HomeMy WebLinkAboutPermit Building 1994-09-13B
P
ESIDENTIAL
ERMIT APPLICATION
lnspectlons: 726.3769
Office: 726-3759
PrlIhlGFIELE'
JOB NUMBER
225 Fifth Street
Springfleld, Oregon
LOCATION OF PROPOSED WORK:
{t"\ g
ASSESSORS MAP:t-r \-[ A.TAX LO'I:
LOT
-
BLOCK:SUBDIVISION: _
To request an lnspectlon, you must call 726-3769. Thls ls a24fiaut recording. All inspections requested before 7:00 a.m. wlll bemade the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followtng work day.
REOUIRED !NSPECTIONS
Temporary Electrlc Rough Mechanlcal - prlor to
cover.
Flnal Plumbing - When allplumblng work ls complete.
Site lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Rough Electrlcal - Prior to
e <.t
q0
W
F
m
ry
ry
[_l UnderslabPtumblng/Electricat/ r-FtlJ Mechanlcat - Prlor to cover. t+J
m
Flreptace - Prtor to factng Wmaterlals and framlng lnsp. /
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
Framlng - Prlor to cover.
Wall/Celllng lnsulallon - Prlor to
cover.
Drywall - Prlor to taplng
Wood Stove - After lnstallatlon
lnserl - After flreplace approvsl
and lnstallatlon of unlt.
Curbcut &.Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Drlveway - After
excavation is complete, forms
and sub-base materlal ln place.
Fence - When completed.
Slreet Tr€€s - When all requlred
trees are planted.
Final Electrlcal - Wlren allelectrical work is complete.s
Flnal Mechanlcal - When allmechanlcal work ls complete.
Flnal Bullding - When all
requlred lnspectlons have been
approved and bulldlng is
completed.
MOBILE HOME INSPECTTONS
Blocking and Set.Up - WheO ail
blocking ls complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocklng, set-up, and plur0bing
lnspections have been approved
and the home is connected to
the servlce panel.
Final - After all required
inspeclions are approved andporches, skirting, decks, and
ventlng have been lnstalled.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng,
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulatlon - Prlor to
decklng,
Sanltary Sewer - Prlor to fllllng
trench.
Storm Sewer - Prlor to fllling
trench.
Water Llne - Prlor to filling
trench.
Rough Plumbing - Prlor to
coYer.!
\
PHONE:3s 1
f,3.,
CqSTATE:
6- s.?q
ztP: q? Y ?8CITY:
ADDRESS:
OWNER:
NEW- REMODEL ADDITION X
-t (
DEMOLISH OTHER
DESCRIBE WORK:
EXPIRES PHONE
\
ADDRESS
3a
CONTRACTOR'S NAME
PLUMBING:
GENERAL:
MECHANICAL:
ELECTRICAL:
CONST.
CONTFIACTOR #
.qP - OFFICE USE -
FLOOD PLAIN
OCCY GROUP:
LAND USE:
ZONING CODE:
r OF BDRMS:
WATER HEATER:
# OF STORIES
BANGE:
* OF UNITS:
SECONDARY HEAT:
SOUARE FOOTAGE:
QUAD AREA:
r OF BLDGST
CONSTR. TYPE:
HEAT SOURCE:
tl
E
tl
E
f-_l ottrerll
tl
tl
\
ri r
''.iq':;'i..'ix "!{ a
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total hpight
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
ks !S THE PROPOSED WORK TN THE -
HISTORICAL DISTRICT, OR ON t r ^THE HISTORICAL REGISTER? IU O
lf yes, thls applicatlon must be slgned
and approved by the Historical
Coordinator prior to permit lssuance,
APPFIOVED:
P.L.HSE GAR ACC
N
S
E
"WIW,:siEs ,ff+s;az
e/{3oP
-?q -zE
s?H.,r^ -=E(A) 86-qz
\5o
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT,
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
b This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfleld, includlng the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
/Byewe
Receipt Numbe
upon violation of
Plan Check Fee:
any provisi
Plans
Date Paid
Received By:
said ordinances,
SYSTEMS DEVELOPMENT C
(B)
HARGE (SDC)
/ n.?{
Systems Development Charge is due on all undeveloped
properties within the City limits which are being lmproved.
FEE
a(c)
No
FT.
FT.
FT.
PLUMBING PERMIT
Plumblng Permit
State_ Surcharge
Total Charge
ITEM
Flxlures
Ftesidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobiie Home
ITIONAL COMMENTSA
MECHANICAL PERMIT
Furnace
Exhaust Hood
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuahce
State Surcharge
Total Permit
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work described
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 compliance with ORS 701.055 will be used on this
project.
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 at the front
of the property, and the approved set of plans will remain
q:l{,al
T
on the site at al tim
Slgnature
Date
ring constructlon.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)r<
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E Comblned)
teOJjL
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
BECEIVED BY
223
?</ Dat{
ATTACHMENT 81
r0B N0.
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENI CI.IARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA},IE OR COMPAI{Y:B"*r;*/
I.OCATION:zYo 5. 38 .4
1
DEVELOPMENT TYPE:c/"/ 75'r/o' //&d zq? /.M; r ' /' Gr/A
BUILDING SIZE:ZE SQ. Ft.
STORH NRATNAGF
IMPERVIOUS SQ. FT.7o
,i
X $0.209 PER SQ. FT.s /F, E/
2. SANTTARY SFhIER-CTTY
X $43.26 PER PFU $
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x x $436.19
x $436.19 $
x _ x $436.19 q
SUBTOTAL (ADD ITEMS 1,2. & 3)s /tr. F/
4. SANITARY SEWER-MI^JMC
NO. OF PFU'S $17.19 PER PFU + $10 ll,l!.lMc ADMIN.FEE $
(Use PFU Tota]rom Item 2 Above)
MI^IMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
SUBTOTAL (ADD ITEMS L,2,3 & 4)$ 1tr,F/
5. AT}MINISTATIVE FEES
BASE (s o.7/
Date: f-2/-Zz
g.P.E
SDC
NO. OF PFU'S
(See Reverse)^Z
) x .05
82. SDC
i nator
TOTAI SDC f
b ^/
s /7.
225 YTYTE SI?.EEf,
SPRINGPIELD, ORBGON 97477
INSPEGTION RE0UEST: 726-3769
OPPICB: 726-3759 oas Cl-)c)-it4t
-#_J.
m
The.followlng prcject
zo:,Inu, arrd does flot
approval.?3,11 iJli[3i,iglpguuu,
Ci ty Job Nunber
COHPLETE PEE SCEEDTILE BELOU
Authcrtzoci signarurs_l, l*6f-Res { dd S i ngl e o r
SPRli. :LO
PERXTT APPLICATION
HuIti-Family per duelling unit.
Service Included:Items Cost
1000 sq.ft. or less $ 85.00
rach additional 500
sq. ft or portion
thereof S 15.00
Each Hanuf'd Home or
-Hodular Dvelling
Servlce or Feeder S 40.00
Services or Feeders
Installation, Alterations
or Reloeation:
1 fi
IJGAL DESCRTPTION L
permits are non-transferable and expire
if vork is not started vlthln 180 days
of lssuance or lf vork ls suspended for
180 days.,
2. COIII"ACf,OR INSTALI.ATION ONLY
EIecLrlcal Contractor@
Address 1130 BAILEY HILL RD #24
CltY EUGENE Phone 3t4- 6?q6
Supervisor License Number 36145
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps-
over 1000 amps/volts
-Reconnect Only
Sum
B
s s0.00
$ 60.00
$100.00
$130.00
s300.00
$ 40.00
Explration Date
'L+
Constr Contr. Number 66894
Expiration Date
Slgnature f Supervlsing Blectriclan
Ovners
Address 2-%.f- 3a.2r
Ci tv Phone
OVNER INSTALI^ATION
The.installatioh is beirig made on
property I ovn vhich is not intended
for salel lease or rent.
Ovners Signature:
DATE:
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
.00
.00
.00
xB'.
r0/1/95 ,,
s40
Sss
$80
see
200 amps or less
201 amps to 400 amps _Over 401 to 600 amps
0ver 600 amps or 1000 voT[s aEove
D. Branch Circuits
SUBTOTAL OP AI}OVE5f State SurchargeT0TAL 3.i)., .fu27.n, .
Nev, Alteration or Extension Per Panel
one circuit I g 35.00 35*'
Each Additional
Circui t or r.ri th Service
or Feeder Permi I Z Es 2.00
E. Miscellaneous (Service/feeder not ineluded)
-Each installation
Pump or irrigation
Sign/0utline Lighting-
Limited Energy/Res
-Llmited Energy/Comm
$ 40.00
s 40.00
s 20.00
$ 36.00
5 0o
RECBIVED
C1
vrTz
JOB DESCRIT ION//Z.Z-. a -tt"',Tu'
E ? /otr