND ST Springfield TYPE OF WORK: Commercial Miscellaneous
ASSESSOR'S PARCEL NO.: 1703353301000
TYPE OF USE: Alteration Industrial
PROJECT DESCRIPTION: Removal and replacement of Formaldehyde Tank Farm.
Owner:
Address:
Contractor Type
General
Electrical
Engineer
HEXION SPECIALTY CHEMICALS
470 S 2ND STREET
SPRJNGFIELD OR 97477
PhoneNumber: 541-744-3224
risl ++)
Contractor
ADVANCED MECHANICAL INC
CHRISTENSON ELECTRIC INC
JHI ENGEINEERING
License
148196
458
Expiration Date
06t29t2007
05/01/2009
Phone
541-466-3939
541-688-6121
503-223-7799
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
U
VB
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Buildilqgl 1f;f," n/a
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant
ORK
ri prnutr Is NoT
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
COMME
O DAY PERIOD Handicapped:
Total:
UNDER IH
NCED OR IS ABA
B
Paved Drive Rqd:
oh of Lot Coverage:
Sidewalk Type:
Downspouts/Drains:
Compact:
PUBLIC IMPROVEMENTS
Notes:
Page 1 of4
in OAR 952-0
0090. You mi
calling the ce
lrulLLrLi\u li\lltJt(lYlA I l(rl\ |
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007APPLIEDz 0312112007EXPIRES: 11/3012007VALUE: S 840,000.00
Description
Estimate
Type of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
s1.00 840,000.00
Total Value of Project
Amount Paid Date Paid
Value
$840,000.00
$840,000.00
Date Calculated
03t2u2007
Fee Description
Plan Review Comm/Ind/Public
+ l0o/o Administrative Fee
+ 57o Technology Fee
+ 87o State Surcharge
Building Permit
FLS Safety Systems Review
Plan Review Fire & Life Safety
+ l0%o Administrative Fee
+ 57o Technology Fee
+ 8olo State Surcharge
Add, Alter, Extend Circ Ea Add
Low Voltage - Commercial Indus
Perm Serv/Fdr 200 amps or less
Temp Power 200 amps or less
Total Amount Paid
$1,930.92
$297.07
$148.53
$237.6s
$2,970.65
$325.00
$1,188.26
$73.60
$36.80
$s8.88
$1s0.00
$45.00
$441.00
sr00.00
$8,003.36
4t9t07
5t30t07
5t30t07
5t30t07
st30/07
5130t07
5t30t07
6t6t07
6t6/07
6t6t07
6t6t07
6t6t07
6t6t07
6t6t07
Receipt Number
2200700000000000507
1200700000000000644
1200700000000000644
r200700000000000644
1200700000000000644
1200700000000000644
1200700000000000644
2200700000000000917
2200700000000000917
2200700000000000917
2200700000000000917
2200700000000000917
22007000000000009r7
2200700000000000917
Plan Reviews
Fire Department Review 0411012007 WE
Fire Department Review 0512912007 05/29t2007 0K GRG
Initial Review 04/09t2007 04t09t2007 APP LLH
IO JMP
Waiting on American Petroleum
Institute (API) 650 standards or
exerpts.
See attached document for Fire
Department Plans Review
comments.
Plan review fee receipted in at
Finance Department. Plans had
been in our office waiting for fee to
arrive. I transferred the payment
today. Okay to process plan review
WI. Received structural responses
from Greg Wilberger.
PIan Review Comments 04t27t2007
Paee 2 of 4
Valuation Descrintion
lees ratd I
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007
APPLIEDT 0312112007EXPIRES: 11/3012007VALUE: $ 840,000.00
Plannine Review
Public Works Review
Structural Review
Structural Review
SUB Review
SUB Review
04n0t2007 04t30t2007 APP EMM Allowed by building permit only per
Sarah Summers. Similiar to a
proposal discuseed in DIM
ZON2004-00017. Applicant to
verify street side setback. Is fence
property line?
Attached SDC Worksheet. No New
SDC's. (JHJ)
See attached documents for 7
structural comments faxed to
Michael J. Smith.
Received final internal approval.
No energy code issues or inspections,
JMP left a voice message on Michael
J. Smith's cell phone requesting the
energy code forms and information.
04n0t2007
04t0912007
05t29t2007
05t04t2007
04n0t2007
04t30t2007
04n2t2007
05t29/2007
05t04t2007
04n6/2007
APP
WE
APP
APP
WE
JHJ
JMP
JMP
JF
JF
To Request an inspection call the24 hour recording at 726-3769, All inspections 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.
Foundation: After forms are erected but prior to concrete placement.
Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
Structural Concrete: In excess of2500 psi. To be done during construction by a State Certified Inspector.
Provide results to City Buiding Inspector
Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector.
High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection
results to City Building Inspector.
Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test
results to City Building Inspector.
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Final Electric: When all electrical work is complete.
Reouired Insnections
Paee 3 of4
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541 -7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0s13012007APPLIED: 0312112007EXPIRES: 11/3012007VALUE: $ 840,000.00
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information 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 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 with ORS 701.005 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 of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature Date
Prse 4 of 4
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
Crav of Springfield Official Receipt
, elopment Services Department
Public Works Department
RECEIPT#: 2200700000000000917 Date: 0610612007 t2:14:2ePM
Job/Journal Number
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
Description
Temp Power 200 amps or less
Perm Serv,/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Low Voltage - Commercial Indus
+ 57o Technology Fee
+ 8% State Surcharge
+ llYo Administrative Fee
Amount Due
100.00
441 .00
150.00
45.00
36.80
58.88
73.60
Item Total:$905.28
Payments:
Type of Payment Paid By
rc
Received By Batch Number
ffi
Number How Received Amount Paid
CreditCard MIKE HUGHES
CHRISTENSON ELECTRIC
ddk 006028 In Person
Payment Total:
$905.28
s90s.28
cReceint I Page I of I 616/2007
6!lh Qr*''l o>a(6K b
Date
INITIALS
DATE
3?r FIELI' :
{ft,
zoN
225FIFTHSTREET r SPRINGFIELD,OR97477 r PH:(541)72G3753 oFAX: (54t)726-3689
E LECT RI CAL P E RM IT AP P LI CA
SOURCE
frlru,rtn 'ffiltt r rCity Job Number
1
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
Electrical Contractor @
Address -W S.DAutW /W
City Et{Ext€Phone td66-L/21
Supervisor License Number -{ U ) 1 5
L,\
LEGAL DESCzuPTION: l1O3 35 = 3 O \Nor Rcsidential - Single or i\lulti-Falnill'per dn'elling unil.
/-lex ION S?N)Atry olEl[tcAL
JOB DESCRIPTION:
(oE uL^LD U+Oe ra xl ( Fnxt't E-lfi-tIz tc at-
UPGRADE
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
200 Amps or,lgss_
201 Arnps to 400 Amps
401 Anips to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsA/olts
Reconnect Only
$50.00
,n.,,8* tdt3'oo
cjiun"n utifrP'oo
rte*ie-set flr4f,'oo
h e,iE-!r,2-0lF&00
3 o{ thc rttie$339.00
, :',--lr+e.ijj.Lr,4d0'00
$106.00
$ 19.00
C
D.
++t?
/ oQ.*.
K
[_
/SCte
Expiration Date a
Constr.Confi.Number h f V U
Expiration Date I
Signature
Name
Owners Signature
Address c{?c, 5 2 {J>
City Sot-0.1 iliDl"uJzz'b,*orirrigation
Installation, Alteration or Relocation
200 Amps or less Z $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
or 1000 Volts see "B" above.
xeg bXPfidt"rr fHl- friun
ER THi,$ PIB14tpffi.flh
$*BANBUiD $fhho0[
$ s0.00
Si grr/Outline Li ghting $ s0.00
Limited Energy/Residential $ 25.00
LimitedEnergy/Commercial I $45.00 '15'd
ee.
11 2- @, \.). --2/ 80t'l^.
seffi{of gQp{Sp,fpPFrI
tI
OWNER INMAIUTIOX
The installation is being made on properfy I own which
is not intended for sale, lease or rent.Minimum Electric Permit Inspection Fee is $45.00 * Surcharges
8% State Surcharge
10% Administrative Fee
50% Technology Fee
*S
aos.sInspection Request: 72G37 69
4.
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application 8-06.doc
3. COMPLETEFEE
41O S- Jr.,o St S"fLD. & flt1"7
ONLY
.:
B. Services or Feeders - lnstallation. Alterations or Relocation:, ' '.,:
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541 -7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007APPLIEDz 0312112007EXPIRES: 11/3012007VALUE: $ 840,000.00
SITE ADDRESS: 470 S 2ND ST Springfield TYPE OF WORK: Commercial Miscellaneous
ASSESSOR'S PARCEL NO.: 1703353301000
TYPE OF USE: Alteration Industrial
PROJECT DESCRIPTION: Removal and replacement of Formaldehyde Tank Farm.
Owner:
Address:
Contractor Type
General
Electrical
Engineer
HEXION SPECIALTY CHEMICALS
470 S 2ND STREET
SPRINGFIELD OR 97477
Contractor
ADVANCED MECHANICAL
CHRISTENSON ELECTRIC IN0 tiAf(
tollow
PhoneNumber: 541-744-3224
Phone
541-466-3939
541-688-6121
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
JHI ENGEINEERING 0090
# ofStories:
Height of Structure:
Type of Heat:
Water Type:
Path:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
nla Occupant Load:
IHE Hft
s03-223-7799
REQUIRED PARKING
Total:
Handicapped:
Compact:
U
VB
i,
180 ntOverftrj
# Street
Paved Drive Rqd:
oh of Lot Coverage:
'lt l,$floi
Sidewalk Type:
Downspouts/Drains:
PUBLIC IMPROVEMENTS
Notes:
Pase I of3
Those
through
(Note: the
lulas I
. , 6.tn_
Floor:
/s
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007APPLIED: 0312112007EXPIRES: 11/3012007VALUE: $ 840,000.00
Description
Estimate
Type of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$1.00 840,000.00
Total Value of Project
Amount Paid Date Paid
Value
$840,000.00
$840,000.00
Date Calculated
03tzu2007
Fee Description
Plan Review Comm/Ind/Public
+ l0oh Administrative Fee
+ 57o Technology Fee
+ 87o State Surcharge
Building Permit
FLS Safety Systems Review
Plan Review Fire & Life Safety
Total Amount Paid
$1,930.92
$297.07
$148.s3
$237.6s
$2,970.65
$325.00
$1,188.26
$7,098.08
4t9t07
5t30t07
st30t07
st30t07
5t30t07
5t30t07
st30t07
Receipt Number
2200700000000000507
1200700000000000644
1200700000000000644
1200700000000000644
1200700000000000644
1200700000000000644
1200700000000000644
Fees Paid
Plan Reviews
Fire Department Review 0411012007 WE
Fire Department Review 0512912007 05t29t2007 OK GRG
Initial Review 04t09t2007 04t09t2007 APP LLH
05t29t2007 APP
Paee 2 of3
Waiting on American Petroleum
Institute (API) 650 standards or
exerpts.
See attached document for Fire
Department Plans Review
comments.
Plan review fee receipted in at
Finance Department. Plans had
been in our office waiting for fee to
arrive. I transferred the payment
today. Okay to process plan review.
WI. Received structural responses
from Greg Wilberger.
Allowed by building permit only per
Sarah Summers. Similiar to a
proposal discuseed in DIM
ZON2004-00017. Applicant to
verify street side setback. Is fence
property line?
Attached SDC Worksheet. No New
SDC's. (JHJ)
See attached documents for 7
structural comments laxed to
Michael J. Smith.
Received final internal approval.
Plan Review Comments
Planning Review
Public Works Review
Structural Review
04n0t2007
04fi0t2007
04t09t2007
04t27t2007
04t3012007
04t30t2007
04fi2t2007
JMP
EMM
JHJ
JMP
IO
APP
APP
WE
Structural Review 05t29t2007 JMP
Valuation Descrintion
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007-00418ISSUED: 0513012007APPLIED: 0312112007
EXPIRES: 11/3012007VALUE: $ 840,000.00
SUB Review
SUB Review
05t04t2007
04n0t2007
05t04t2007
04n6t2007
APP
WE
JF
JF
No energy code issues or inspections,
JMP left a voice message on Michael
J. Smith's cell phone requesting the
energy code forms and information.
To Request an inspection call the24 hour recording at 726-3769, All inspections 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.
Foundation: After forms are erected but prior to concrete placement.
Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
Structural Concrete: In excess of2500 psi. To be done during construction by a State Certified Inspector.
Provide results to City Buiding Inspector
Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector.
High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection
results to Cify Building Inspector.
Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test
results to City Building Inspector.
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building is complete.
street, that the card is located at the front of
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information 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 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 Safefy.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I
further agree to that all required inspections are requested at the proper time, that each address is readable from the
property, and the approved set of plans will remain on the site at all
times during co n,
70
Owner or Contractors Signature
Paee 3 of3
Date
l(equlreq lnsDectrons I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
Ch of Springfield Official Receipt
L. elopment Services Department
Public Works Department
RECEIPT #: 1200700000000000644 Date: 0513012007 e:ll:41AM
Job/Journal Number
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
Description
Plan Review Fire & Life Safety
Building Permit
+ 5% Technology Fee
+ 8% State Surcharge
+ l0%o Administrative Fee
FLS Safety Systems Review
Amount Due
r,188.26
2,970.65
I 48.s3
237,65
297.07
325.00
Item Total:$5,167.16
Payments:
Type ofPayment Paid By Received By
Check Number
Batch Number
Authorization
Number How Received Amount Paid
Check
CreditCard
HEXION
MAUREEN GALBREATH
b
b
dj
dj
246512 In Person
017319 In Person
Payment Total:
$2,280.00
$2,887. l 6
$5,167.16
Job/Journal Number
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
coM2007-00418
Description
Plan Review Fire & Life Safety
Building Permit
+ 5% Technology Fee
+ 8% State Surcharge
+ llYo Administrative Fee
FLS Safety Systems Review
Amount Due
r,188.26
2,970.6s
148.53
237.65
297.07
3 25.00
Item Total:$5167i6
Payments:
Type ofPayment Paid By
Check Number
Received By Batch Number
AuthoiiZatibn
Number How Received Amount Paid
Check
CreditCard
HEXION
MAUREEN GALBREATH
djb
djb
246512 In Person
017319 In Person
Payment Total:
$2,280.00
$2,887. l 6
$5,167.16
cReceint I Page 1 of I 5/3012007
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
coM2007-00418
Hexion Specialty Chsmicals
JOURNAL OR JOB NUMBER
NAMEORCOMPANY:
LOCATION:
MAP & TAX LOT NUMBER:
DEVELOPMENT TYPE:
470 S.2nd St.
17 03 35 33 01000
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
5. ADMINISTRATTVE FEES:
BASE CHARGE (SI.JBTOTAL ABOVE)
Jesse Jones
Civil Engineer, EIT
No New lmpervious Area
$ 0.336 PER SF
ITE:
ITE:
LOr S|ZE (S.F.):
TOTAL STORM DRAINAGE SDC:
Tank
NEW DEVELOPED AREA (S.F.):
EXISTING DEVELOPED AREA (S.F.):
TOTAL IMPERVIOUS SURFACE (S.F.):
x $0.00
3. TRANSPORTATION No New Building Square Footegc
BLDG AREA TGSF x TRIP RATE X COST PERADTX NEW TRIP FACTOR
NEW:
A, REIMBURSEMENTCOST:
0.00 x 0 x $ 19.81 PERTRIP x 0
illap-nowpmvrcoST,
0.00 x 0 x $ 87.39 PERTRIP x 0
E)ASTTNG
A. REIMBI.]RSEMENT COST:
0.00 x 0 x $ 19.81 PERTRIP x 0
E.-lllpnovrwvrcosr:
0.00 x 0 x $ 87.39 PERTRIP x 0
2. SANITARY SEWER-CITY (see rwerse side)
A. REIMBURSEMENTCOST:
NUMBER OF DFU's 0
B. IMPROVEMENT COST
NUMBER OF DFU's
4. SANITARYSEWER-MWMC
NEW:
A. REIMBURSEMENT COST:
NLIMBER OF FEU's 0.00
B. IMPROVEMENT COST:
NUMBEROF FEU's 0.00
E)CSTING:
A. REIMBURSEMENTCOST:
NUMBER OF FEU's 0.00
B. IMPROVEMENTCOST:
NUMBER OF FEU's 0.00
MWMC CREDIT IF APPLICABI-E (SEE REVERSE)
No New Fixtures
x $ 26.03 PER DFU
x $ 19.79 PER DFU
TOTAL LOCAL WASTEWATER SDC:
NTF
NTF
$0.00
$0.00
NTF $0.00
NTF
TOTAL TRANSPORTATION REIMBURSEMENT SDC
TOTAL TRANSPORTATION IMPROVEMENT SDC
TOTAL TRANSPORTATION SDC:
No New Building Square tr'ootage
x #N/A PER FEU $0.00
x #N/A PER FEU $0.00
#N/A PER FEU $0.00
x #N/A PER FEU
TOTAL MWMC REIMBURSEMENT
TOTALMWMC IMPROVEMENT
MWMC ADMINISTRATIVE
TOTALMWMC
SUBTOTAL (ADD ITEMS 1,2,3, & 4
5%
TOTAL SEWER ADMINISTRATION
TOTAL TRANSPORTATION ADMINI STRATION
4/3012007
x
$0.00
$0.00
$0.00
$0.00
$$0.00
00
$0.00
$0.00
$
$0.00
$0.00
$
$0.00
-@
$
DATE
TOTAL SDC CHARGES
r 178
0
l 183
1 184
I 173
1094
I 054
I 186
I 187
1189
1175
I 190
NOTE: FORREMODELS.CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
Tank
TYPE
BATHTUB
DRINKING FOUNTAIN
FLOOR DRAIN, FLOOR SINK
INTERCEPTORS FOR GREASE/OII-/SOLIDS/ETC.
INTERCEPTORS FOR SAND/AUTO WASH/ETC.
LAUNDRY TUB
CLOTHES WASHER/MOP SINK
CLoTHES WASHER - 3 OR MORE (EA)
MOBILE HOME PARK TRAP (I PER TRAILER)
RECEPTOR FOR REFRIGERATOR/WATER STATION/ETC.
RECEPTOR FOR COMMERCIAL SINK/ DISHWASHER,/ETC.
SHOWE& SINGLE STALL
sHowE& GANG (NUMBER OF ITEADS)
SINK: COMMERCIAL, RESIDENTIAL KITCHEN
SINK: COMMERCIALBAR
SINK: WASH BASIN/DOUBLE LAVATORY
SINK: SINGLE LAVATORY/RESIDENTIAL BAR
I]RINAL, STALI"/WALL
TOILET, PUBLIC INSTALLATION
TOILET, PRIVATE INSTALLATION
MISCELLANEOUS:
NUMBER OF EDU'S*
*EDU (Equivalent
FXTURES
NEW OLD
UNIT
TOTAL DRAINAGE FIXTURE I./NITS:
DRAINAGE
FTXTURE
UNITS
3
I
3
3
6
2
3
6
t2
I
3
2
)
3
2
')
I
5
6
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Dwelling Unit) is a discharge equivalent to a single family dwelling (20 DFU) set at 167 gallons per day
0
CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY
YEAR
ANNE)GD
CREDIT FOR PARCEL ORLAND ONLY IF APPLICABLE
IMPROVEMENT (IF AFTER ANNEXATION DATE)
RATE PER $1,OOO
ASSESSED VALUE
$r.45
$ l.2s
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
$0.00
$0.00
$0.00
x
x
$0.00
RATE PER $1,OOO
ASSESSED VALUE
YEAR
ANNEXED
1979
I 980
l98l
1982
1983
1984
t98s
l 986
1987
1988
l 989
1990
t99l
or before $5.29
$s.19
$s.12
$4.98
$4.80
$4.63
$4.40
$4.07
$3.67
$3.22
$2.73
$2.2s
$ 1.80
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
$0.00
$0.00
CREDIT TOTAL
DRAINAGE T'D(TURE UNIT (DFTD CALCUL{TION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUTVALENT: DRAINAGE FIXTURE UNITS
SPIITI*GFIELE}
Special losPeclion and Testing
finished, ackno,gledge an "ri"*il#rg ;f tt " lrrrormario,.. by-sigLring be lo;' and rctum this form to Ge Ciry'
iiry ft. ,.ri"* and appmval this fcrrm completed on both the front and back'
Theowner and ceneral conlractor, rrhcre appticoble, shall also acknorvledge the [o!lorvingcondit'ions applicable to sprci':tt Inspection and/or'l'tsling'
I . contractor is responsibte for proper nolifrc<rt[on for the I nspeclioo or 'lesting o f itenrs I isled'
T.TestinglaboraroryshalltokenppmpriateiErnplesandtrrnsportthemlothejrlaburatoryforpropclevaluationortcsting.
r copics of nll lnboratory reporrs and inspections are to be sent to the CiB by lhc Testing r\gency'
3.spcciatlnspectionAgencyistosubmitnamesarrdqualificationsofon.sitespecial]nspectorstotheCitytbrapproval.
4. Speciallnspeclorshallprovidelnspectionr€portstolhebuildingolltcialol'atlinspeclionactivities-
5. conira.tor is responsible to rw,ierv the city apprul'ed planr for additional inspectton or tesling rtquitemenr$ that may be trolcd'
EEFOREACEnrtFrcATEoFoccupANCy\vlLr'BEISSUEO: ThespeciailnrpecrionAe;ncrslllf.lbrnittotheBuildingclrLcial astatemcntthatnllitemsreqr'riring
prrvrsions. Those items no-r;;;;;.1/",. lnspectei rbail be nored in the stgtemenr-;;;6;ii; ,o be srum:ttcoloirttcity prio' tu t' reqrrest lbr linal inspections'
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CitY of SPringfield
Commu nity Servicer DiYisio n
225 Fiflh Street
Springfield, OP.97471
Telephoner {5 4 l) 176-31 59
Fax (541) 726-3689
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ADDITIONAL I TEST, & INSPECTIONS:Form CornPleted bY
*PROVIDESTRENGTH REQUIRED BY ARC}IITECT OR ENGINEER OR CONTHT\CT DOCU}IEI\TT I-OCATION OT VA LUES
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AcceptancE lests * PSF
Establish final grade
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Soil DensitY
ST'ITUCTTJRAL STEEI,/lVELDINC:
Sample nnrt test (lisl specific members belorv)
Shon material idcntificadon (mill cerl)
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Metal strtd rvtltlirg insPection
Concrete insert rvelrting inspcr:tio t
lvlomenl resisting rtecl liarnes
STRUCTUR.{L }YOOD:
Shea" rvatl nailiog insPection
Shear rvatl archors
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Fobrlcation rvelding of sleel accealor'ies
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