HomeMy WebLinkAboutPermit Building 1994-02-15CO M M ERCIAL/ I N DUSTRIAL
PEBMIT APPLICATION
225 Flfth Street, Sprlngfleld, Oregon 97477
SPFIINGFIELO
uCa ruuugeR
INSPECTION LINE: 726.3769
OFFICE: 726.3759
LOCATION OF PBOPOSED WORK://1,/3 *-
ASSESSOBS MAP:,/?-d3-<1*2/TAX LOX
,4;zgzs ZIP:
'NEW ,(OTHER VALUE:
STATE:7^! ;
A oLt
PHONE:.6vf
ONREMODEL
OESCRIPTION OF WOBK:
CITY:
ADDBESS:
OWNERI
NAME ADDRESS PHONE
PHONE2)ry.e EXPIRESCONTRACTOR'S NAME
ARCHITECI':
MECHANICAL:
ELECIRICAL:
PLUMBING:
GENERA
CONST.
CONTRACTOR ,r
NO FEE CHARGE
Slngle Flxture
Relocated Bldg.
(new llx. addtl)
Water Servlce
ft
Sanltary Sewer
ft.
Storm Sewer
ft.
Backllow Devlce
TOTAL PERMIT
NO EFtr EHA FIGE
Furnace/burner & vent
100,Q00 BTUs
Furnace/burner & vent
>100,000 BTUs
Floor furnace and vent
Suspended wall or floor
mounted unlt heater
Appllance Vent
separate
Stallonary evap.
cooler
Vent Fan/Slngle
duct
Vent System apart
lrom AC or htg.
Mechanical exhaust
hood and duct
Permlt lssuance $10.00
TOTAL PERMIT
r OF STORIES:
- OFFICE USE -
ZONING:
LAND USE:
OCCY GROUP:
-
QUAD AREA:
r OF BLDGS:
CONSTB. TYPE:
HEAT SOUBCE:
r OF UNITS:
HANOICAP ACCESS:
FLOOD PLAIN:
LIGHTING POWER BUDGET:
WATER HEATER:-
SO, FT.$/SQ. FT.VALUE
x
X
TOTAL VALUE OF PROJ
SO. FTG MAIN
SO. FTG ACCESS
SO. FTG OTHER
RCPTI'iDATEBYPLAN CHECK FEE 82 /3
BUILDlNG PERMIT /3/.9a PLUMBING DEMOLITION
5% State
Surcharoe Q..Z>,5% Stato
Surcharoe
MECHANICAL FENCE
VALUE $
5% State
Surcharoe
SIOEWALK
FT.
SUBTOTAL
PERMITS //u ??
PAVING CURBCUT
FT.
SYSTEMS
OEVELOPMENT
a2-'PTOTAL PEBMIT FEES
EXCLUOING ELECTRICAL
,{
z4_
^
REQUIRED INSPECTIONS
It ls the responslblllty of the permlt nitOe, to see that all lnspectlons are made at the proper tlme. To requost an lnspectlon, call
726.3769 (recorder), etate your Clty deslgnated Job number, lob address, type of lnspectlon requested and when you wlll be ready
for lnspectlon. Requests recelved before 7:00 a,m. wlll be made the same worklng day, requests made after 7:00 a.m. wlll be made
the followlng work day.
SITE INSPECTION: To be ROUGH PLUMBING, PAVTNG: After gravel is ln
mado after excavatlon, but ELECTRICAL & place but prlor to placlng
prlor to setup of forms. MECHANICAL: No work ls to asphalt or concrete.
be covered untll these
UNDERSLAB pLUMBING, lnspectlons have been made SpEC;AL INSpECTIONS: ln accordance
ELECTBICAL & and approved. Sectlon 306 of th€ State Speclalty Code
MECHANICAL: To be made a speclal lnspector shall be employed
before any work ls covered. ATTIC DRAFT STOPS & Uy ine Ownei/ Contractor durln!CURTAIN WALLS constructlon of the followlng w6rk. A'/ FOOTINGS & FOUNDATIONS: copy of the epeclal testlng r-eports shall7t- i;b;-;;; atter trenches are FIREPLACE: Prlor to placlng be'furnlshed io the Bultdtig Dlvlston.
excavatect and forms are faclng matsrlals and before. erocted, all steel ln place, but framlng lnspectlon' STRUCTURAL CoNCRETE: lnprlor to placlng concrete. FRAMING: To be made after excess ol 25OO pS.l. (306 a.1)
coNcRETE SLAB: To be the roof, all framlng' flre
made afrer ail rnsrab buildrns Bl::|,lfio":fl Bi'3:It";,';l:r" BIX3,fl"T|"t H5t,3of',,rrn osorvlce oqulpment, condult, and vents ar€ complete andplplng, accessorles and other
iricrrri'rv equrpment rtems are n'. H',":Hli'ji'':,'J' j#[?lH Bl?,If],?=o}?H,:.i#st"nln place but before any errrv'vv'
lghtenlng operalons. (306concrete ls placed. INSULATIoN & vApoR a.6)
UNDERGRoUND: prumbrns, lntll:',ffi *ff ffi:;rX:"J"?" spRAyED oNelectrlcal, gas, sanltary sewer, barrlers are ln plabe but FIREPROOFING: U.BC.storm sewer, water and before any lath or gypsum Standards 43.g.dralnage llnes. To be made board lnterlor wall-coverlng lsprlor to coverlng or fllllng applled. 6hEAr^trenches. SPECIAL GRADING, t
,NDERFL..R: prumbrns,
-
[l1"t,St"t"tf;m'JfllLg}tt, ff:,il!il'-tli:dJbtj],"t
etectrlCatlmechanlcal. T5'be accordlng to ptans. chapter 29)
made prlor to lnstallatlon of
floor lnsulatlon, decklng or LATH ANDTOR GYPSUM GLU'LAM BEAMS: lnspectlon
lloor sheathlng. BOARD: To be made after all Certlflcate by an approved
lathlng and gypsum board, gS9ncy, furnlshed to the Clty's
pOST & BEAM: To be made lnteilol and eicierlor, ls ln ' Bulldlng Dlvlslon before
prlor to lnstaltailon of floor place but boforo any 99qq" qre placed. (2501 U.BC.
insulatlon, decklng or floor plasterlng ls appllei or before STDS. 25'10'11).
sheathlng. - gypsum board lolnts and
fasteners are taped and STRUCTURAL MASONRY: (306
FLOOR TNSULATTON & flnlshed. a.Zl
VAPOR BARRIERS: To be
mad6 prlor to lnstallatlon of
decklng or lloor sheathlng.
MASONRY: Steel locatlon,
bond beamg groullng or
vertlcalg ln accordance wlth
uBc 2415.
ROOF SHEATHING AND
NAILING: Prlor to lnstailtng
any roof coverlng.
S]DEWALK & DRIVEWAY:
Requlred for all concrete
pavlng wlthln street rlght of
way, to be made after all
excavatlng complete and form
work and sub.base materlal ln
place.
CURB AND APPROACH
APRONS: After forms are
erectod but prlor to placlng
concrets.
'ln addltlon to the lnspec.
tlons specllled, the Bulldlng
Offlclal may make or requlre
other lnspectlons of any
construotlon work to ensure
c_ompllance wlth the Bulldlng,
Clty or Development Gode. -
FINAL PLUMBING
FINAL ELECTRICAL
FINAL MECHANICAL
SITE PLAN REVIEW BOARD: Musr be requested 2 days ln advanceof the date you wlsh tnspecilon. All prolect condltloni sucn iJ '
landscaplng, parklng lot strlplng, etc. must be completec, befoierequestlng thls lnspecilon.
FINAL aUtlOittC: Requested after the flnal ptumblng, electrlcal,mechanlcal and Flre Department lnspectlons are made andqpproved. No occupancy of the premlses can be made untll acertlflcate.of occupancy has bsen issued by the gurrolng-6rvtsron
and posted on the premlses.
tt/
r/
ADDITIONAL COMMENTS:
By slgnaturq I state and agree, that I have carefully examlned the completed appllcatlon and do hereby certlfy that all lnformatlonhereln ls true and correct, and I further certlfy that any and all work performed shall be done ln acoordance wlth the Ordlnancesof the Clty of Sprlngfleld, and the Laws of the State ol Oregon pertalnlng to the work descrtbed hereln, and that NO OCCUpANCywlll be made of any structure wlthout permlssion of the Bulldlng safety Dtvlslon. I further ceril fy that only contractors and emptoyeeswho are ln compllance wlth oRS 701.0ss wilr be used on this proJect.
PLANS REVIEWED BY o^rE 2/*2r'
ensure that all requlred lnspectlons are requested at the proper tlme, that project address ls readable from thestreet, that the ls at front of the propert% and the approved set of plans wlll remaln on the slte at alltlmes durlng
Slgnature Date
BECEIVED:DATE PAID:VALIDATlON:
on.
RECEIPT T:
'?72.>>
RECEIVED BY;
tb k6 "ts
I further agree
,
/z7g
225 North Fifth StreetSpringfield, 0regon 97417
FENCE PBRHIT APPLTCATION
CITY OF SPRINGFIBLD
BUILDTNG SA.FETY DIVISION
SPFlINGFTELE,
0ffice:
INSPECTION LTNE:
Job Location:U czTA
Assessors Mup *t fl 05 Lv Tax Lot {t: 7,'lr(1?k
0vner:L,b
Addressr I 511 5vxl.:'i DLr)f Phone #:
ct ty: eil*r:f-
Value of Fence , i r,qco
Contractor/fnstaller, 0U.l$68
State Of-
Fence Permit is 95.00
zip:q1 +o +
Address:
Ci ty:
Phone #:
zi p:
Construction Contractors Registration #:
iy signing this permit/a pplication, I agree to call for an ins peetion once myfence has been construct ed (726-3769).I also stated that aII information onthis application/permi t is correct and t hat I vas provided vith the Springfield .Develo nt code requirements for fence s tandards.
Date of Application:
Receipt lf
Tota1 Amount Collected:
S tate :
)
te
FOR OFFTCE USE
JOB #:
Issued By:
s t
V-Clrecked f or Delinquene i e.s :
OD
Checlced for Historical. Starrrs:
726-3759
726-3769
SPRINGFIELD JOB T BER 4SIGN PERMIT APPLICATION
225 Fifth Street
Springf ield, OR 97 477
SITE ADDRESS:
ASSESSORS MAP:
OWNER:
lnspection Line: 726-3769
Office:726-3759
tn
PHoNE: btc - L115
ADDRESS tb11 9uAs1 9L
T LOT:
CITY ST ZIP:11+ac+
BUSINESS NAME, FIRII/ E[C.:
DESCRIPTION OF PROPOSED SIGN(Sl: (please check and complete all appropriate inlormationl
. Wall X Fr"".tanding
-
Projecting
-
Roof
-
Marquee
\a Sinole Face Double Face Billboard Other
Square Footage:,t . N{r4p Total Height above Grade:4.'-o"
Vertical Dimension of sign or enclosure:
-- -JAi-am - HorizontalWidth n or enclosure: 1' - It-l
Dimension lrom Grade
to bottom of Sign Enclosure:
Electrical lnstallation: _ YeL'- O"(lf yes additional electrical permit
VALUE
} OF SIGN:6oo e
Material Sign is constructed of :hlooP
List ALL existing signage and attach a photograph of each sign:
(al Type
(cl Type
Sq. Ftg..
Sq. Fts.
(bl
(dl Type
Sq. Ftg.
Sq. Ftg.
CONTRACTOR/IN STALLER:olr$a-PHONE:
ADDRESS:
CITY
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER:
CITY BUSINESS LICENSE NUMBER:
STATE:_ ZIP:
EXPIRES:
EXPIRES:
OFFTCE USE
Sign Distri
Zoning:
Sign Permit Fee
REOUIRED INSPECTIONS:
_ Site
to be made prior
to sign placement
Use:
Code Section:
Approved By:
Quad Area:
Electrical
prior to energizing
electrical installation
DATE
_L Footins
prior to placement
of concrete
Attachment
after fasteners are
installed/prior to cover
{r,nu,-completion ol stgn
installation
Additional Comments and/or Conditions:
By signature, I state and agree, that I have carefully examined the completed application and do hereby certily that all information herein
is true and correct, and I lurther 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. I further certify that only contractors and
employees who are in compliance with ORS 70'l .055 will be used on this prolect.
Validation:
Receipt Number:
rty, and thep;d of
Received By:
I lurther agree to ensure that
the permit card is located front of
of the sign(sl
Signature
Amount Received:
are requested at the proper time, that pro.iect address is readable {rom the street, thattn
plgnp will rerpain on the site at all times during the installation
4>4/"7
Date
Date Paid:
SIGN PERMIT APPLICATION
The application on the reverse side needs to be completed entirely. lf you are the sign contractor/installer, or if you are
hiring a contractor, you need to make sure that both the City of Springlield Business License Number and the Registration
Nunrber lrom the State of Oregon Construction Contractors Board are listed on the application along with the expiration
date of each.
lf the sign you are proposing to install is illuminated, an electrical permit application also needs to be completed and signed
by either a supervising electrician, limited sign electrical contractor, or if you are the business owner who also owns the
building in which you are occupying, and you will be performing the electrical installation yourself, you may sign the
electrical application.
lf there are existing wall and/or freestanding signs, a photograph(sl of each exlsting sign noeds to bs attached to the
application. The size of each existing sign also needs to be listed on the application.
PLANS
To submit for a sign permit, you need to prepare two complete sets oI drawings showing all dimensions, total height, and
a plot plan indicating where the proposed sign will be located. lf you are installing a freestanding sign which exceeds 20
f eet in total height, the looting detail needs to be prepared and stamped by a registered engineer or architect. Alter the
plan review process is completed, and, if your sign(sl is approved, one setof plans will be returned to you. The approved
set of drawings need to be at the site when an inspection is requested for the inspectors reference.
INSPECTIONS
Depending on your sign(sl, you may be required to request one or all of the following inspections during the installation
of your sion:
Site:To be requested after indicating on the lot where the proposed sign will be located but prior to any work
being performed for the installation of the sign. This inspection is required if there is a question on the
location of the proposed sign.
Footing To be requested after excavation and the forms are installed, but prior to pouring concrete. lf there will be
electrical conduit placed in the f ooting, it must also be in place prior to requesting this inspection.
Attachment: To be requested when all fasteners are installed but prior to cover
Electrical: To be requested after the electrical connection to the sign is made, but prior to energizing
Final:Alter all required inspections are conducted and approved and the sign installation is complete
Ttre inspections that are required for your sign installation will be indicated on the application during the plan review
process. Failure to request ANY of the required inspections could result in sign removal in order to inspect the sign at the
required intervals of work.
To request an inspection, phone 726-3769. This is a 24 hour recording. On the recording you will need to leave your City
Designated Job Number, location of where the sign is being installed, the type ol inspection you are requesting, and when
you will be ready for the inspection. All inspections called in to the recorder prior to 7:00 a.m. will be made the same
working day, all inspections phoned in after 7:O0 a.m. will be made the lollowing work day.
lf you have any questions regarding the application, required plans or inspections, please leel lree to phone the Building
Safety Division at 726-3759
City of Springtield
Building Safety Division
225 Fitth Street
Springfield, OR 97477
Tl^liov.ring project e.e submitleC has the foilowing
z( ,, and d,les nct require epecific lanC use
aptr'uVal.
OFEGSCITY OF SPF
2{L
LECAE DESCRTPTION
JOB
Pcrmlts ara non*transf,erablc arld cxpire
if vork is not started rrithin 180 days
of lssuance or if vork ls suspended for
180 days.
2. CONfRACTOR INSTATTATION ONLY
EIect rical Contractor
Address blrOO ^,,6 >3.d c-(
SPRIt\rGFIELO
EI.ASIRICAL PSRHIT APPI,JCAUON
Ct ty Job Nunber
3. CO}fPI.gtg TEE SCEBDUI^E BELO1I
A- Neu Resldelrtial-Single or
llultl..FamllY Per dvelllng unlt.
Service Includedl
I tems Cos t
s 85.00 +Jtr
D*e -q
Surn
1000 sq.ft. or less
Each additional 500
sq. ft or Portionthereof
Each Hanuf'd Home or
Hodular'ttvelllng
SerVice or Feeder
Services or FeedersInstallation, Alterations
or Relocation;
$ 15.00
$ 40.00
50.00
60.00
100.00
130.00
300.00
40.00
-9
cl ty fnzrt t ,c Phone Soi ZSt L4o?
Supervisor License Number a,t qn*g
Expiration Date
Constr Contr. Number qbG 7
Expiration Dare *o L-24
si sl cian
Ovners Name
Address
Cl rv Phone
OVNER INSTALT,AITON
The installation is being made on
property I orrn vhich is not intended
for sale, lease or rent.
Ovners Signature:
200 amps or less
201 amps to 400 amps
401 amps to 600 amPs
601 aops to 1000 amPs
Over 1000 amps/volts
Reconnect onIY
Temoorarv Services or Peedsrsrnsiallailon, Alteration or Relocation
200 amps or less $ 40.00
,oi ;;; io aoo anps
-
$ ?1.99
-
Over 4b1 to 600 amps --l $ 80.00
over 500 amps or rbOO-v6Tis see rrB" aE6te-
Branch Circults
Nev, Alteration or Extension Per Panel
B
c
5 $
$
$
$
$
$
.25o
_:.-
D
One circuit $ 35'00
Each Addi tional
:lT:::":'rxl,ll,'""1i2 s 2.oo al*
E. I'liscellaneous (Service/feeder not included)
-Each ins tallation
Fump or irrigation S
SigirzOutline LightingT !
Limi ted EnergY/Res
-
$
Limi ted enertyu Comm
-
$
40.00
40.00
20.00
36 .00
DATE:
RECEI
o5SUBTOTAL OF ABOVE
5Z State Surcharge
32 administrative Fee
1OTAL6a^rr?trtfn El
s '?.-
225 gTYTfl STREET
SPRIfiGEELD, OREGoN 97477
INSPECf,ION REQUUST" 726-3769
OPPICE: 726-3759
1. LOCATION 9p 11,151er.tATI0N_.
1 q 14 il 5r t* sYre'-r
bb
CO M M ERCIAL/ I N DUSTRIAL
PERMIT APPLICATION
225 Fifth Street, Springfield, Oregon 97477
!iPRINGFIELO C'JOB NUMBER
INSPECTION LINE: 726-3769
OFFICE: 726-3759
/2
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:'*D 7 z-a 2- d TAX LOT:
PHONE:
ZIP:STATE:CITY:
ADDBESS:
OWNER:
VALUE:ADDITION DEMOLISH OTHER
ELECTRICAL:
NAME ADDRESS PHONE
ADDRESS EXPIRES PHONE
PLUMBING
ARCHITECT
MECHANICAL:
CONTRACTOR'S NAME
GENERAL:
CONST.
CONTRACTOR d
NO.FFF CHARGF
/Single Fixture /oe zpa+
Relocated Bldg.
(new fix. addtl)
Water Service
ft
Sanitary Sewer
ft
Storm Sewer
ft
Backf low Device
TOTAL PERMIT "%po
MECHANICAL
N r'l FFF (:HA RGF
Furnace/burner & vent
<100,000 BTUs
Furnace/burner & vent
>100,000 BTUs
Floor furnace and vent
Suspended wall or f loor
mounted unit heater
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Slngle
duct
Vent
f rom
System apart
AC or htg.
Mechanical exhaust
hood and duct
Permit lssuance $10.00
TOTAL PERMIT
- OFFICE USE _
LAND USE:
ZONING* OF UNITS:
HANDICAP ACCESS:
FLOOD PLAIN
LIGHTING POWER BUDGET:
WATER HEATER:
OCCY GROUP:
* OF STORIES:
QUAD AREA:
r OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
SQ. FT.VALUE
X
X
X
SQ. FTG MAIN
SO. FTG ACCESS
SQ. FTG OTHER
RCPT#DATEPLAN CHECK FEE BY
2/"6 0
BUILDING PERMIT PLUMBING 'b,dv DEMOLITION
5% State
Surcharoe
5% State
Surcharoe
t'flt'- A.,
MECHANICAL FENCE
VALUE $
5% State
Surcharoe
SIDEWALK
FT.
SUBTOTAL
PERMITS
PAVING CURBCUT
FT.
SYSTEMS
DEVELOPMENT
TOTAL PERMIT FEES
EXCLUDING ELECTRICAL
?7/t4
Ag.b 79 c-
$/SQ. FT.
TOTAL VALUE OF PROJECT-
REQUIRED INSPECTIONS
It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call
726.9769 (recorder), state your City designated iob number, job address, type of inspection requested and when you will be ready
for inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made
the following work daY.
SITE INSPECT|ON: To be ROUGH PLUMBING, PAVINGI After gravel is in
made after excavation, but ELECTRICAL & place but prior to placing
prior to setup of forms. MECHANICAL: No work is to asphalt or concrete.
be covered until these
UNDERSLAB pLUMBING, inspections have been made SPECIAL INSPECTIONS: ln accordance
ELECTRICAL & and approved. section 306 ()f the state specialty code
MECHANICAL: To be made a special inspector shall be employed
before any work is covered. ATTIC DRAFT STOPS & oy ine Owner/ Contractor during
CURTAIN WALLS construction of the following work. A
FooTINGS & FoUNDATIoNS: E,DEDT A^E. E copy of the special testing reports shall
To be made after trenches are FIREPLACE: Prior to placing be furnished to the Building Division.
excavated and forms are facing materials and before
erected, alt steel in ptace, but framing inspection' srRUcruRAL CoNCRETE: ln
prior to placing concrete. FRAMING: To be made after excess of 2500 PS.l. (306 a.'l)
coNcRETE SLAB: To be the roof' all framing' fire
made arter an insrab buirdins ;n:l'::.':l Sfjlt;';;:r" F:R:,"J"'J3},Y5[Tirrr, ,
service equipment, conduit, and vents are'complete and
3i?[,?;""",",:;il:? ?i:L""'::J :X? H::H]tii:,X'J,$[3:t: Bl?lf],?E],?l*,?i*l5i".
in place but before any tightening operations. (306
concrete is placed. TNSULATION & VApOR a.6)
BARRIER: To be made after all
UNDERGROUND: Plumbing' insulation and required vapor SPRAYED ON
electrical, gas, sanitary sewer, barriers are in place but FIREPROOFING: U.BC.
storm sewer, water and before any lath or gypsum Standards 43-8.
drainage lines. To be made board interior wall covering is
prior to covering or filling applied. S'EC,AL GRAD'NG,trenches.
,NDERFL..R: p,umbing [;1:,ST'fm'J3[H]* EM1!iil''tll:'5Jbi]'"t
electrical, mechanical. To be according to plans. chapter 29)
made prior to installation of
floor insulation, decking or LATH AND/oR GYPSUM GLU'LAM BEAMS: lnspection
floor sheathlng. BOARD: To be made after all Certificate by an approved
lathing and gypsum board, agency, furnished to the city's
posr & BEAM: To be made interiol ano elierior, is in Building Division before
prior to lnstallation of floor place but before any beams are placed' (2501 u'Bc'
lnsulation, decking or floor plastering is applied or before STDS' 25-10'11)'
sheathlng. gypsum board joints and
fasteners are taped and STRUCTURAL MASONRY: (306
FLooR TNSULATToN & finished' a'7)
VAPOR BARRIERS: To be
made prlor to installation of
decking or floor sheathing.
MASONRY: Steel location,
bond beams grouting or
verticals in accordance with
uBc 2415.
ROOF SHEATHING AND
NAILING: Prior to installing
any roof coverlng.
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material in
place.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
'ln addition to the inspec-
tions specified, the Building
Official may make or require
other inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
By slgnature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
herein 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 further agree to ensure that all required inspections are requested at the proper time, that project address is readable f rom the
street, that the permlt card is located at the front of the property, and the approved set of plans will remain on the site at all
-// -Slgnature Date
ontimes durlng
VALIDATION:
t
AMOUNT RECEIVED:
RECEIPT #zZqrL{
GO
RECEIVED BY:
DATE PAID:
FINAL PLUMBING
FINAL ELECTRICAL
FINAL MECHAN!CAL
FTNAL FIRE DEPARTMENT
SITE PLAN REVIEW BOARD: Must be requested 2 days in advance
of the date you wish inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
requesting this inspection.
FINAL BUILDING: Requested after the final plumbing, electrical,
mechanical and Fire Department inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been issued by the Building Division
and posted on the premises.
PLANS REVIEWED BY DATE
ADDITIONAL COMMENT",
CO M M ERCIAL/ I N DUSTRIAL
PERMIT APPLICATION
225 Fillh Street, Springfield, Oregon 97477
SPRIt.GFIELO JOB NUMBER ?
INSPECTION LINE: 726-3769
OFFICE: 726-3759
LOCATION OF PROPOSED WORK:fit+ N qfl
. OT , LL ,L,1 nbft
l1 TAX LOT:0ASSESSOBS MAP:
PHONE:OWNER:2/7-9jr6
STATE:CITY:OLoMe)g
ADDRESS:
ZIP:1t4o*
bb\ n1q
dtrY DL,h1q 9e
i.TTW X REMODEL ADDITION DEMOLISH OTHER
oot4?tof
VALUE:
tt, Urr r f A?f .DESCRIPTION OF WORK:
PHONENAMEADDRESSd6il
EXPIRES PHONEADORESS
I
Iobettq avc?1b rlf, b
lW* O@ct A,tvt . {rrr- 0+t11 1Lb. obill
MECHANICAL
ELECTRICAL:
CONTRACTOR'S NAME
AfigTtlTEoF
coNsr.
CONTRACTOR #
GENERAL:
PLUMBING E',l6lb 1?q, uq.bc-t ?o bove*v$*
PLUMBING
NO.FEE CHARGE
I
I
Single Fixture
Relocated Bl
(new fix. add
dg.
t t)
?a I Water Service 66tt /4o
/y47 sanitary s"*.r grlra1,.zro,a
86y Storm Sewer Wft 1/d,e
2W Backf low Device /2 2a.Q
/a?z',Dn+L,vr /?q.4
TOTAL PERMIT ?6;
MECHANICAL
NO trFtr l1I{A EIGF
Furnace/burner & vent
<100,000 BTUs
Furnace/burner & vent
>100,000 BTUs
Floor furnace and vent
Suspended wall or f loor
mounted unit heater
qb Appliance Vent
separate v ,UE-*
Stationary evap.
cooler
t?b Vent Fan/Single
duct 7 ,/&.n
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duct
Permit lssuance $10.00
TOTAL PERMIT 77a*
5tr ZONING* OF UNITS:
LAND USE:
HANDICAP ACCESS:
FLOOD PLAIN
LIGHTING POWER BUDGET:CONSTR. TYPE:
HEAT SOURCE:
OFFICE USE _
\\34
OCCY GROUP:
* OF STORIES:
QUAD AREA:
S OF BLDGS:
,@.<Z %c wArER HEATER;
VALUE
a_ ro
la4?7y."^a4€-
TOTAL VALUE OF PROJ
$/SQ. FT.
32./oSQ. FTG MAIN
SO. FTG ACCESS
SQ. FTG OTHER .
SQ. FT. \
FEE2@.-51-lz1t4 5-r 4 /i^rt*'"-PLAN CHECK DATE BYRCPT#
(I
?//aey."g
BUILDING PERMIT OE7)2
PLU M BI NG ?er,d DEMOLITION
5% State
Surcharoe t4 5% State
Su rcharqe
br-r'7 4*:E
vecntucat /5.7 /'32r4a47z_4 FENCE
VALUE $
JZ>
5% State /e/.o ,?aa SIDEWALK
FT.
SUBTOTAL
PERMITS f,/zz. /A
PAVI NG CURBCUL--,b Fr./f- {a SYSTEMS
DEVELOPMENT 'e s,goF, lv
TOTAL PERMIT FEES
EXCLUDING ELECTRICAL
Willamalane
Park & Recreation District
lob No.
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAM PHONE:
srArE:Qr,, qh04
ADDRESS:
LOCATION OF FROPOSED SITE:
Street Address if Known:
Platt Name:Tax Lot Number:
DEVElOpfvlENT TYEE (Check appropriate dwellingG). SDC Calculations and dwellingtype
ffit.l1
A. Single Family - Detached
Single FamilY home
NO OF UNITS
B. Single Family - Attached
NO OF UNITS
C. Multi-Family APartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS
mu Services
Manufactured home not in a Park
X $400 PER UNIT =
X $370 PER UNIT =
X $277 PER UNIT =
X $280 PER UNIT =
$
$
$
$
\5b\2---T-
$ \5F\2-WPRD SDC
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAT WPRD NEr SDC ASSESSED (lf SDC reduced for credit)
$U
City of Springfield
Date
$l5Fl2/
r-
flocto
CITY OF SyIIINGFIELD SYSTEHS DEVELOPh"T{T CIIARGE
RKSHEET
ERCIA & RESTDENTIAL)
NAHI 0R ColtPAl'tY:
LOCAT I0l'l:
DEVELOPI'IENT TYPE : SC [/*r,/ 4 ,1, Mr4
r4
BUILDING SIZT:T siz
I . STORI.I DRA I NAG E
TMPERVIoUS SQ. FT.5823i x so. 203 PER SQ. ' FT.
2. SANITARY SElllER-CITY
b/X 542.08 PER PFU
3 TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
sc x o.s8 x s424.31
x s424.31x
x _ x s424.31
4. SANITARY SEh'ER-l'll{l'tc
N0.0F PFU'S b/C x $15.125 PER PFU + $10 Hh'HC ADM FEE
(Use PFU Total From [.tem 2 Above)
Mh'r'rc CREDIT IF AppLICABLE (SEE REVERSE)
TOTAL-HWMC SDC
SUBToTAL (ADD ITEHS 1,2,3 & 4)
5. ADHINISTRATIVE FEES
. Ft.
NO. OF PFU'S
(See Reverse)
s
s
BAS (TAL ABoVE) X .os
s ?32/.oo
//3.o 7
s 6276 7, rd
3 8 ,f,2
2/ s.?
3t 38,
SDC Co nator
TOTAT SDE CS o7. /
FlxTUHtr, UNI l U,{l-v\-, U1 l .\./l! l nULL. |\1,,..!rLl \,1 .i!
i"r ,a-tg"ls. c:rtctrl}io orrly llrc t'JET :r("Jiiiorr;tl li'itrrt':')
r.,tLr!.lsEIl Lrl:
FIXTUnE n'PE \--, tJE\i'f l'\lUnES
-
L'l{11'
l: OLll\'r"L E IJT
r IXI UNE
U'.JITS
/o8S4:l
:
:l
3
6
2
6
6
I
3
2
I
2
2
1
33th1ub.......
Drinking Fcrurri;ii:t..."'
Floor Drain """ :"'
lnlerceplors For Grease/Oil/SolidsrE!c" " " "" " ""
lnl ercepiors For Sand//'ut o \"'a slrlEl c" " " " " " " " "
taurdry Tub/Gothesrvasher.' " "'
Clothe*rasher' 3 Or l'4ore.....
lJobile Hdriie Park Trap (l Per Trailer)""""
R eceplor Fgr Fef rigerat orfVal e r S t at ion/ Et c" " " "
F ecepior For Commerclal S ink/Dishr"'a she r/El c"
{C - rl2
-a-
tE-
eb
^4-
diHShorver. Single'Stall..
Shower. Gang......-...'
S!nk, Bar. Commercial
' Urinal. Stallf{all..-.5bWash Basin/tevatory. Single"""""""
Yr'ater C)oset Public lnstallaiion.
Vrtater C{oset. Frivaie...-....5O
l,liscellaneous:
TOIi.L FIXTUiE Ui\'lTS b/b
CREDIT CALCUI-A,TION TABLE: tsaseJ on assessd vatue. lf imp;ovements occurra) a?,er annexation daie in table'
<(.
b
calculate creii',s Ietes.
Cred?t for Parcd or t.ard Onty lf Applicable
lmprovement Crf after annexation date)
x s 3s.2, o
(Rate X Assessed Value)
// r.o7
xs
(Rate X Assessed Value)
CREDIT TOTAL = s l/ 3' o 7
RUNOFF COEFFICIENTS FOR STOBM DBAINAGE
Residential......
Commercial....
lndustrial....
Governmental................'.-....
0.4
0.9
0.45
0.5
Ye.r
Annexerj
Fate per 51,000
AssessaJ ValueYear
Annexed
Faie per 51,0S,9.,rargg3 Valu9
1979 or before
193C
1931
1*2
1933
1934
1995
s3.21
3.13
3.09
2.q;
2.e2
2.63
2.51
i995
1 937
19e8
1939
1-o39
1.o31
1932
s 2.24
1.93
1.57
1.1 I
0.79
0.44
0.28
urpERVroUS AREA = TOTAL LoT SlzE x RUNOFF coEFFlclENT
,-7
'4
ff >- V66-Mo.-
siPllII{GFTELD
225 FTFTE STREET
SPRINGFTELD, OREGON 97477
TNSPECTION REQUESTz 726-376
OFFICE: 726-3759
ELECTRICAL PERHIT APPLICATION
city Job N*b", 7 /O6@
COHPLETE FEE SCEEDTILE BELOV
zoning, and does nol
approval.
Authorized
Zrnins-UZ--
ga.34-Q!-
1. LOCATTON OF
I..EGAL DESCRIPTION
PTTON
Address
cit
Supervisor License Number
Expiration Date
Constr Contr. Number 67/4=
Expiration Date
s ture of
Ovners Name
Nev Residential-Single orMuIti-Family per dvelling unit.Service fncluded:
Items Cost
3
A
Sum
Permits are non-transferable and expireif vork is not started vithin 180 diysof issuance or if work is suspended for
180 days.
2. COITIRACTOR INSTALT,ATTON ONLY B
.E+ect=ha+-Con t rac t o, @
1000 sq.ft. or less
^ Each additional 500
sq. ft or portion
thereof
Each Manuf,d Home or
-
$ 8s.00
$ 1s.00
$ 3s.00
$ z.oo
Service or Feeder $ 40.00
Services or FeedersInstallation, Alterationsor Relocation:
200 amps or less
201 amps
Yhone ??-?)F ,r431 amps
1 amps
c.
to 400 amps
-to 600 amps
-to l-000 amps-
amps/voIts
-
s s0.00
s 60.00
$100.00
$130. 00
$300.00
s 40.00
Over 1000
Reconnect 0n1y
Temporary Services or FeedersInstallation, Alteration or Relocation
D. Branch Circuits
Nev, Alteration or Extension Per panel
;3? :ffi: :: lffi".,," 5 3 13:33 w
over 401 to 600 amps
-
$ 80.00
Over 600 amps or 1000-voT[s see uBu a66E
adire'ss
Ci ty Phone
One Circuit
Each Additional
Circuit or vith Serviceor Feeder PermitOgNER TNSTALI.ATION
The installation is being made onproperty f ovn vhich is not intendedfor sale, lease or rent.
Ovners
E. Miscell-aneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0ut1ine Lighting-
Limited Energy/Res
-Li+ited Energy/Qomm.?+ryr'zZf rX
SUBTOTAL OF ABOVE
ry
40.00
40.00
20.00
36.00
$
$
$
$
DATE:5Z State Surcharge
3Z Administrative Fee
TOTALRECEIVED
ure:
5 -.8o