HomeMy WebLinkAboutPermit Building 1995-02-23RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WOFK:-
ASSESSOHS MAP:
LOT:
IELD
JOB NUMBEB
225 Fifth Street
Sprlngfleld, Oregon 97477L
TAX LOT:
BLOCK:SUBDIVISION:-
lon, you must call 726'3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. wlll beng day, lnspections requested after 7:00 a.m, wlll be made the followlng work day.
REQUIRED INSPECTIONS
Slte lnspectlon - To
after excavailon, but o?i"nio" ffi;;"t: Electrlcal - Prlor to l!filnar Etectrtcat - when alt
settlng forms. Felectrlcal work is complete.
n Underslab Ptumblng/Electrical/
-
Mechanlcal - Prlor to cover.
To request an lnspectl
made the same workl
f] TemPorary Etecrrtc
Footlng - After trenches are
excavated.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - prior
to fllllng trench.
Post and Boam - Prlor to floor
lnsulatlon or decklng.
Rough Mechanlcal - prlor to
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Flnal Plumblng - When allplumblng work ls complete,
Flnal Mechanical - When allmechanlcal work ls complete.
K flftnat Buitding - When al
)f--requlred lnspectlons have been/ approved and bullding is
completed.l-l Masonry - Steel locailon, bond
-
beams, groutlng.
N
I-l Underlloor Plumblng/Mechanlcat
Prlor to lnsulatlon or decklng.
E'
Wall/Celllng lnsulatlon - Prlor to
cover.
Drywall - Prlor to taplng
Wood Stovo - After lnstallatlon.
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prlor toplacemcnt of concrete.
Sidewalk & Drlvewav - After
excavatlon ls complete, forms
and sub.base materlal ln place.
Fence - When completed
Street Trees - When all requlred
trees aig ptanted.
Other
MOBILE HOME INSPE TIONS
Blocklng and Sot.Up - When ailblocklng ls complete,
Plumbing Connecllons - When
home has been connected to
water and sewer.
Electrical Conneclion - Whenblocking, set.up, and plumbtng
lnspectlons have been approved
and the home ls connected tothe servlce panel.
Flnal - After all required
inspectlons are approved andporches, sklrtlng, decks, and
ventlng have been lnstalled.
ffit"'ntng - Prlor to cover.
N
.K
fY ftoor lnsulatlon - prtor tolAdecklng.
[-l Sanltary Sewer - Prtor to filting
-
trench.
n Storm Sewer - prlor to filling
-
trench.
_l Water Llne - Prlor to filllngJ trench.
Rough Plumblng - Prior to
cover.
PHONE:
STATE:6k
9e,(-, - ./)/-
ztP, a7/ 7 7CITY:
ADDRESS:
OWNER:
NEW
-
REMoDEL ADDrrroN _-tz"oe MOLISH OTHER
DESCRIBE WORK:
ADDRESS EXPIRES PHONEL
CONTRACTOR'S NAME
MECHANICAL:
ELEfiBICAL:
PLUMBING:
GENERAL:
CONST.
CONTBACTOR '
-
t\ \ \
I OF BLDGS:
\)
QUAD ABEA:AQ ft)- oFFtcE usE -
, OF BDRMS
A OF UNITS:
LAND USE:
ZONING CODE:
FLOOD PLAIN:
4..3
I
SECONDARY HEAI:
SOUABE FOOTAGE:WATER HEATEB;
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
l
O 3
.O z+2.e18?./o t,z
RANGE:
tl
tf
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
--
lnterior
-
Corner
-
Panhandle
._- Cul-de.sac
IS THE PROPOSED WORK TN THE .
HISTORICAL DISTRIG'r, OR ON
THE HISTORICAL REGISTER?
--
lf yes, thls appllcailon must be slgnedand approved by the Hlstorlcal
Coordlnator prlor to permit lssuance.
APPROVED:
ADDITIONAL COMMENTS
P.L.HSE GAR ACC
N
S
E
BUILDING PERMIT
VALUE
5./?91'7' z?e
,72
o :€ A?
(A)
Zo
SO. FT. X $/SQ, FT.ITEM
Maln
Garage
Carport
4-z) g" t
Total Value
Building Permit Fee
State Surcharge
Total Fee
Fy.t_LqtNG VALUE, PLAN CHECKAND BUILDINC PENMif -
Thls permit is granted on the express condrtron that the sardconstructlon shall, ln all respecis, conform io the Ordlnanceadopted by the Ciry
. of Spif ngtf eiJ, incrudtng theDevetopmenr code, reguratrng irr" "ln"til"iron and use ofbulldings, and may be suspended or revoked at any trmeupon violailon of any provisions of sald orJln.n""".
D/
ewedan
SI
Date Pald:
Recelpt Number:
Recelved
Plan Check Fee:
EMS DEVELOPMENT CHARGE (S
b(B)
DC)
7/.
SYST Systems Development Charge ls due on all undevelopedpropertles within the City limlts whlch are belng lmproved.
ITEM
Flxtures
Resldential Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
PLUMBING PERMIT
FEE
No
FT.
FT.
FT.
(c)
Plumblng permit
State Surcharge
Tctal Charge
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
-
(D)
N0
Mechanical permlt
lssuance
State Surcharge
Total Permlt
Fu rnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have carefully examlnedthe completed applicailon and do hereby cerilfy that alllnformatlon hereon is true and correct, and I f urther cerilfythat any and all work performed shall be done ln accordancewlth the Ordinanccs of the Clty of Sprlngfield, and the Lawsof the Stale of Oregon pertalnlng to tho work descrlbedhereln, and that NO OCCUPANCy wlll be made of anystructure wlthout permission of the Bulldlng Safety Dlvlslon.I further certlfy that only contractors anOimptoyees whoare ln compllance wtth ORS 70.1.055 wlll be used on thlsprolect.
I (urther agree to ensuro that all requlred lnsrequested at the proper ilme, that each
from the street, that the permlt card lsof the property, and the approved seton the slte at all times durlng const
Date
pectlons are
address ls readable
located at the front
of plans wlll remaln
ructlon.
Xnn^ru
MISCELLANEOUS PERMTTS
Moblle Home
State lssuance
State Surcharge
Sidewalk tt
Curbcut (t
Demoliilon
State Surcharge
Total Mlscellaneous Permits (E)
TOTAL AMOUNT DUE(A, B, C, e and E Com
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT R
FIECEIVED ]
ECEIVED(exctudrns erecrricar) /n:i Sl
blned)
BY
?/
CEP-
ri:a '
Co
-
-
ATTACHMENI- Bi 'rBN0.7to .z
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENI CHARGE
WORKSHEET
(COHMERCIAL & RESIDENTIAL)
NA}4E OR COMPAI'IY:5z-*-"
LOCATION:/o//-J/. 7a <1"
DEVELOPMENT TYPE:
BUILDING SiZE:x
1. STORM NRAINAGF
IMPERVIOUS SQ. FT.
2. SANITARY SFWER-CITY
NO. OF PFU'S
(See Reverse)
TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x
-
x $436.i9
x
-
x s436.19
x
-
x $436.19
4. SANITARY SEh]FR-HW|'4C
SIZ
X $0.209 PER SQ. FT.$ 7O. ra
X $43.26 PER PFU
$17.19 PER PFU + $10 Hl^lMC ADMiN.FEE
Above)
$
$c
$
$
SUBTOTAL (ADD iTEMS 1,2. & 3)5 3O,za
Ft
3
NO. OF PFU'S
(Use PFU Total F Item 2
M|^IMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWHC SDC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)S 7O,r a
5. ANMTNISTATIVF FFFS
BASF.CIIARGE (ABOVE) X .05 s /.fd
2 -,ts- 7{
is.
82 . SDC
Coordi nat or
Date:
TOTAI SDC GrO
lJJh
$,s/
CITY OF OFEGO'V
225 FIFTE STREET spproyal,
SPRINGFIELD OREGoN 97477
INSPECTTON REQIBSTt 726-3769
OFFICE: 726-3759
SPllIHGFIELt,
PERI{IT APPLICATION
7a ?7o/33
City Job Number
3. COHPTETE FEE SCEEDULE BELOV
ial-Single or
Multi-Family per dvelling unit.
Service fncluded:
The fcllowing proioct
zoning, and ooes"not
L
')-
1. L'CATT,N oF lNsTAll6'1fpfr"rlzec
i^it tt. ?Tl-t
LEGAL DESCRIPTION/703 3< /2- o,/200
JOB DESCRIPTION
Q1a'stot),t-€
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspented for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor trvaENE FLEl-TfZtC
Address t7-i; VlarJza€.
Ci ty €ot4gNE Phone 3+4 '357o1
Supe rvisor License Number /ry1? S
Exp iration Date /o-rc'
Constr Contr. Number Zo. ZZI>C
Expiration Date /0.15
Signature of Supervising Electrician
0wners Name
Addr"ss
city-Phone b$?e-&o<g
OI,INER INSTALLATION
The installation is being made on
property f ovn vhich is not intended
for sa1e, lease or rent.
Owners Signature:
DATE:
RECBI
L000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Martuf 'd Home or
Modular Dvelling
Service or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
Items Cost Sum
s 85.00
$ 1s.00
s 40.00
$ s0.00
s 60.00
$100.00
$1 30. 0o
s300.00
$ 40.00
B
C
200 amps or
201 amps to
401 amps to
601 amps to
Over 1000 a
Reconnect 0
Iess
600 amps
1000 amps
mps /voI ts
nly
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 4
201 amps to 4oo amps
-
$ 5
over 401 to 6oo amps
-
$ I
Over 600 amps or 1000 voTEs see a86il6-
0.00
5. 00
0.00l'Bil
D. Branch Circuits
E
Nev, Alteration or Extension Per Panel
oneCircuit t- $35.00 s{f
Each Addi tional
Circuit or vith Service
or Feeder Permit Z S 2.00 W
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0utI ine Light ing_
Limited Energy/Res
Limited Energy/Comm
$ 40.00
s 40.00
$ zo.oo
$ 36.00
5 SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
6c)
o
zRBCEIVED B
\
v
) Rtm
,qi1rirl!1rria-- ri ! Ir .{i. .k i:i Li '
1+1.1 N 7rH 51r
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$ u:tf\N R Lrjil rirllii-*f,.r.lil
ltrlI Nt.,l:,:tl-l 7tH $II{H}::.
$ 'I, it .t N G E .t li L tr " tl lt t] l-i l,] N ':)'i 4'/ 'l
* If'l't'tr*
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CITY OF SPR OFEGO'V
225 FIFTE SIREET
SPRINGFIELD, OREGON
INSPECTION REQIIEST:
OFPICE: 726-3759
JOB DESCRTPTION
Permits are non-transferable and expire
if vork is not started vithin 1B0 days
of issuance or if vork is suspended for
1B0 days.
2. COMRACTOR INSTALI,ATTON ONLY
S
DATE:
RECEI
SPEINGFIELE'
BI,ECTRICAL PERI{IT APPLICATION
City Job Nunber 7 5O/ 3?
3. COUPI,ETB FEE SCMDTILE BELO}I
A Nev Residential-Single or
MuLti-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ Bs.oo
$ 1s.00
$ 40.00
B Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
-40L amps to 600 amps _
601 amps to 1000 amps-
Over 1000 amps/volts
Reconnect 0niY
$ s0.00
s 60.00
$100. 00
$130. 00
$300. 00
$ 40.00
Electrical Contractor
Address
Ci tv Phone
Supervisor License Number
Exp iration Date
Signature of Supervising Electrician
Ovners Name fcts*) r€ze
Address
cir.y 5/n Phone 1c,186'lr&,)b
OHNER INSTALI..ATION
The installation is being made on E'
property I ovn vhich is not j.ntended
for sale, lease or rent.
.:..,:tt-j\ |pe) -'t
s747T' z-:/*'7 5
726,.37:6?,: ,":,-ii.l..{.: i:-. A}n \
1 TOCATION OF INST.ON
LEGAL DESCRTPTION/7a3 3f /L b/zae Sum
Expiration Date
Constr Contr. Number
Temporary Services or Feeders
Installation, Alteration or Relocationc
200 amps or less
201 amps to 400 amps
-0ver 40L to 600 amps
Over 600 amps or 1000Til[s
SUBTOTAL OF ABOVE
5Z State Sureharge
3Z Administrative Fee
TOTAL
40.00
55.00
80.00
ee rrBrr aSove
3S-777
$
$
$
s
b
D. Branch Circuits
Nev, Alteration or Extension Per Panel
one circuit ts $ 35.00 ZLtu
Each Additional
Circuit or vith Service
or Feeder Permit
-
$ 2'00
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $
sign/outline Lighting- $Limited Energy/Res $
40.00
40.00
20.00
36.00
RECEIYED
6lk
aS