HomeMy WebLinkAboutPermit Building 1995-02-07SPRINGFTELE,
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office; 726-3759
LOCATION O
?fr,
JOB NUMBER
225 Fifth Street
Springf ield, Oregon 97 477
TAX LOT:ASSESSOBS OA\
LOT:LOCK:SUBDIVISI
OWNE
CITY:
ADD
STATE:
PHONE:
ZIP:
ADDITION D H
-
OTHEFI
DESCFIIBE WORK:
NEW l/- REMoDEL
NAME ADDRESS EXPIBES PHONE
Z
CONST.
NTBACTOR #
ELECTRICAL:
CONT
GENE
PLUMBING:
MECHAN
are-
L
ui)
€,.RANGE:
FLOOD PLAIN
- OFFICE USE -
# OF UNITS:
LAND USE:
WATER HEATER:
ZONING CODE:
* OF BDBMS:
QUAD AREA:
# OF BLDGS
SECONDARY HEAT:
SQUAFIE FOOTAGE:
CONSTR. TYPE;
HEAT SOURCE:
OCCY GROUP:
* OF STORIES;
To request an inspectlon, you must call 726-3769. Thls ls a24hour recording. All lnspections requested before 7:OO a.m. wlll be
made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the following work day.
REQUIRED INSPECTIONS
flFoundation - After forms are.J erected but prior to concrete
placement.
l--l-Eramlng - Prlor to cover.
l-)I/atl/Celllng lnsulatton - prior to|J cover.
f}Drywall - Prlor to taping.
ll-FootinO - After trenches are
-
€xcavaleo.f-ftflna Building - When ailtJ requlred lnspections have been
approved and building is
completed.
nal Mechanical - When all
mechanical work ls complete.
Other
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Wood Stove - After lnstallation
lnsert - After flreplace approval
and lnstallatlon of unit.
Streel Trees - When all requlred
trees are planted.
Temporary Electric
Sile lnspection - To be made
after excavation, but prior to
setting forms.
Underslab Plumblng/ Electrical /
Mechanical - Prior to cover.
Masonry - Steel locatlon, bond
beams, grouting.
Underground Plumbing - Prior
to filling trench,
l-l]-Rough Mechanlcal - Prior tolJ cover.
[-].Rough Electrical - Prlor tot-J cover.
l-lfElectrical Service - Must be.J approved to obtain permanent
electrlcal power.
flFlnal Plumbing - When ailtJ plumblng work ls complete,
f-fttlnd Electrical - When ailu electrical work ls cgmplete.
ll-Underlloor Plumblng / Mechanicalr-r - Prlor to lnsulation or decklng.
[l[+ost and Beam - Prior to floor: lnsulatlon or decking.
lTl-Floor lnsulation - Prior toLgdecklng,
@&anitary Sewer - Prior to fillingtJ trench.
fJ€torm Sewer - Prior to fillingE trench.
l-.-l-lftater Line - Prior to fillingM trench.
@Aough Plumblng - Prior to
-
cover.
[lf-eurbcut & Approach - After'J forms are erected but prior to
placement of concrete.
f/siaewalk & Driveway - Afteru excavation ls complete, forms
and sub-base materlal in place.
[-l Fence - When completed
MOBILE HOME INSPECTIONS
Blocking and Set.Up - When all
blocklng ls complete.
Plumblng Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and plumbing
inspectlons have been approved
and the home is connected to
the servlce panel.
Final - After all requlred
inspectlons are approved and
porches, sklrting, decks, and
ventlng have been installed.
qSDICq
WORK:
\ rDA_
?
lt t I
tt)11
I
Rs+M
3R.\e -
,1.1
lt
e
E
E
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Se ks [ .s THE PROPOSED WORK rN THE
HISTORICAL DISTRICT. OR ON .
rH E H tsronrcAL REGrsrERq=n-D-
lf yes, this appllcation must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED
ACCPL.HSE GAR
N
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit ls granted on the express condltlon that the sald
constructlon shall, in all respects, conform to the Ordlnance
adopted by the City of Sprlngfleld, lncludlng the
Development Code, regulating the constructlon and use ol
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of sald ordinances.
ans Reviewed By Date
Fleceipt Numbe
Plan Check Fee:
Date Paid
Recelved By:
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT.
1t510
{Agpasl qL
Srute
VALUE
state surcharge tio/O
Total Fee (A)
\\.\D rl
S\\p.ZD \-03\fl+
Total Value
Bulldlng Permlt Fee
Maln
Garage
Carport
\\i3
.5\oD
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)f 1s ?6.o/
ADDITIONAL COMMENTS
ITEM
Flxtu res
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
\\oDco
t 3o/o
r1D..8D
FEE
(c)
(fr
\?D
FT.
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
N.&
FT.
Wood Stove/ lnsert/ Fl replace Unlt
Dryer Vent
MECHANICAL PERMIT
4.BD
\\ o .5O
A? a3(D)
No
3.oo
Mechanical Permlt
lssuance
State Surcharge
Total Permlt
\ lr\.DD
r-33
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certify that all
lnformation hereon ls true and correct, and I further certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfleld, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCY wlll be made of any
structure wlthout permission of the Buildlng Safety Dlvlslon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
prolect.
I further agree to ensure that all required lnspections are
requested at the proper time, that each address ls readable
from the street, that the permlt card ls located
of the property, and the approved set of lre
Slgnature
Date
on the site at mes during
f ront
maln
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
Total Mlscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
S Su
State Surc
Demolltlon
ft
ft
Sldewalk
Curbcut
DATE PAID
VALIDATION:
RECEIPT NUMB
AMOUNT REC
RECEIVED BY
B
.rnX
q.d)
s@-
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CI-IARGE
I^IORKSHEET' (COMHERCIAL & RESIDENTIAL)
ATTACHMENT 81
/oS.
JoB No . _7to/p1
NA}4E OR COMPAI,IY:
LOCATiON -rr'
DEVELOPMENT TYPE : iFD
BUILDING SIZE:OT SIZ
1.
II.{PERVIOUS SQ. FT.X $0.209 PER SQ. FI'
2. SANITARY SFWFR-CiTY
NO. OF PFU'S
(See Reverse)
/f,X $43.26 PER PFU
.)a*',,sponrATT0N
NO OF UNiTS X TRIP RATE X COST PER TRIP
y l,o/ XS436.i9
x
-
x s436.19
x
-
x s436.i9
Date 2-z-?s-
. Ft.
lao.s
S
S
g 3/7,42-
t
SUBTOTAL (ADD iTEMS 1,2. & 3) S /.IA,Z3
4. SA.NITARY SFI{FR-l'fn'HC
NO. OF PFU'S r Si7.i9 PER PFU + S1O Ml,'lMC ADMIN.FEE
(Use PFU Tota'l F rom Item 2 Above)
HI1|I'lC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAI -MI.IMC SDC
G.2 >
SUBTOTAL (ADD ITEMS 1.2.3 & 4)s / ,/2, /z
5. ANMINISTATIVF FFFS
BASE CI{ARGE (
Ha
) x .05
ig. P.E
SDC rdi nator
82. SDC n sDt rrrr/,'7 h&
TOTAI SDC s /tF{,o 7
Ev7{;-:-
FIXTU.RE U.q{,lT CALCUL, . ION TABLEI Numbcr of New Fixrures X U^it Equivatcnt = Fixrure Unirs
INOTE; For ieorodclp, dalculctc only thc fif,f odditionol lixrurcs]'
FIXTURE T\'PE
BathtuU.
Floor Drain.
lnterceptors For Grease/Oil/Solids/Etc.................
lnterceptors For Sand/Auto Wash/Etc...
t.aundry Tub/Clothesrvasher..........
Clotheswasher - 3 Or More.....
Mobile Home Park Trap (1 Per Trailer)......
Receptor For Refrigerator/lVater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Slrower, Single Stall.
Slrr:wer, Gan9...............
Sink: Bar, Commercial, Residential Kitchen..
Urinal, Stallff/all..:...............
Wash Basin/tavatory, Single.
Toilet, Public lnstallarion
l'oilet, Private...........
Miscellaneousi ,l,t* ropl .gxt
Z
?-
TOTAL FIXTURE UNITS
NUMBER OF
NEW FIXTUNES
UNIT FIXTURE
EOUIVALENT UI,IITS
-3-
2
I
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
o
?
a,
2
7
CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Baie per $1.OOO
Assessed Value
Year
Annexed
Rate per $'l ,OOO
Assessed Value
1979 or bef ore
1 E80
1 961
1 982
.t oQ2
1 984'
1 985
s3.46
e?o
3.32
3.21
3.06
2.92
2.73
1 985
i 986
1 987
1 988
1 989
1 990
1 991
I OO2
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o.15
Credit for Pbrcel or Land Only lf Applicable .3,y'6 x$1.'tra 24.23
(Rate X Assessed Value)
lmprovement (if after annexation date)x s_
(Rate X Assessed Value)
CREDITTOTAL =s24.23
I
C'TY OF OREGO'V
225 FTFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQIIBST:
OFFICE: 726-3759
97477
approval.
726-3769
Oata
The following project
zontng, and does not
SP'IINGFIELO
APPLICATION
a1-Single or
per dvelling unit.
ded:Items Cost
3. COI{PLETE EEE SCEEDULE BELOS
1 LOCATION OF INSTALTA
JOB DESCRIPTION
Permits are non-transferable and expire
if vork i,s not started vithin 180 days
of issuance or if vork is suspended for
1B0 days.
2. CONTRACTOR INSTALI,ATION ONLY
Electrical Contractor AlLrc F.l*tu i ^
Address l.l (D <d ,*rso t
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
Services or Feeders
Installation, Alterations
or Rel-ocation:
200 amps or less
20i. amps to 400 amps _
401 amps to 600 amPS
-
601 amps to 1000 amPs-
0ver 1000 amps/voIts
-
Reconnect 0n1Y
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
Mult i-Fami
Service In
1y
clu
/ $ 8s.00
-+ $ 1s'oo
$ 40.00
Sum
8S
-L
B
Phone -)
$ s0.00
$ 60.00
s 100. 00
$130. 00
s300.00
$ 40.00
$
$
$
s
Supervisor License Number Irt
Expiration Date lo-t-q{
constr contr . nwaer \t914{
Expiration o"t" ?- 9- t?S
ture of s ing Electrician
0vners Name
Address
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
-0ver 40L to 600 amPs _
Over 600 amps or 1000 volts
s
c
D
E
40. 00
55.00
80. 00
Ci ty Phone
The installation is being made on
property I ovn vhich is not intended
for sale, fease or rent.
Ovners Signature:
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
3
ee rrBtt a6ove
not included)
40.00
40.00
20.00
ft+lAtdp
Miscellaneous ( Service/feeder
-Each instal-lation
Pump or irrigation $
Sign/Outline Lighting- $
Limited Energy/Res
-
$
Limited Energy/Comm
-
S
D5
DATE:
RECETVED
city f,t\M€l'.t39
)