HomeMy WebLinkAboutPermit Miscellaneous 1998-4-22
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COMMERCIAL/INDUSTRIAL PERMIT APPLICATION
CITY OF SPRINGFIELD Job Number: 980156
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 1001 MAIN ST
Assessors Map #: 17033541
Tax Lot #: 05300
.
Owner: SUB
Address: 1001 MAIN ST
Phone #: 726-2395
,City/State/Zip: SFPLD OR,97477
Description Of work:~__
No,
NEW
Value:
0.00
PLUMBING
Fee
Charge
40.00
Storm Sewer
100
ft.
TOTAL PERMIT
,
40,00
~_ ~\111mr'
\
OFFICE USE --
Item
Square Feet
x
$/Square Feet
Value
TOTAL VALUE OF PROJECT
0.00
Surcharge/Admin
MECHANICAL
Surcharge/Admin
PAVING VALUE
PLUMBING
Surcharge/Admin
PLAN REVIEW FEE
CITY SDC FEES
19,050.00
0.00
0,00
0.00
140.50
40.00
3.20
45.13
3,812.94
SUBTOTAL PERMITS
4,041.77
TOTAL PERMIT FEES EXCLUDING ELECTRICAL
-'7l!!PJ1o&? ~~/Ye<~.
4,041.77
~-
S'c51'~. 77
REQUIRED INSPECTIONS
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,
Special Inspections: In accordance with
a special inspector shall be employed by
construction of any following "*" work.
shall be furnished to Building Safety.
Section 306 of the State Specialty Code
the Owner/Contractor during
A copy of the special testing reports
In addition to the inspections specified, the Building Official may make or
require other inspections of any construction work to ensure compliance with
the Building, City or Development Code.
SPRINGFIELD
--~
.....-
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Job Number: 980156
Page 2
STORM SEWER LINE - Prior to filling trench.
ROUGH GRADING - After gravel is in place but prior to placing concrete
FINAL PAVING - After paving is complete.
FINAL PLUMBING - When all plumbing work is complete.
- - - ADDITIONAL COMMENTS - - -
Plans Reviewed By: LORNE PLEGER
Building Site Reviewed By:
Date: 03/09/98
By signature, I state and agree, that I have carefully examined the completed
application and do hereby certify that all information hereon is true and
correct, and I further 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
Community Services Division, Building Safety. 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
., "~',:;'C"~ .<c.",.n n~. 'ono, O.O"'~~'t~L q€
Sign~e I V Date-
--- VALIDATION ---
Date Paid:
,
I ~ '....'J
-::?.,~., ~'-.7:::&-' 'I ~ ~
7'''7''<- ;:~
Receipt Number:
Received By:
0/'47"'''- 77
~
/~~
Amount Received:
I 2215 FIFTH STREET' . ._......._
~ SPRINGFIEL!). OREGON 97477
. ENQJNEERING DIVISION ",/" ," '~'., .~,
OFFICE TELEPHONE (603) 726-3753 . , -.. ~
INSPECTION LINE SEE INSPECTIONS ON BACK SIDE'
ENCROACHMENT PERMIT '
NUMBER:
PERMIT NUMBER: ~,~:::V~
.
APPLlCA TIONDA TE:
'.
DATE ISSUED:
,LOCATION OF WORK
APPUCANT ~/....-'?<' ,PHONE 72~<:?~~
SITE ADDRESS: /I!!:?/!>/ -M#h!/ ..-5)<', ,TAX MAP: /7~"3'<;"-C//
y' ~.-......
CITY: STATE: ZIP: TAX LOT: -S-~.~-::-';'::-,~
SUBDIVISION: ." 6~e:rc:::> "
OWNER: -5/........?? PHONE:
ADDRESS: /;&:" /' ~~,;"(,.< CITY: ~~ STATE:' "",?-j>. I
CONTRACTOR: ,If?t,zy~#. ADDRESS: ~~ 7'7"2f!- ~
CONTRACTOR REGISTRATION NO: ~A4~ EXPIRATION. DATE: j.-..c~;;>.~
PROJECT SUPERVISOR: ~ "L>7'?- PHONE: 9~-?<=;" ~
ZIP: ""'='.?7?:?
,PHONE: .v~~ -
REQUESTED PERMITS: '
o ENCROACHMENT PERMIT NO: .u.~.......................~.. n
VAl.D RlR IIlCTY lIOl DAYS FROM DAn ~ I88UANCI
Q CUT STREET Q BORE Q OTHER Q
Q DUST CONTROL ITYPe OF CONTROU
tcSP!C11OHI RIOUUlIDI
AMlCATXlH FU' 0U08IT
ACCOUNT NOI
~
.
Q $20.00 I
Q.
Q CONSTRUCTION, STORAGe. STAGING
QOTHER
n
n
Q.
O.
O.
O.
Q $10.00+t.16/FT.
a ASPHALT DEPOSiT......:............................................,...................................................!.....
TVPI: nc SI;ClJRJTV O~POSIT
, Q BlANKET SURETY SONO ,Q SURIITY BOND Q CASH / CHECK
Q CURB CUT PERMIT NO:..................~... FT. 0
rN""I'!TIt'lill. CURl I APPROACH NTIR fORMS ARE ERECTIO BUT PfUOR TO POURING CONCRfTL
, VAUD I'OR 110 DAYlFftOM DAn 0' IUUANCI,
Q sEcoriii DRIVEWAY ISEE SEPARATE APPUCATlONl
CJ SIDEWALK PERMIT NO:.................... FT.
VALl) 'C)R 110 DAya "'OM DATI OP IllUANCL
Q NEW Q REMOVE / REPAIR Q PAVE PLANT STRIP
Q'SETBACK Q CURBSIOE Q LENGTH
1~~PlI'l"'TIn",. RtDlWAUt/DRlVlWAV FOR ALL._~"_,,,..... PAVING WlTHtN THE STREIT IUQKT 0' WAY, TO BE
MADI AnER AU EXCAVATING IS COMPUTl. AND fORM WORK AND IUB-8481 MATERIAL IS IN PLACI.
D SANITARY SewER CONNECTION PERMIT: ................ n
VALl) POll SIXTY IIOJ DAYS MOM DATI 011' ISSUANCe
Q TO STUB Q MAIN UNE lEASEMENT.R/W) Q OTHER
~ STORM SewER CONNECTION PERMIT: .................... n
VALl) POll IIXT't CIOI OAVI MOM DATI OfI..UAHCI
Q CATCH BASIN 'IlUSBLER "QSTUB QMAINUNE
I!"f'nc nF INSURANCE' .600.000 MINIMUM
. Q ATTACHED Q REQUIREO AMOUNT
n
Q .10.00H.151FT.
o $6.do I .
Q. .6.00 I
~
, TOTAL DUEi-.
TOTAL DUE WITH PERMIT.
',~:~
DESCRIPTION OF PROJECT:
PERIOD OF USE OR TIME OF CONSTRUCTION:
o PLANS (TWO SETS) ATTACHED
AREA: LENGTH:
TYPE OF WORK: CUT:
OTHER:
EXISTING SURFACE MATERIAL:
BACKFILL MATERIAL TO BE UTIUZED:
SURFACE REPLACEMeNT MATERIALS TO BE UTILIZED:
TYPE OF DUST CONTROL TO BE UTIj.IZED:
NAME OF OTHER UTILITIES IF THIS IS A JOINT PROJECT:
WARNING DEVICES TO BE UTILIZED:
Advance .Ignlng and work zone .prot.ctlon to be In compliance ~~.I ~,. ;.nu'; on Uniform TraUlc Control Dlvlc.. IMUTeO).
FROM DATE:
TO DATE:
,wIDTH:
DEPTH:
.TIME: .
,TIME: ,
HEIGHT:
BORE:
, BACKFILL MATERIAL:
DESCRIPTION:
;
WORK SHALL COMPLY WITH CHAPTER X ARTICLE 6 OF THE CITY CODE. CONTRACTOR TO COMPLY WITH MUTCD .
Rev.SIONS 1/24/11 FORM "" '
.
f
PLAN REVIEW COMMENTS I SPECIAL INSTRUCTIONS: , .
gfit<<&~'B~~~~mcA'W~,BdW~~C'm. EXISTING CITY CODES AND.MPUANCE WITH CURRENT
.. .,...
.3
001 81ckfl11 WIth ~. mlnuo rock.
002 C.mp.ct ...ry IS' I.... d.pth.
. 003 R.qulll. c.mp.otI.n with .11111 rom".
. 004 A.C.I. m'lch tho gll.l"ollldlllng d.pth.. 4'.
.. 005 All CUll 1I.I.d 10. IInoIIMP'cilon.
. OOS. T.mpO<lry p.lch m.y b. us.d.1 tho.nd .t Ih. d.y.
. 007 Signing .nd Z... p..t.ellon t. comply with MUTCD
. OOS CUI concrll. .nIy on IC.II Ilnll .r c.1d jolnll.
OOS SId.w.lko .nd drtV.w.y. rntn. 3,OOOpll.
.
. 010 Curbing mln 3.500pll I N. potchwort I.u th.n 3'.
011 MO'I min. ..qulrom.nll .n curb 0llI.. Spld. cod..
~ 012 R.II... pl.M.d,...u. Spld. cocI. 208.3.05
013 Splc. I. S... / J.ck I N. A.C. 0llI..
014 Mo.honleal .omp'ellng ..qvltod.
015 N. polchwo'" .a.wld.
. 01S LoIIIII CUll I. ho.. conllOl d'MIty nil.
. 017 CIlIII. bo p.Iym.....d click ...I.d I.. tln.IIMp.CII.n.
. 01S Mlnlnum 2' crushod rock ~. mlnuo.
- 018 M1numum 4' clllllnc. .1 .ny polnl. .wlng',w,y~
.
. 020 Concr.to mln1m\llll4' d.pth. 3,OOOp.I.
021 T..nCh I. bo "T" 0llI. .
.
. 022 N.Id. Sill. I CounIY p.rmh.
L~ 023 No .bon ground .ndollng.1n old.w.lk .. h.ndlc.p romps.
. 024 Dlom.nd 0llI A.CJC.ncr.t. ..In. b.... t. grod..
. 025 FlIsh on IIgM' Glld.d.
. 02S Comply with Amt~eaM with DI..bmu.. A.t.
. 027 Concnto lI.b., 72hra. curtng 11m., 4500psl.
. 02S C.ncrot. lI.bo "qutlll.1nt I..t m.II,"'I.
. 02e Drlv.way ..quire. d.w.ls .very IS'.
. 030 Submh Ir.lno cont.oI pl.n prl.. I. ......II.n.
. 031 N.tlfy T..m. DIvtoIon bot... ......tl'n.
. 032 C.II d~D main Un.. inllnlll, 2~ min. erod..
. 033 Muat comPly wI1h tho provltlona.' ORS 757.541 t. 757.571.
. 343 S' CIrcuI.. h.'"1H2o.V.c.
-
CommanlS:
.
.,
YOU ARE REQUIRED TO CALL
THE LANE UTILITIES COORDINATING COUNCIL'S
"ONE CALL NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
j
INSPECTIONS:
'0
CURB CUT AND SIDEWALK INSPECTIONS CALL 728-3789 (RECORDER} STATE YOUR DESIGINATED CITY JOB
NUMBERJPERMIT NUMBER, JOB ADDRESS. TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR
INSPECTION. CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE
MADE THE SAME DAY, REQUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WOijK IS IN PLACE BUT PRIOR TO POURING CONCRETE.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
728-3781.
SIGNATURE:
AMOUNT RECEIVED: ~ -
RECEIPT NO: "7.q'-=':>>':::>~
10
DATE PAID:
RECEIVED BY:
o/-~";? ~~
/2...,.-
//
DATE:
DATE:
DATE:
DATE:
, FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
INSPECTION:
:, INSPECTION:
, WORK IN PROGRESS
AT TIME OF COMPLETION:
ELEVEN:rH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DAT~:
DATE:
DATE:
.'
, JOB NO .7'Po /..,,h
ATTACHMENT A. "
CITY OF SPRINGFIELD' SYSTEMS DEVELOPMENT CHARGE'
WORKSHEET
.
NAME OR COMPANY: ' f) Ij f?
-,
LOCATION:
,
,/c;O/ ~h-In ~
/J if,
1t~~?-.j1
,/I/A
l..,f,f/.--{'/,,>e/~,J-~ (A/e"',( / ;5-0/> f1;t:~)
/
LOT SIZE-"1'{,,;t..i~~;~,? - , <;0. Ft. _' .
, .' rtc.:)'~n'Yr(/.2.><'Y'l) ~/,,/C'c.,&
DEVELOPMENT TYPE:
BUILDING SIZE:
1 . <;TORM ORA 1lffiG(
IMPERVIOUS SO. FT,
.3/
/(,./1?C,8 'X $0.226 P,ERSO, FT, $.~ &.1/.-
2. SANTTARY SEWER-CTTY, - /v~ ~tJ,,/ C<-'hAn:I>b~,;'
NO. OF PFU'S
(See Reverse Side)
3. TRANSPORTATION ".-: M, c.k...1{i<!' ,i. l/~'
I '
,NO OF UNITS X TRIP RATE X,COST PER TRIP
X $46,86 PER PFU
$C
x X $472.49 $ -G-
X X $472.49 ' $
X X $472.49 $
4. SANITARY SFWFR,MWMC -db CJ.,;t!J:3.r 4""htJ<:..f,,J...s
NO. OF FEU'S
, X
PER FEU + ~1~ MWMC/ADM' FEE $ ,~
, MWMC CREDIT IF APPLICABLE (SEE REVERSE)
$
TOTAL-MWMC SOC
$ 4J-
, 17
$ '7 If i "--'
SUBTOTAL (ADD ITEMS 1,2.3 & 4)
5. AI)MINISTRATIVF FFFS '
BASE CHARGE ( SUBTOTAL ABOVE) X .05
, $ /}~/S7
1Y1/' v..-y..4< ,,' '
,"1 SD~ .(00# riator
Date :2?~ /9,11
I0TAI SOC
, .9r'..
$ ~f3I"r-
, FIXTURE UNIT CALCULA TIUN T Atilt:: Number of New Fixtures X,Unit Equivalent = Fixture Units
(NOTE: For remodels, calculale onllliliie NET additional fixtures) , '. ._ . . . .
, .. NUI'v\BER OF ,UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub.................:..............,."..,.......:......;................. ..
Drinking. Fountain.. .......................,'....................,......
Floor Drain... ............ .............,....... ;'.......:.................... .'
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc........,.........
Laundry Tub/Clotheswasher.................. ..... :.:.........
Clotheswasher, 3 Or More......................................
Mobile Home Park Trap 11 Per Trailer}...........'.......
~ .
Receptor For Refrigerator/Water Station/Eic........
Receptor For Commercial Sink/Dishwasher/Etc.. .
Shower, Single Stall.................................................
Shower, Gang........,...........................;.................... .
Sink: Bar, CommerCial, Residential Kitchen.............."........:
" Urinal, Stall/Wall. ,..... ............".......... ......,..,...............
Wash Basin/Lavatory, Single......................:...........
Toilet, Public Installation..........,...,..........................
Toilet, Private................. ......,..,:..........:.................
Miscellaneous:
TOTAL FIXTURE UNITS
2
1
2
3
6
2
'6
6
1
3
2
1/Head
'2
2
1
6
4
=
Based on assessed value. If improvements occurred after annexation date in table,
CREDIT CALCULATION TABLE:
~alculate credits separates.
I
II
Rate per $1,000
Assessed Value
Year
Annexed
Year
Annexed
1979 or before
1980
1981
,1982
1983'
1984
1985
1986
$3.97
3.89
3.83
3.70
3.55
3.39
3.20
2.91
1987
1988
1989
1990
1991
1992'
1993
1994
1995
1996,
Rate per $1,000
Assessed Value
$2.56
2.17
1.73
1.31
0.9~
0.74
, 0.61
0.45
'0.31
:0.17
Credit for Parcel or Land Only If Applicable
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
Improvement lif after annexation date)
=
=
CREDIT TC>TAl, = $
, ,
RUNOFF COEFFICIENTS FOR'STORM DRAINAGE
(For, Estimating Purposes Only) .
'Residential...:.'.:................~... 0.4
Commerical........,................. 0.9
'Industrial.....:....,...........:..... 05
Governmental........:.....:....... 0.5
"
IMPERVIOUS AREA. = TOTAL lOT SIZE X RUNOFF COEFFICIENT