HomeMy WebLinkAboutPermit Building 1994-09-14RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726-3769
Office: 726-3759
LOCATION OF PROPOSED
ASSESSOBS MAP:
JOB NUMBER
225 FIfth Street
Sprlngfleld, Oregon 97477
TAX LOT
LOT:1-BLOCK:SUBDIVIS
STATE:
PHONE:
ZIP:
oWneR:
CITY:
ADD
NEW- REMODEL ADDITION DEMOLISH OTHER
DESCBIBE WORK:
'S NAME ADDRESS PHONE#coCONST.
ELECTRICAL:
coN
GEN
PLUMBING:
MECHANI
\rx
*u
- OFFICE USE -
RANGE:WATER HEATER:
LAND USE:FLOOD PLAIN:
* OF UNITS:ZONING GODE:
Y OF BDBMS:
SECONDARY HEAI
SOUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
OUAD AREA:
* OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:OO a.m. wlll be
made the same worklng day, lnspections reguested after 7:OO a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
x
K
R
K
,x
x
X
Temporary Electrlc
Slte lnspection - To be made
after excavation, but prior to
settlng forms.
Underslab Plumbing I Electrical /
Mechanical - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Floor lnsulallon - Prior to
decking.
Sanltary Sewer - Prior to fllling
trench.
Storm Sewer - Prior to fllllng
trench.
Rough Mechanlcal - Prlor to
cover.
Rough Electrical - Prior to
cover,
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Framlng - Prlor to cover.
WalllCelllng tnsutatlon - Prlor to
cover.
Drywall - Prlor to taping
Wood Stove - After lnstallatlon.
lnsert - After flreplace approvql
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected brrt prior to
placemeni of concrete.
Sldewalk & Drlveway - After
excavatlon ls complete, forms
and sub-base materlal ln place.
Fence - When completed
Treeg - When all requlred
es are planted.
l\<1 Flnal Plumblngt<->rplumblng work
K
- When all
ls complete.
Flnal Electrlcal - When all
electrlcal vrork ls complete.
ilTElectrlcal Servlce - Must betA\*approved to obtaln permanent
electrlcal power.
pl'flnat Mechanlcal - When allzGt mechanlcal work ls complete.
pfrlnat Bulldlng - When an
P requlred lnspectlons have been
approved and buildlng is
completed.
lfFoundatlon - After forms are/AL erected but prlor to concrete
placement.
l-l Underground Plumbing - PriorlJ to fllllng trench.
F3B?i,l':ffi
ls?f Post and Beam - Prlor to floor.-6lnsulatlon or decking.
X
B
Olher
MOBILE HOME INSPECTIONS
Plumblng Connectlons - When
home has been connected to
water and sewer.
Electrlcal Connection - When
blocklng, set-up, and plumblng
lnspectlons have been approved
and the home ls connected to
the servlce panel.
Flnal - After all required
lnspectlons are approved andporches, sklrtlng, decks, and
ventlng have been lnstalled.
K
[VnWut"r Line - Prlor to filling
,!a( trench.
[pf nougtr Plumbing - Prior to
rJAtcover.7
E
[-l elocklng and Set-Up - When ailu blocklng ls complete.
E
tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lotlype
,X rnt"rro,
-
Corner
-
Panhandle
-
Gul-de-sac
P.L.HSE GAR ACC
N
s
W
E
S THE PROPOSED WORK TN THE .. HISTOFIICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcatlon must be slgnedand approved by the Historlcal
Coordinator prlor to permlt lssuance.
APPROVED:
X $/SQ. FT.
,207
ZOW
(A)
fraoO 3
/o,/o
BUILDING PERMIT
Total Value
Building Permit Fee
State Surcharge
Total Fee
ITEM
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit ls granted on the express condition that the said
construction shall, ln all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
bulldlngs, and may be suspended or revoked at any tlme
2,7 zUte
D
Plan Check Fee;
Date Pald
Fleceipt Number:
Rec
upon violation of ordlnances.
2'.?4,6 /
_ ^?'/,6 ?
SYSTEMS DEVELOPMENT CHA
(B)
R,GE (SDC)
? zsze.c3
Systems Development Charge ls due on all undeveloped
properties withln the City limits which are belng lmproved.
ITEM
Flxtures
Besldentlal Bath(s)
Sanltary Sewer
Waler
Storm Sewer
Moblle Home
FEE
E-t
J72.e3lQnad Ela
(c)
FT.
FT.
ooNo2
T-ov
EO
PLUMBING PERMIT
Plumblng Perntlt
State Surcharge
Total Charge
. FT.
ADDITIONAL COMMENTS
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
22,5u
g4-s r
d@d{o
rc
64
o.oo
Vent Fan
uOoOD
Mechanical Permlt
lssuance
State Surcharge
Total Permit
,Q.t.p j/o
(D)
MECHANICAL PERMIT
Furnace
Exhaust Hood
No3
By slgnature, I state and agree, that I have caref ully examlned
the completed applicatlon and. do hereby certlfy that all
lnformatlon hereon ls true and correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Building Safety Divislon.
I further certify that only contractors and employees who
are ln compllance with ORS 701.055 will be used on thls
prolect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remain
Date 1-tu - 7 4
{n.,,,"
on the slte at all ti durlng constructlon.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolltlon
State SurchargeF&s ' <^t rltrrtqsr -) ?z44,
Total Mlscellaneous Permlts (E)
TOTAL AMOUNT DUE (excludlng electrical)
(A, B, C, D, and E Comblned)
_#41b,rg
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT BECEIVED
FIECEIVED BY
" i). ii
/3/,
I2
pz
I6
)CITY OF OREGON
225 FTTTE SlTBEf,
SPRINGFTBLD, ORBGON
INSPECTION REOTIEST:
OFFICE: 726-3759
1
ll;atne-. l-Ze.
-
BIJGIRICAL PERilIT
SPRI]{GF'ELO
ue9
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Modular Dvelling
Servlce or Feeder
:oning, ar,tl
approvai.%
J-3
nql
974
72
?o7-';y,6$:J5-ltg city Job
AutircrizedSignalure. - l?.n^'. *'"...-Nunber
3. COHPI,ETB FBB SCEBDTII.E BBLOII
A. Nev Residential-Single or
A Multi-Family per dwelling unit.
Service Included:Items Cost
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. COllTRACf,OR INSTALI,ATION ONLY Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amPs
-
601 amps to 1000 amPs-
Over 1000 amps/volts
Reconnect Oniy
200 amps or less
201 amls to 400 amps
-0ver 401 to 600 amps
0ver 600 amps or 1000-GTfs
$ Bs.oo
$ 15.00
$ 40.00
ee trBt' aSove
Sum
b35
Electrical Contractor l(too E/rcr6rc
Address fl o, Bor l0b-7
Ci ty €J.0 Y Phone 72b-?3o3
Supervisor Licen-se Number e La/ -S
iration Date to /r /rr
Da e )o/, /rrExoiration
Eottur,r-f (tt.t
B
c.
(/
$
$
$
$
50.
$300
$40
00
00
00
00
00
00
60
100
r.30
40.00
55.00
80.00
s
$
$
s
Exp
Constr Cont r. Number 26-/llC Temporary Services or Feeders
Installation, Alteration or Relocation
Signature
rs
Address
an
,
Ci ty Phone
OVNER
The installation is being made on
property I own vhich is not intended
for sale, Iease or rent.
0vners
DATE:
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit S 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Ou tline Ligh ting_
Limited Energy/Res
Limi ted Energy/Comm
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
Halr%l
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5
RECEIVBD
oO
=iPRIhlGFIELD
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
qrv OF SPB,,I,G FIELD, OREGO,I,
1tJOB LOCATION:
ASSESSORS MAP *:\1 TAX LOT *:o\too
O\.INER
ADDRESS:PIIONE #:
CITY STATE:ZIP:
BACIGLOII IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
[0 rrt
ADDRESS:PHONE *:
CONTRACTOR:
CITY:STATE:Zf?t
CONSTRUCTION CONTRACTORS REGISTRATION *:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE THE
BACKFLOI.I PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). r ALSO STATE THAT ALL INFoRMATIoN 0N THIS PBRMIT/APPLICATIoN IS
CORRECT.
/-/7-?3-
DTTE
FOR OFFICE USE
DATE OF APPLICATION:
RECEIPT 1I:
TOTAL AMOUNT COLLECTED:
ISSUED BY:
tl .1l .
Willamalane
Park & Recreation District
fob No.
SYSTEMS DEVELOPMENT CHARCE
NAME:PHONE:
t
X $370 PER UNIT =
0Q-* q'W}
c{:to
oc)
ADDRESS:STATE:
LOCATION OF
Stre€t Address if Known:
Platt Tax Lot Number:
DEVETOPMENT TypE (Chect appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.)
1
A. Single Family - Detached
I__[_ Single Family home Manufactured home not in a park
NO OF UNITS
B. Single Family - Attached
NO OF UNITS
C. Multi-Family APartment
I * g4oo PER UNtr -=
NO OF UNITS X $277 PER UNIT =
D. Manufactured Home Park
NO OF UNITS X $280 PER UNIT =
$
$
$
$
m
$
$ 4fl40'
$
WPRD SDC
2. SDC CREDIT (lf applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit WorksheL
3. TOTAT WPRD NET Sfrc ASSESSED (lf sDC reduced for Credit)
Community Services
City of Springfield
tuA4
ATTACHMENT 81 ''rB No. ?ao;6r
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CI-IARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA},IE OR COMP/$IY:
LOCATION:L4S9 7/ds/.
DEVELOPMENT TYPE: <F D
BUILDING SIZE:OT SI
1.
IMPERVIOUS SQ. FT.,4C8
2. SANITARY SEWER-CTTY
NO. OF PFU'S
(See Reverse)
/7 X $43.26 PER PFU
3. TRANSPORTATTON
NO OF UNITS X TRiP RATE X COST PER TRIP
x /,a/ x $436.19
x
-
x s436.19
x x $436.i9
4. SANTTARY SFI^.'ER-Mhll'4c
NO. OF PFU'S
a. Ft
(Use PFU Total From item 2 Above)
MI,IMC CREDIT IF APPLICABLE (SEE REVERSE)
T0TAI -Mtll4c snc
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
5. ANHTNTSTATIVE FFFS
Tom ABoVE) X .05
s
SUBT0TAL (ADD ITEMS i.2. & 3) s t ?fz'oz
$17.19 PER PFU + $10 Ml,'ll'4c ADMiN.FEE s ?/v. l2
s 2zc7.4G
7-tf-7/
BSE (
S
ig,
ina
$7 7v.0 Y
3r/7I
82. SDC
orn
Date:
TOTAI SDC 23 7C.
,'/,
x $0.209 PER SQ.
'l
FIXTURE UNIT CALCULATI')N TABLEi Numberof New Fixtu -- X Unit Equivalent = Fixture units
(NOTE: For remodels, calculate only t
FIXTURE TYPE
rET additional fixruresl
NUMBEB OF
NEW FIXTURES
UNIT
EOUIVALENT
FIXTURE
UNITS
2-
t
_/7
Bathtub.
Drinking Fountain....
Floor Drain
lnterceptors For Grease/Oil/Solids/8tc.................
lnterceptors For Sand/Auto Wash/Etc..........
Laundry Tub/Clotheswasher....
Clotheswasher - 3 Or More....
Mobile Home Park Trap (1 Per Trailer)......
Receptor For Refrigerator/lvater Station/Etc....,...
Receptor For Commercial Sink/Disltwasher/Etc..
Shower, Single Sta!|..........
Shower, Gang
Sink: Bar, Commercial, Besidential Kitchen..I,
Urinal, Stalulvall
Wash Basin/Lavatory, Single.Z
Toilet, Public lnstallation
I z_
1
/Head
2
1
2
3
6
2
6
6
1
3
2
1
2
2
1
6
4Toilet , Private....
Miscellaneous:tTr+,^l roeS g,lt 2
TOTAL FIXTURE UNITS
2
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per S1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
1 9BO
1 981
1 982
1 983
1 984
1 985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
1 985
1 986
1 987
1 988
1 989
1 990
1 991
1 993
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
X$3ft2
(Rate X Assessed Value)x$
(Rate X Assessed Value)
CREDIT TOTAL $
,t
1