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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