HomeMy WebLinkAboutPermit Building 1994-2-1
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CO M M ERCIALlI N DUST RIAL
PERMIT APPLICATION
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225 Fifth Street, Springfield, Oregon 97477
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JOB NUMBER
9~O/~/
INSPECTION LINE: 726-3769
OFFICE: 726-3759
LOCATION OF PROPOSED WORK' '2.1JIe> ~ p.o~
ASSESSORS MAP: ''7-L)~-'2 "i'...:;:.e:.
TAX LOT: DC> 9~ c::>
OWNER:~ ~Bf", ~ ~~rr~
ADDRESS: 1'2oC;4$ H1 ~"'IC'O <<
~e
PHONE:
"~,,.- '1~~..'M
j::~;~
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CITY:
STAT~'
c::lR.
DESCRIPTION OF WORK'
NEW ~ REMODEL
MeDt~ GVI foJ\4:0
ADDITION
DEMOLISH
OTHER
1i'IP SAt:. 09Y3. ~I
-c:r .
VAL~E:~D /C'.
ARCHITECT-
NAME
eE{qI.,/ ~rtecsrS
ADDRESS
1<<-;0 Wll"""""MCtt&
PHONE
4fJC; "'!fll1D
CONTRACTOR'S NAME . tJ)DRESS
.,..,_ .....-:::;. ~;/Y.ce
GENERAL:~~""'.A7' "s7.i . ~.~7~
PLUMBING: ~LV~
MECHANICAL:~ 7.~CtF
ELECTRICAL: ~ .M~~
CONST.
CONTRACTOR' EXPIRES PHONE
~gF~ .R~r~_ ?Y'4.I'-.D6/z.
r
PLUMBING I MECHANICAL I
NO. FEE CHARGE I Nn ~~~ rI-lARn;~ I
~ Single Fixture 'T'a:::> I 2> Furnace/burner & vent b.-1i8'~ I
/0 <100,000 BTUs
Relocated Bldg. I Furnace/burner & vent I
(new fix. addU) > 100.000 BTUs
..--- Water serv;c:..::::S": ~-t>.'.,. Floor furnace and vent I
;,::orl.
y Sanitary Sewer ~ Suspended wall or floor I
""'~. mounted unit heater
V Storm Sewer ~ 11:s:-1 Appliance Vent I
II. separate
/ /ttJ. - I Stationary evap. I
Backflow Device cooler
~ I Vent Fan/Single I
duct
I -:j Vent System apart ~~ /?.s9
from AC or hlg.
I Mechanical exhaust I
hood and duct
I I
I Permit Issuance $10.00 I
TOTAL PERMIT , 57~"" TOTAL PERMIT ,b;. 5"0 I
QUAD AREA~CJl)uJ - OFFICE USE - HANDICAP ACCESS:
LAND US.' e53C{) FLOOD PLAIN:
. OF BLDGS' I . OF UNIT~' ZONING- (0(1 _
OCCY GROUP' th rl, CONSTR. TYP~' LIGHTING POWER BUDGET:
'f,_HJ~RIES: r HEAT SOURCE: ~.t:.~.'" PA. WATER HEATER' G-
.,
SQ. FT. $/SQ. FT. VALUE
SQ. FTG MAIN ql~ X ~A:}-SY;: ;z/
SQ. FTG ACCESS X
SQ. FTG OTH ER X
TOTAL VALUE OF PROJECT
MI)/~~~A~<~~!C::--, -, RCPP !/"5:/'s
DATE '2.."....-~~ BY ~~ _
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I BUILDING PERMIT I /g~. S't:> I PLUMBING
15% State I 9Y. 9'31 5% State
Surcha~qe SurcharQe
I MECHAN~~;r\ /&/1 . -,. FENCE
p.~~ VALUE $_
5% Stale I ~.I6S SIDEWALK
$urcharoe FT.
PAVING I CURBCUT
FT.
67"5: - I DEMOLITION I
8--- ~//I"""''''~(,~ I
":? d '" ~...v/?'_ _ . 2-:::1/.='3
, '. I
267/.;:1i: I.
ff 7groo:E- If"
SUBTOTAL
PERMITS
SYSTEMS
DEVELOPMENT
TOTAL PERMIT FEES I
EXCLUDING ELECTRICAl
1~7-9:3. 9~
It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call
726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready
for inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made
the following work day.
SITE INSPECTION: To be
made after excavation, but
prior to setup of forms.
X FINAL ELECTRICAL
)( FINAL MECHANICAL
x' FINAL FIRE DEPARTMENT
C AG~O~~~Q~~M' \ \ ~ f _ Y\C\J\ f\O r' ~ c-ih.st ~~A lY
~~'. ~~,~\of\, ~f\Qj(C"fL'tl)~' \C\I\,5 ,
.
)(
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work is covered.
yo
FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel in place, but
prior to placing concrete.
v
CONCRETE SLAB: To be
made after all inslab building
service equipment, conduit,
piping, accessories and other
ancillary equipment items are
in place but before any
concrete Is placed.
UNDERGROUND: Plumbing,
electrical, gas, sanitary sewer,
storm sewer, water and
d ral nage Ii nes. To be made
prior to covering or filling
trenches.
UNDERFLOOR: Plumbing,
electrical, mechanical. To be
made prior to installation of
floor insulation, decking or
floor sheathing.
POST & BEAM: To be made
prior to Installation of floor
Insulation, decking or floor
sheathing.
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to installation of
decking or floor sheathing.
MASONRY: Steel location,
bond beams grouting or
vertlcals in accordance with
UBC 2415.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
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FINAL PLUMBING
REQUIRED INSPECTIONS
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PAVING: After gravel Is In
place but prior to placing
as phalt or concrete.
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No work is to
be covered until these
. inspections have been made
and approved.
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special inspector shall be employed
by the Ownerl Contractor during
construction of the following work. A
copy of the special testing reports shalt
be furnished to the Building Division.
ATTIC DRAFT STOPS &
CURTAIN WALLS
FIREPLACE: Prior to placing
facing materials and before
framing inspection.
STRUCTURAL CONCRETE: In
excess of 2500 PS.1. (306 a.1)
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FRAMING: To be made after
the roof, all framing, fire
blocking and bracing are In
place and all pi pes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
HIGH STRENGTH BOLTING:
During all bolt installation and
tightening operations. (306
a.6)
STRUCTURAL WELDS:
Performed on the job. (2722 f)
x
INSULATION & VAPOR
BARRIER: To be made after all
insulation and required vapor
barriers are in place but
before any lath or gypsum
board interior wall covering is
applied.
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
SPRAYED ON
FIREPROOFING: U.B.C.
Standards 43.8.
FIRE & SEPARATION WALL:
Located and constructed
according to plans.
y
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division before
beams are placed. (2501 u.Be.
STDS. 25-10,11).
LATH AND/OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
interior and exterior, is in
place but before any
plastering is applied or before
gypsum board joints and
fasteners are taped and
finished.
STRUCTURAL MASONRY: (306
a.7)
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material in
place.
......
""In addition to the inspec-
tions specified, the Building
Official may make or require
other inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
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SITE PLAN REVIEW BOARD: Must be requested 2 days in advance
of the date you wish inspection; All project conditions such as
landscaping, parking lot striping, etc. must be compieted before
requesting this inspection.
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FINAL BUILDING: Requested after the final plumbing, electrical,
mechanical and Fire Department Inspections are made and
approved. No occupancy of the,premises can be made until a
Certificate of Occupancy has been Issued by the Building Division
and posted on the premises.
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PLANS REVIEWED BY '1' ~~~/
DATE -::;?-25'"-:7<;.r'
,
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information
herein Is true and correct, and I furtner certify 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 described herein. and that NO OCCUPANCY
will be made of any structure without permission of the Building Safety Division. I further certify that only contractors and employees
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 project address Is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during con u ion.
Slgnat.x I ~ J!.,~
Date
_~-/7-91-
VALIDATION:
AMOUNT RECEIVE9if('I';;~( 90
RECEIPT ': lL:1l1?(:J
DAT~ PAID: ~fl:J _~\ ~ )-~
RECEIVED BY:~
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. JOB NO. q 4 () I () (
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(PROFESSIONAL OFFICES & INDUSTRIAL)
NAME OR COMPANY: 'SACfZ.C;f/ f-/f;A-R-, Gf:.Nf;{<.AL. !-IasPITA-L
LOCATION: -Z2-~O IVI~C()L-A RD
(70'3 z.'5oo - ooqiJO
DEVELOPMENT TYPE:. ('c.. , NI t::l> leAL.. or-f-ICfi. .
N(;w M.ov~I\"-
BUILDING SIZE: 'T1'2(. -"Z'5'Z-C "" (P(.:,oc", LOT SIZE
SQ. Ft.
l. STORM DRAINAGE
IMPERVIOUS SQ. FT. 0.5 x (.:,00(., X $0.203 PER SQ. FT(("c",70 5!)
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2. SANITARY SEWER-CITY
NO. OF PFU'S 0.5 X 3.f X $42.08 PER PFU {(;,? 3~
(See Reverse) ~
3. TRANSPORTATION . . .
u>PE. I'2-D-NlE:.C>1CAL. OF-FICE." ..,..Og /T6-S{-
NO OF UNITS X TRIP RATE X COST PER TRIP
0.5 X (,.(.oc., X '1.t>8 X $424.31 ~'lgl~
........ ..-/
0.5 X X X $424.31 .$
0.5 X X X $424.31 $
4. SANITARY SEWER-MWMC
NO. OF PFU'S 3L../- x $15.125 PER PFU + $10 MWMC ADMIN. FEE $ 110 ~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
$ (07 7.2-
TOTAL-MWMC SDC ~B'l- ~
4q
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ ('-f~(" -
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~31<-{-3~
'-- ./
~..~LuL
At1p Burdick
stir Coord i nator
'2-/'3h'i-
I f
TOTAL SDC
OSI
$ 1"6&0 -
FIXTURE UNIT CALCU LA' 0 N T A8 LE: Number of Ne~ Fixtures Init Equivalent = Fixture Unit;~NOT.E"
For remodels. calculate only the NET additional fixtures)
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
Bathtub.. .............................................. .....................
Drinking Fountain.....................................................
Roor Drain.................................. ........................... ...
Interceptors For Grease/Oil/Sollds/Etc.................
Interceptors For Sand/Auto WasH/Etc..................
laundry Tub/Ootheswasher.. .... ..:....... ......... ..... .....
Ootheswa~er - 3 Or More.....................................
MobDe Hdme Park Trap (1 Per Trailer)..................
Receptor F!Jr RefrigeratorjWater Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single.StaIL..............................................
Shower, Gang..........................................................
Sink, Bar, CommerciaL...........................................
Urinal, StalljWall.......................................................
Wash Basin/lavatory, Single..................................
Water Ooset, Public Installation.............................
Water Ooset, Private.....:.........................................
Miscellaneous:
I
'3
"2-1.
4-
I
MCQLll..AP- CIU-P~)
5(.. - '}...'2-- -= "-.?i
TOTAL FIXTURE UNITS
-5(.,
UNIT FIXTURE
EOUIVALENT UNITS
2
1
2
3
6
2
6
6.
1
3
2
l/Head
2
2
1
6
4
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'2-1
U
4-
CREDIT CALCUlATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
1979 or before
1980 ..
1981 ..
I 1982
l 1983
1984
'1985
Rate per $1,000
Assessed Value
Year
Annexed
$3.21
3.13
3.08
296
2.82
2.68
251
1986
1987
1988
1989
1990
1991
1992
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Credit for Parcel or land Only If Applicable 3 ' 2- f X $ ?? , ? "
(Rate X Assessed Value)
Improvement Cd after annexation date) X $
(Rate X Assessed Value)
CREDIT TOTAL
Rate per $1,000 'I
Assessed Value .1
$ 2.24
1.93
1.57
1.18 J
0.79
0.44
0.28
= f0/7~
= ~
= $ /07 ?::-
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RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Residential........................................................ 0.4
CommerciaL................................................... 0.9
IndustriaL............................................ ............. 0.45
GovernmentaL................................................. 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
'.. I.....
~503 6 3689 SPFD DEV. SER.
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The follow1ng project Il9 .t.omb .,.
zoning, end does not require SpecfilC rand usu
225 FIFTH STREE'l' approval.
SPRINGFIELD, OREGON 97477 Zonlno' c.c..
INSPEctION REQUESTI n6-3~ ~-l'l~t:\tJ City Job Number
OFFICE: 72.6-3759 '-€!.\
Authorized Signature 9 3:''''/ ,,(mr...:.u. tu.. SCHEDULE BELOIl
l'"rm1~DeF~ ~~~tJl.h )
\ .lfr~~D~W~ rY'Pt()
, il'\l\JpB~BSCRIrnONt'\^. '/\
~10t)_~ . ~ ~ I (l.h._' -!
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A. .Nev Residential-Single or .
Multi-Family per dwelling unit.
Service Includedl
SUlll
Items
Cost
$ 85.00
1000 sq. ft. or less
Each additional 500
sq. ft or. portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
Permits are non-transferable and expire
if vork is not started within 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
$ 15.00
$ 40.00
'.. t.....
B. Services or Feeders
Installation, Alterations or
Relocation:
. Electrical cont.ractor~
Addre~s 4 <6'? )tIDe!!T
City 'Zf; i/P Pho~e l~lr7 -o'ifl {
Supervisor License llumber cSovc.:: - '3
Expiration Date I" - / - ~ <L
200 amps or less ~
201 amps to 400 amps I
401 amps 'to 600 amps 1
601 amps to 1000 amps
Over 1000 amps/volts --L---
Reconnec t Only .
f~
~
$ 50.00
S 60.00
$100.00
$130.00
$300.00
$ 40.00
c. Temporary Services or Feeders
Installation, Alteration or Relocation
o 1<6'~~
{; -g-7'-!
Constr Contr. Number
Expiration Date
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or'lOOO
S 40.00
S 55.00
S 80.00.
volts see "B" above
Signa jure 0 upervising Electrician
" /1,> /! ~
r J _n r/... LtP 0 Branch Circuits
Ov~ers!(ame '- rr:-~_O(<J,/. '\w . .
Address (fA. SS -~ t (lJt I Nev, Alteration or Extension Per Panel
~_~ ~[O-, nr(jc::' (lne Ci.rcuit $ 35.00
City_U (1 ./ Phone lQ()n "l~W Each Additional
- Circui t or vi th Service
. 01lNER I STALLATION or Feeder Permit 100 S 2.00~Q)
'.. '.....
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each. installation
Pump or irrigation
Sign/Outline LightinF
Limited Energy/Res
Limited EnerzY/Comm
. S 40.00
$ 40.00
S 20;00
$ 36.00
Owners Signature:
-1l.,,(J .cO.
,~h.(..A../
'...1!:1.P-..CU
5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
~~Ti7=-. ~7 l"'1' L7''1~ /.-
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