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Home My WebLink AboutPermit Building 1995-01-18RESIDENTIAL PERMIT APPLICATION lnspections: 726.3769 Office: 726-3759 LOCATION OF PROPO D WORK: ASSESSORS MAP: SP FIhrGFIELE, vn JOB NUMBER 225 Fifth Street Springfleld, Oregon 97477 TAX LOT: SUBDIVISION:LOI - BLOCK: PHONE:OWNER CITY: ADD STATE:ZIP: NEW - REMODEL ADDlrloN DEMOL|SH orHER DESCRIBE WORK: NAME ADDRESS EXPIRES PHONE co GENE PLUMBING MECHANICAL: ELECTRICAL: CONST. CONTRACTOB # _ OFFICE USE _ WATER HEATER ZONING CODE: FLOOD PLAIN:LAND USE:QUAD AREA: I OF BLDGS: SECONDARY HEAT: SOUARE FOOTAGE: # OF BDRMS: _ BANGE: OCCY GROUP: I OF STORIES: # OF UNITS: .- To request an inspectlon made the same worklng , you must call 726'3769. Thls ls a24 hour recordlng. All lnspections requested before 7:0o a.m. wlll beday, lnspections requested after 7:00 a.m. wlll be made the following work day. [--l Temporary Electrtc REQUIRED TNSPECTIONS ffiRoueh Mechanical - prior to - cover. ffi Rough Electrical - prior toG cover. x Final Plumbing - When ailplumblng work ls complete. Site lnspectlon - To be made after excavation, but prlor to settlng forms.E Final Electrical - When ailelectrical work is complete. Underslab Plumbing/ Electrical / Mechanlcal - Prlor to cover.Electrical Service - Must be approved to obtaln permanent electrlcal power. r Final Mechanical - When allmechanical work ls complete. Footlng - After trenches are excavated.Flreplace - Prlor to faclng materlals and framing lnsp. E Final Buildlng - When ail required lnspections have beenapproved and building isMasonry - Steel locatlon, bond beams, groutlng.completedE K x Framlng - Prlor to cover. E Foundatlon - After forms are erected but prior to concrete placement. ther Wall/Celling tnsulalion - Prlor to cover. E Underground Plumbing - Prior to fllllng trench.Drywall - Prlor to taping E MOBILE HOME INSPE TTONSUnderlloor Plumblng/ Mechanlcal - Prior to lnsulatlon or decking.Wood Stove - After lnstallation. Post and Beam - Prior to floor lnsulatlon or decking.lnsert - After flreplace approval and lnstallatlon of unit. Blocking and Set.Up - When all blocklng ls complete. Floor lnsulatlon - Prlor to decking.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to f illing trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. E Storm Sewer - Prior to lilllng trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Llne - Prior to filling trench. Fence - When completed. Rough Plumbing - Prior to cover. Slreel Trees - When all requlred trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and ventlng have been installed.K CONSTR. TYPE: HEAT SOURCE; tl E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Typ\ - lnterior - Corner - Panhandle - Cul-de-sac P.L.HSE GAR Acc N S E IS THE PROPOSED WORK TN THE . HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this applicatlon must be slgned and approved by the Historlcal Coordinator prior to permit issuance. APPROVED: VALUE le (A) X $/SO. FT, Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express conditlon that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plans Rcviewed By Date Plan Check Fee: Date Paid Receipt Number: Fleceived By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved, ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE Plumblng Permit State Surcha rg" +3PO Total Charge (c) N0 FT. FT. PLUMBING PERMIT Wood Stove/ lnsert/ Flreplace Unit Dryer Vent Mechanical Permit lssuance State Surcha rse +3% Total Permit (D) @ c\1. o \S N0Vent Fan MECHANICAL PERMIT Fu rnace Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned the completed application and do hereby certlfy that all informatlon hereon is true and correct, and I f urther cerilfy 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 descrlbed herein, and that NO OCCUPANCY will be made of any structure without permission of the Bullding Safety Divislon. I further certify that only contractors and employees who are ln compliance with ORS 701.055 will be used on thls proiect. 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 permit card ls located at the front of the property, and the approved set of plans will remaln Slgnatu /f,- 7{Date tmon the site at MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOIAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E'Combined) VALIDATION: FIECEIPT NUMBER DATE PAID AMOUNT REC FIECEIVED BY D t-[n,r\DN JJ FT. ADDITIONAL COMMENTS Permit #: Address Issued by:Date:6 Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statementbefore abuilding permit canbe issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and,Z, and either box 3,A' or 38: 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3,A,. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this huilding permit of the name of the contractor. I hereby certify thatthe above informationis correctand that I have read and dounderstand the Information about on the reverse side of this form. OR I (Signature of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) Notice to (Date) 75 Information Notice to Property Owners About Construction Responsibilities Note : 'l'his lnJ'ormatiott Notice to Property- Awrrcrs about Constnrr:tion ResponsiltilUi"i --'^-t*as ilevelipect by the Coistiuciion Contractors Board in accordance *,ith ORS 70t.055Oj; , If you are acting as your own contractor to construct a ncw home or make a substantial improverncnt t() an ex isting structure, ]-'ou can prevgnt,ryagryi problenu by being aware oJ the following responsibilifies and ilreas of concern. . .. : EMPLOYER HESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "rnploy", and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law:' As aa employer, you must withhold income taxes from employee wages at the time employees are paid. You will'be liable forihe thx payments even if you don't actually withhold the tax from your employees. For more information, call the Oregort Dept. of Revenue at 945-8091 Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the OregonEmployment Division at the Department of Human Rbsoui(rcs at378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation l,aw, and hrust oltain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurarrce, you may besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremptoyeesisinjuredonthejob. Formoreinformation, call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax frorn employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-80G829-1040. OTHER HESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to rneet code requirements that may be brought to your attention through inspections. Liabitity and proper,ty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done" Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades- and to notify building officials at the appropriate times so they can perform the required inspections. If you have additionai questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1t94 LT.' RESIDENT'AL PERM'T APPLICATION Insl.rec:titlns r .'t'i'3769 Ollrt,c 7?6 )7:") LOCAI lol'l , )r l'lloi'ol;ED WOltl(: ? /4 5 ASS E:;SOIIS t.t AP: /? ^?2'7 {2* Jr.zd NUMBEr', -V?-Ef2 225 Flf th Streot Spri nglield, Oregon 97 47 7 rAX Lor: -ZSerO SUBDIVISION h, e --- --2./ft LOT: OWNt:R: ADT)NESJS CITY: coNl ilAClOri :l NAMt 4rlarWrr_7qa/-274 5= v?G%-:5rz2/. PH.NE: ?Q€=74,- )r*, -Zz Z7sSTATE: - DESCNIBE WC)RK: -fudE-?- 2A2_?.,TfrprzqZ--SZb ?-NEW _ _ l-lEMODEl, -- ,,ADDrroN a- DEMoLIsH orHER N DDIiL:f]S CONST. CONI-RACTOR /EXPINES PI IONF O@C EN E FIAL: PLLJMI]ING MECI-IANICAI_ ELECTRICAL: 3RSO, , oF uNlTS, \ -lcoNSrR.rYPt::-V L/ -- RANGE: # OF BDRMS: WATL-.R HEAI F.R: OUAD ARFA: # OF BLDCS FLOOD PLAIN: ZONING CODE SECONDARY t'IEAT: -f.] SQUARE FOOTAGE: - | - OFFTCE U LAND USE: --U\-\=-_ nEAr sounCF:D,/effi, OCCY GRCIUt']: .- , OF STOBIES] To recluest ari rnspeclior-r, you must call 726-3769. This ls a24hour recording. All inspections requested before 7:oo a.m. will be mac.le the t;arrrc working day, inspeclions rr:queste<I after 7:00 a.nr. will be made the following work day. REOUIRED INSPECTIONS [-- .J -fernPot.rry Elaclri<:l)Zf norrgh Meclranical - [)rior to Flcorer. }7'l nough Elcctrical - Prior tol'--\cover. ,K fl Final Plunrbing - Wlrc'n all plurilbing wotl( is cotl)l)lute. [- -l Site ln:;lrecliott - To bc rn.rc.leLJ alter 1;).r.irvation, l,ut pri(rt to settirrg {r)frllS. Final Electrical - Wltcn all electrical wor lr is cotttl-rlr-'te. tJ Undersl ab Plumbing/ Electrical / Mecharrical - Ptior to c(rver. Electrical Service - Must be approved lo obtain Perrnanent electrlcal power. {n finat Mechanical - Wlrr:n all lA,ne.l''anical work is t:ottrlrlete. X Fooling - After trenches are excava tL'(l.Fireplace - Prior to facing materlals and f rartring lnsP. TYI final Building - Wlrr.ln all Arequired inspections ltave beerr approved and builcling is contpleted.Masonry - Steel locatioll, bond beanrs, groutit-lg.x[. X K Framing - Prior to cover K Other - Foundation - Af ler fornts are erecte(l t)ut Prior to conclete plac()nli,{ I t. Wall/Ceilinr; lnsulation - Prior to cover. Undcrground Plumbing - f]rior to fillirr!l trencll.Drywall - l'rior to taPing MOBILE HOME INSPECTIONSx. K Unclcrl Wood Slove - Af ler irlstall;rtion - l)rior to n Post ancl Beant - Prior to floor inStrlat rr,11 q; 6lgr;Iirte.lnsert - Af ter firepla<:r: aplltoval anr! lnstallation of unit. Blocking and Set-Up - Wlterr all blo(ikinO is cotnplete. E.;:'.1:;l]'u'ut'on - Prior tcr Curbcut & Approach - Aftcr forrns are erected but Irrior to placemelit of cottr:rete. Plumbing Cotrneclions - Wltcrl horne has been connected 1cr water and sewer. n Sanitaty Sewer - Prior to fillittg tren(:h.Electrical Connectiorr - Wltctr blocking, set-up, ancl plr-rrrtbintl inspections have bectt approvc(l an(l the horne is conrlected tt) the service PiUlel.ffi1;:; sewer - Prior to rirrins Sitlewalk & DrivewaY - After excavatiotr is colltplete, fortrls arrcl sub-base tttlttcrial in plat;e. t_l Water Line - 1'(tt.>r to lillirlg tren()h. Fence - Wlterr cotnlrlotcd Street Trees - When all recluired trees are planted. Final - After all recluired inspections are approvecl ancl porches, sl<irting, decks, and venting have l.reen installcd. eclraniclunr &Rough Plumbilrg - Priot trl covcr. t_l 8t-ocK: r_l rJ tl fltl rl tf Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type - lnterlor -_ Corner - Panhandle -_ Cul-de'sac Set P.L.HSE GAR ACC N S E I?r 5' .S THE PBOPOSED WORK IN THE - HISTORICAL DISTHICT, OR ON THE HISTORICAL REGISTER? .----- lf yes, this application must be signed and aPProved bY the Historical Coordinator prior to permit issuance' APPROVED: BUILDTNG PERMIT ITEM SO. FT.x s/so. FT.VALUE Main Garage Carport,4zr :72.>2 Total Value Building Permit Fee State Surcharge Total Fee 2o (A)/?3,2, BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express conclilion that the saitl consiruction shall, in all respects, conform to tlre Otr'linance adopted by the City of Springfield, includirrg thc Development Code, regulating the construction an(l use o[ buildlngs, and may be suspended or revokerl at ;trty titrttr upon violatlon of any provisions of saicl ordirlanccs' 4;aPlan Check Fee Date Paid: -4G -?2- Receipt Number:z7 R By:ffi*eviewed BY SYSTEMS D EVELOPMENT CHARGE (sDc) rbi2-IB (B) Systems Development Charge is due on all undeveloped properties within the City limits which are beirrg improvecJ' PLUMBING PERMIT ITEM Fixtures Residential Bath(s) SanitarY Sewer Water Storm Sewer Mobile Home FEE 5 ee N0 FT. FT. FT. 1 50 25?o Plumbing Permlt State Surcharge Total Charge ?5lo' 3?{ (c) ? .-c AD ITIONAL COMMENTS MECHANICAL PERMIT Fu rnace Exhaust Hood Vent Fan N0 oo @ (@rlnsert/ Fi rePlace Unlt Dryer Vent 3 eo eo Mechanical Permit lssuance State Surcharge Total Permit oo 20 a 3 20 (D) By slgnature, I state and agree, that I have carefully examined the completed application and do hereby certify that all informationhereonistrueandcorrect,andlfurtlrercertify that any and all work performed shall be done in accordance wlth the Ordinances of the City of Springfield, and tlre Laws of the State of Oregon pertaining to the work clescribcd herein, and that NO OCCUPANCY will be tnaclc of atry structure without permission of the Building Safety Divisiotr' I further certify that only contractors and cmployees 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 each address is readable from the street, that the Pe rmit card ls locatcd at the fronl of the prope the ap plans w on the site at mes 0 nat u re 7^ ?z-Date - VALIDATION: RECEIPT NUM R DATE PAID AMOUNT REC unn s FIECEIVED E MISCELLANEOUS PERMITS Mobile Home State lssuance stat6 surcharge Sidewalk -*-- fl Curbcut .-- ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, O, and E Combined) 7y'zPg ?- 1 2 Permit No: Address: lssued Date: R OFFICE USE ON STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in t applicable blanks, and initial boxes 1 and 2, and either box 3A or 38 I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. A My general contractor is , Contractor registration number-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3.8 I will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. ! hereby certify that the above information is correct and that I have read and understand the lnformation Notice to Property Owners about Construction Responsibilities on the reverse o this form. 3 gnature o rm pp cant CONSTRUCTION CONTRACTORS BOARD 0244J 8191 7*7-7<- Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT a ,*ro*loroN NorcE ro pRopERT, ol*r* ABOUT CONSTRUCTION RESPONSIBILITIES lf you are acting as your owrt-cdntractor to construct a new home or make a substantial imprwement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsurance Tax: As an em ployer, you are required to pay a tax for unemployment insurance For more information, call the Oregon Employment.Division DHBpurposes on the wages of all employees.. at 378-3224. 1, .l Workers' Compensation lnsurance: As an employer, you are su$ect to the Oregon Workers' iompensationLawpensationinsuranceforyouremployees'ityoufailtoobtainworkers, compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, callthe Workers'Compensation Division DIF at 373-2494. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. ymentevenifyoudidn'tactuallywithholdthetax.Formoreinformation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Compliance code requrrem ents Liability and Property Darnage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own gjeneral contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspbctions. If you have additional questions, write to Construction Contractors Board 700 Summer St, NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 As the permit holder for this project, you are responsible for resolving any failure to meet that may be brought to your attention through inspections. \OTE;' -"This liformation Notice to Property Owners About Construction Responsibilitbs was developed by theConstruction Contractors Board in accordance with OFIS 701.055(5), p4sse-d by the J989 Ofeg_on Legislature. a244J 10124t89 Th ,wing prolect a8 submittod h6e tho !cll'"v!n3 ii"*-, Ji'tJ?5"iinot require specliic iai'i'r ' r"' approval.l-Db OF OFEGO'V Authorized Signatute 225 FTTTB SIREET SPRINGFIELD, OREG0N 97477 INSPECTION REQUESTz 726-3769 0FFICE: 726-3759 1 OF JOB PTION Permits are non-transferable and expire if vork is not started vithin 180 diys of issuance or if.vork is suspented for 0 days. 2...INSTALLATION ONI,Y Elec t r'I Contractor Address Ci ty Supervisor Lice Expiration Date Constr Contr. Nu Expiration Signa clan Ovners Address Ci ty Phone OVNER ALI.^ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Ovners Si gnature: DATE: RECIiIP'I' SPrrINGFTELD ELE TRICAL PERHIT APPLICATION Ci ty Job Nurnber COHPLETE FEE SCBEDT'LE BELOS 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 Hanuf'd Home or -Hodular Dvelling Service or Feeder s 8s.00 s 15.00 $ 40.00 Services or Feeders Installation, Alterations or Relocation: 3 A Sum B 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -60L amps to 1000 amps- Over 1000 amps/volts -Reconnect On1y s 50.00 s 60.00 s100. 00 s130.00 s300.00 s 40.00 C Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less S 40.00 201 amps to 400 amps - S 55.00 ; over 401 to 600 amps - S 80.00 0ver 600 amps or 1000 voTts see uB" a66Til 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 a<@sJ-g E. Miscel]aneous (Service/feeder not included) -Each installation Pump or irrigation $Sign/0uttine Lighting- S Limi ted Energy/Res - $ Limi tcd Energy/Comm S SUBTOTAL OF ABOVE 52 State Surcharge 3Z Administrative Fee TOTAL 40. 00 40.00 20. 00 36.00 5 Phone Numbe of Supervising EIec r e RECEIVED I} @ C'TY OF OREGO't' };#l'#'fll;:tr,,i,ti*I#,4T":i5J:g*,T SPFlIlllGFIELO I.^ECTRICAL PERHIT APPLICATION225 FTV.IE STREET SPRTNGFIEID, oREGON 97477 INSPECf,ION REQTIEST:Dl&6-37OFPICE: lZ6-ltSg Authcrized r 1. LOCATION OP3la ,5,ST; e City Job n rO", ?h84? t ]- ao 3.LETB PEE SCEBDT'LE BELOV A idential-Single or Multi-Fa[i1y per dvelling unit. Service Included: I tems Cos t 1000 sq.ft. or }ess Each additional 500 sq. ft or portion thereof Each Manuf'd Home or -Modular Dwelling Service or Feeder s 8s.00 s 1s.00 s 40.00 B. Services or Feeders InstaIIation, Alterations or Relocation: -?3 COHP LEGAL JOB DESCRIPTIONE 4/P 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. COTiITRACTOR INSTALI..ATION ONLY Electrical Contractor Addt""" ci ty- Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician jp o"n"r. N.re -?Address Jb S. 3 2nt SPtrto vno"u 7 4 7'7815 200 amps or less / 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/volrs Reconnect 0nIy Sum s s0.00 s 60.00 $100.00 s130.00 $300. 00 s 40.00 g- Ci ty c D. Branch Circuits Nev, Alteration or Extension Per Pane1 One Circuit S 35.00 Each Addi tional Circuit or vith Service or Feeder Permi t $ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/0utIine Light ing- Limited Energy/Res Limited Energy/Comm STIBTOTAL OF ABOVE 5f State Surcharge TOTAI Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less ';, $ 40.00 0ver 401 to 600 amps S 80.00 0ver 600 amps or 1000 voT[s see rrBrr a5ott OSNER INSTALI,ATION The installation is being made on property I own vhich is not intended for sale, 1 ren (. DATB: s 40.00 s 40.00 s 20.00 s 36.00 So aA 5 --3:fr_ P 3a' s<: RBCEIVBD '\K'qa Sltmru*^t-kH -SFIIINI(; %225 FIFTB STREEf,.q :,,;i,:.r,it SPRINGFTELD, OREGON 97477 "' .." i, ;:r,; INSPECTIoN REQUBST: 726-3t6ii' "',, l.i ,'rr. , ''i t,.,-'99 subr reqUire "'. : citY ,.Iob Number ELECTRICAL PERHIT APPLICATION ,,JG? f )cf oPPICE: 726-3759 1 EIec cal Contractor Address Ci ty e Supervisor Licen ber Expiration Date Constr Contr ,ber Expi ra t i Date si of Supervising Electri Ovners Na COUPI,ETB TEE SCMDULE BELOV New Residential-Single or MuIti-FamiIy per dvelling unit.'Servic-e--f ncluded: I tems 1000 sq.ft. or less Each additional 500 sq. ft or portion t hereo f Each Manufrd Home or -Modular Dvelling Service or Feeder B. Services or Feeders Installation, Alterations or Reloeation: 200 amps or less $ 201. amps to 400 amps - $ 401 amps to 600 amps - S 601 amps to 1000 amps- $over 1000 amps/volts - $ Reconneet Only $ Cos t $ 8s.00 $ 1s.00 s 40.00 s0. 00 60.00 100. 00 130.00 300. 00 40.00 Sum )l. Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. C Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 20L amps to 400 amps Over 401 to 600 amps 0ver 600 amps or 1000 ,GTfs a6ove 00 00 00 Bll s 40. $ ss. $ so. see rr Address Ci ty Phone OTINER INSTALI.ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Ovne D. Branch Circuits Nev, Alteration or Extension Per Pane1 One Ci rcui t Each Additional s 3s.00 q-ft SF Circuit or vith Servic;l or Feeder Permi I 'f' i $2. 00 E Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Si gnloutline Lighting- Limi ted Energy/Res Limi ted Energy/Comm SI.ETOTAL OF ABOVE 5Z State Surcharge TOTAL $ s s s 00 00 00 00 40. 40. 20. 36. DATE:. RECEI *: r RECEIVED BY: 5 d) COI{TRACf,OR INSTALI.ATION ONLY 65CDa JoB No. 12o84?- CHARGECITY OF S,-.iNGFIELD SYSTEMS DEVELOPML.. WORKSHEET , , (cof.{t{ERCIAL & RESIDENTIAL) NAI'IE OR COI1PANY:Srlf-Zyta N 'T?-nrew LOCATiON:Zto c. 1"{E3-/-7 OZ +t42--054oo DEVELOPMENT TYPE:LDz - A>>r a.r,,xl BUILDING SiZE: Zat b1 tNoLoDee ?A46L0T SI i. STORM INAGE 2. SANITARY SEI.IER-CITY NO. OF PFU'S 7 X 538.55 PER PFU (See Reverse To Determine Total PFU'S) TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP sQ. Ft- IMPERVIoUS SQ- FT- 18o X 50-186 PER SQ- FT- (See Reverse For Runoff Coefficients If Actual Imperv. Area Is 3 4 x x s388.61 x $388-61 s L x _ x $388-61 (s ee- Attachment C To Deteroine Trip Rates) SUBTOTAL (ADo ITB.IS 1,2,& 3) s. TOTAL-CITY SDC S 4I>b9 EES S* a2- 414 - ADI'IiNISTRATiVE FEES BASE CHARGE (SUBT0TAL AB0VE) X .05 5. SANITARY SEI,IER-H1.'MC N0- 0F PFU',S -- x 513-25 PER PFU .+ SIC t',ll,'l'tc AI$4IN- F (Use PFU Total From Item 2 Above) HW'IC CREDIT IF APPLICABLE (SEE REVERSE) TOTAL-HWMC SDC s @)-,)- ulltitu SOC Coordinator S-{ rGT/TOTAL SDC s s zcq zb FIXTUREUNITCA.LCUL-A.)NTABLE:r.*umoerofNervF,ixturesX^itEquiva{el]t=I..ixlureUrlits(t'JoTE For renrodels, calculate only the NET adcjiiional lixrures) FIXTURE TYPE NUMBEF OF NEW FIKTURES TOTALFXruRE UNTTS xs UNIT EOUIVALENT FIXTURE UNITS ---- 2 l 4 ---J-- -7 Bathtub....-.- Drinking Fountain---.---""""""""" Fl oor Drain----- ------:--------. l nterceptors For Grease/Oil/Solids/Etc'-" "" " "" "' I nterceptors For Sand/Auto Wash/Etc'- "- " "' :-" - "' 2 1 2 J 6 2 6 6 1 J 2 'l I Laundry T Clotheswasher - 3 Or More"-""-"' Mobile Home Park Trap (1 Per Trailer)'--"'-' R eceptor For Ref rigeratorAVater Station/Et c"-"' - - Receptor For Commercial Sink/Dishwasher/Etc-' Showeq Single Srrll Shower. Gang.---------- SinK Bar. Commercial-----':"-""" U rinal. StallflVall---- Wash Basin/La\ratory. Single"---"-- Water Closel Public lnstallation-' Water Closet, Private------ Miscellaneous:- Credit for Parcd or Land Ody tf Apflicable lmprwement $f after annoation date) (Rate X Assessed Value) (Rate X x s- , Assessed Value) CREDIT TOTAL RUNOFF COEFFICIENTS FOR STORM DRAINAGE I /Head 2 2 1 6 / CREDIT CALCULAION TABLE: Based on assessed valua lf.lmpronernents ggnnreo after annexation date in'taue' calcr.date credits = s-- Residential-- Commerc'el lndustrial---.. G overnmenial...------ ------- 0.4 0.9 0-45 0.5 Year Annexdd Rate per Sl.0O'0 Assessed Value Year - Annoced Rate per Sl.Oo0 Assbssed Value 1979 or before 1980 1981 1982 1983 1984 sz66 ZU 253 247 z^19 ZM 1985 1986 1987 r988 1S 1990 s1.@ 1.35 1-15 o-92 0.59 o.23 IMPERVTOUSAREA=ToTALLoTSIZExRUNoFFCOEFFICIENT I