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Home My WebLink AboutPermit Mechanical 1995-7-7 RESIDENTIAL PERMIT APPLICATION Inspections: 726,3769 Oltice: 726,3759 . LOCATION OF PROPOSED WORK: _5L~ ~7.' ~A/~ , ASSESSORS MAP: g;;::.-c>..:?-o5'-"</ LOT: BLOCK: . JOB NUMBER 75"65 y~ 225 Flllh Streel Springfield, Oregon 97477 TAX LOT: SUBDIVISION: C>~ =3" PHONE: 'l;}. h- .d:J-L7/ JJo I, :s G;r -k.. L/3;;)"/ 0n+, Vert1 ON ( Clt/JU-,-_,_- DESCRIBE wom< ,__~ wi -Ife4 iJ~ [) I NEW IlEMOD~L ADDITION -/' DEMOLISH OWNER: ADDRESS: CITY: _ STATE: dK_ ZIP:-2?{/ 'lr{ CONTRACTOR'S NAME GENERAl' PLUMBING' MECHANICAl' ELECTRICAl' H (J/J .'10 lilt , I OTHER ADDRESS CONST. CONTRACTOR' PHONE q:~o7 CJ, Sf?:- EXPIRES Ik.c. 9,) 'l'oS <I' S-- QUAD AREA:, . OF BLDGS: _ OCCY GROUP: . OF STORIES: WATER HEATER: _.. - OFFICE USE _ LAND USE: . OF UNITS: CONSTR. TYPE: HEAT SOURCE: RANGE' 3 t;V~~ FLOOD PLAIN: ZONING CODE:_ . OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: _ To requesl an inspection, you must call 726,3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be made the ~ame working day, Inspections roquested after 7;00 a.m. will be made tho following work day, REQUIRED INSPECTIONS o Tompornry Eloctric O Slto Inspection - To be made after excaVAtion, but prior to setting forms. o Undorslilb Plumbing I Electricall Mechanical - PrIor to COver. o Footlng"_ After trenches are excavated. o Masonry - Steel locatlon, bond beams, groullng. o Foundation - After forms are erected but prior to concrele placement. o Underground Plumbing - Prior to fll/lnQ trench. o Underfloor Plumblng/Machanlcal - Prior to InsulatIon or decldng. o Post and Beam; - Prior to floor InsulatIon or decking. o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior 10 filling trench. o Storm Sower - Prior 10 filling trench. o Wator Line - Prior 10 filling trench. . o Rough Plumbing - Prior to cover. [ZJ Rough Mechanical - Prior to cover. o Rough Electrical - Prior to cover. ' o Electrical Service - MuSI be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. o Framing - Prior to cover. o Wail/Ceiling Insulation - Prior to cover. o Drywall - Prior to laplng, o Wood Slovo - Atter Installation. o Insert - Atter fireplace approvel and Installation of unit. o CurbcUl & Approach - Alter forms are erected but prior to placemont of concreto. o Sidewalk & Driveway - Alter excavation Is com plate. forms and sub-base material In place. o Fence - When completed. o Slreel Trees - When all required trees are planted. o Final Plumbing - Whon all plumbing wqrl< Is complet.e. D Final Electrical - When all electrical work Is complete. o Final Mechanical - When all mechanical work Is COmplete. o Final Building - When all required Inspections have been approved and building Is completed. o Othor MOBILE HOME INSPECTIONS o Blocking and Set,Up - When all blocking Is complete, o Plumbing Connacllons - When home has been connected to water and sewer. o Electrical Connection - When blocking, set,up. and plumbing Inspoc tlons have been approved and the home Is connected to the servIce panel. o Final - After a/l required Inspections are approved and porchos, skirting, decks, and venting hove been Installed. Lol Type. .. .4 THE PROPOSED WORK IN THE Lot faces Setbacks I PL. I HSE Accl .. HISTORICAL DISTRICT, OR ON Lot SQ. Itg. Interior GAR - IN I I THE HISTORICAL REGISTER? Lot coverage Corner II yes, Ihls applicallon must be signed Topography Panhandle Is I I and approved by Ihe Historical Iw I I Coordinator prior 10 permit Issuance. Total height Cul,de,sac U I APPROVED: BUILDING PERMIT ITEM SO. FT. X $/50. FT. VALUE BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Garage " This permit is granted on the express condition that the said construcllon shall, In all respects, conform to 111e Ordinance adopled by the City 01 Springfield, inciudlng the Development Code, regulallng the COl')ilrucUon and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Main Carport Plan Check Fee: ___ Date Paid: Total Value Building Permit Fee Receipt Numbcr:.__.._.__ Slate Surcharge Received By: Total Fee (A) Plans Revlewed'O-y------'-- Dale SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge Is due on all undeveloped properties within tl1n City limits whicl1 are being Improved. PLUMBING PERMIT ITEM ADDITIONAL COMMENTS FEE FIxtures Resldenllal Bath(s) N' Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace ?{fZ/-t?c Exhaust Hood '7/cPP Issuance ;q; /-s:~ /0,- - V'.;.. 7h ,;?c::> By sIgnature, I Gtalc and agree, thnt I have carefully examIned the completed application and do hereby certlly that all Information hereon Is true and correcl, and I further certlfy that any and all work performed shall be done in accordance with the Ordinances of Ihe City of Springfield, and (he Laws of the Stale of Oregon pertaining to the work described herein. and thai NO OCCUPANCY will be made of any structure without permission of the Bulldlr"lg Safety DivisIon, I further eartHy that only contractors and employees who are In complIance wllh ORS 701.055 will be used on thIs project. Ven t Fan N' Wood Slovellnsert/Flreplace Unit Drye: 'jent uc-~ /~./.?? Mechanical Permit ~//Y; Slate Surcharge Total Permit (D) I further agree 10 ensuro that all roquired Ins pee lions are requested at tho proper tlme, that oach address Is readable from the street, that the permit card Is locatad at the front of the property, :md the approved sel of plans will remaIn on the sIlO at all times during construction, ~((hr1t, Signature MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It ft Date 0'1-07- '75- Curbcut Demolition State Surcharge VALIDATION: TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) RECEIPT NUMBER /R.-::?:z.. / DATE PAID' 7- 7--;95' AMOUNT RECEIVED _~ <>0 r-2~ RECEIVED BY TOlal Miscellaneous Permits (E) / .; .' ~. . - . '.' '. '-~". - :".~::N'O. '1'5054-ft, ..CITY OF SPRINGFIELD. SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: DaRtt;, E. KOR.-re LOCATION: 4-?2.1 fVlT, VeRN Ml 1 K 01.. 05 Z I - BEla ~ DEVELOPMENT TYPE: LDf< - Nff;W MANU. HCME. f../(jMt:. G....R'lG-e P.W BUILDING SIZE: 44.,11.7 ./1.)( l(, . ,""')( Z4- LOT SIZE SQ. Ft. 1. STORM DRAINAGE IMPERVIOUS SQ. FT. , Iq(~ X $0.209 PER SQ. FT. (4-00~ 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) l'l . X $43.26 PER PFU (11~40 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $436.19 X $436.19 X $436.19 G 4406;; ----- ---- $ $ 1 X 1.01 X 4. SANITARY SEWER-MWMC NO. OF PFU'S I~ x $17 .19 PER PFU + $10 MWMC ADM FEE (Use PFU Total From Item 2 Above) $ 3194-'Z. TOTAL-MWMC SDC SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ 4-f?~ ~~ ....... ---- $ 1891 ~ MWM~ CREDIT IF APPLICABLE (SEE REVERSE) 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) V. A~~.k- '--7/ Kip Burdick SDC Coordinator X .05 Date: 5Ah~ . 'I TOTAL SDC C 'f4-??; '- .-/ S /Q<l5"'S FIXTURE l!Nr!" C~LGULA T~ TABLE: Number of New Fixtures.nit Equivalent = Fixture U~its (NOTE: For remodels; calculate only theWI: additional fixtures) NUMBER OF UNIT FIXTURE " FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS 2- 2 1 2 3 6 2 6 : .'.6 1 .3 ,2.,' l/Head 2 2 1 6 4 4 Bathtub.......,......""'" ,', ," ,.,.,...., .,.' ,..', ........... ............. Orinking Fountain.............. .......... ........ ......... ............ Floor Drain... ......, ,.",.."""",..,..",..'"..,..,....," ,.."..,..., Interceptors For Grcasc/Oil/Solids/Etc..........,...... Interceptors'For Sand/Auto Wash/Etc..,............,.. laundry Tub/Clothcswashcr",..,.."""....,..",.. '......., Clothes washer . 3 Or More,.............,........,.............. Mobile Home Park Trap (1 Per Traileri,....:...,;...~.:.. Receptor for Refrigerator/Water Station/Etc,....... 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: '2. ....1. 2. z. 'J- -z... 'il TOTAL FIXTURE UNITS = I~ CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table, calculate credits separates. ~nYn:a:~~-'-- Rate per $1,000 Assessed Value Year Annexed Rate pcr $1,000 Assessed Value 1979 or before 1980 1981 1982 19?3 1984 1985 $3.46 3,38 3,32 3,21 3.06 2,92 2.73 1985 1986 1987 1988 1989 1990 1991 1993 $2.46 2,14 1.77 1.37 0,97 0.61 0.44 0,15 Improvement (if after annexation date) 3 .4G. X $ /3. ~'1 (Rate X Assessed Value) X $ (Rate X Assessed Value) ~8 0(" Credit for ParceJ or Land Only If Applicable = CREDIT TOTAL = $ 4'i ~ ~ The, fonowinn r...,~.,~. ,,~_, .},_.~ zon,ng, ana 'j..."" . "d ."~s the following approval. ..-.. - .-.. ,.,. ' ,:, !and use Zon:"LL-p L 225 FIFTH STREET Oi::l& 5- 1'2 -'1--;-- SPRINGFIELD, OREGON 9..7.'1)7 . INSPECfION REQUEST: ~~~\otd-..NM OFFICE: 726-3759 . 1. ~ATION OF INSTAL~TION _ 32./ /HT, Z1tLJ~7 LEGAL DESCRIPTION /~'2 /')5 21 /?P'g"., ~ JOB DESCRIPTION .mH. r &~ Permits are non-transferable and expire if york is not started yithin 180 days of issuance or if york is suspended for 180 days. 2. CONTRACfOR INSTALLATION ONLY Electrical Contractor ~~~ Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expira tion Da te Signature of Supervising Electrician Oyners Name ~,., E. ~TE- Address ~~O 7)A-t,Sr Ci ty ~j!7l Phone.4-"7-7'12J OVNER INSTALLATION The installation is being made on property I oyn yhich is not intended for sale, lease or rent. O'offiers Signatur:? t?5 / -I A)~.'~.6 K~ ;'':-------------------------------------- DATE: ,?,...~-?-;;- RECEIPT #: . '/7-r~;:> RECEIVED BY: ..-7 .z_~7.r ~ 'r 3. ELECTRICAL PERMIT APPLICATION .Ci ty Job NUJIlber $1'25'10 COMPLETE FEE SCHEDULE BELOV A. Ney Residential-Single or Multi-Family per dyelling Service Included: uni t. Items Cost Sum 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home. or Modular'Dyelling Service or Feeder ~ $ 40.00 ~~ B. Services or Feeders Installation, Alterations or Relocation: 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 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts see "B" above D. Branch Circuits Ney, Alteration or Extension Per Panel One Circuit Each Addi tional Circuit or yith Service or Feeder Permit ., $ 35.00 $ 2.00 ~ not included) E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline LightinR Limited Energy/Res Limited Energy/Comm $ 40.00 $ 40.00 $ 20.00 $ 36.00 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL ~."".:s. q~ --2. 58- ~~ ,- . . Permit #: 9 S0 5"-It:? Address: 432./ ~~~) Issued bY7~- ~ Date: 5'-/.2, "?J-~ /~ . Statement: Information 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 statement before a building permit can be issued, This statement 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 the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: g r&' D I, 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. 3A. 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. OR g 3B. 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 building permit of the name of the contractor. I hereby ce~fy that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. / ;<007 :c.. E'c;t/~ .s: /:<- Cj'~- (Signature ot;e:t applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . -" . lln1oi'M21iion No~ice ~o Property Ownei's , ~fpJou~ COU"iSii'n.nc~ioi1llF!espoU"isDlOiliiies -'~r-... -... '.' ,-. ~ -"- Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Con~iri;ction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. IEMPlOVIER RESPONSIBILITIES: 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 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 Dep!. 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 Oregon Employment Division at the Department of Human Resoutces at 378-3524, Workers' compeilsation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees, If you fail to obtain workers' 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, 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 from 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 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property 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 additional questions, write or call the Construction Contractors Bl,ard (I?O Box 14'140, 'Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 SummerS!. NE Suite 300, in Salem, prop-own.pm4 1/94 RESIDENTIAL PERMIT APPLICATION G ~ ~/' . Inspections: 726,3769 Office: 726,3759 SPRINGFIELD LOCATION OF PROPOSED WORK: _4.3-z/ /h.r ~/~/' ASSESSORS MAP: /,p, - ~ '2. -OS -2/ LOT' I BLOCt<. OWNER: ~A?"-.s e; , ~2..r.::r ADDRESS:' ~~('!):/)~ CITY: SPz...eAJ";:;'---; ~~ L-h DESCRIBE WORK: ~S~ NEW y-- REMODEL ADDITION CONTRACTOR'S NAME I J GENERAL:G.JQ4~W-.~ PLUMBING' I{ It MECHANICP' . ELECTRtCA" ../Z/2(2'jj~ / STATE: a.R <..--- .}~B NUMBER ,,95C54 CO 225 Fifth Street Springfield, Oregon 97477 TAX LOT: ~lf'>"'''''' , SUBDIVISION:~. V_AA7al b~~ PHON~' 7-/7_9~~ ../.hA-....JI..I;A.->-".,..~ ,./ .. ~J ~...... ZIP:' "".;76 P "iT ?,~ l~~ DEMOLISH OTHER ADDRESS .szuy4,..., "I' CON ST. CONTRACTOR' ~e;',~ ,,, PHONE ?....~ -2k7/ v o Rough Mechanical - Prior to cover. rv(Rough Electrical - Prior to ~cover. 'rs7I' Electrical Service - Must be ~pproved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. ~raming - Prior to cOl/er. o Wall/Ceiling Insulation - Prior to cover. ~OrYWall - Prior to taping. o Wood Slove - After installation. o Insert - After fireplace approval and installation of unit. o Curbcut & Approach - After forms are erected but prior to placement of concrete. It l/o.!4Pte- EXPIRES //-Q,~ II -" ?; eh6 - OFFICE USE'- QUAD AREA: LAND USE: 116ZJ FLOOD PLAIN' . OF BLDGS: I . OF UNITS: I ZONING CODE: L{)L OCCY GROUP: A ?LftY\ CONSTR. TYPE: -Y rJ . OF BDRMS' ~ J ,pt: - . OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER' b RANGE: f: SQUARE FOOTAGE: ..JJjt1{ji , To request an Inspection, you must call 726.3769. This Is a 24 hour recording. AlllnspectJons requested before 7:00 a.m. will be made the same working day, Inspec~lons requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS o Temporary Electric o Site Inspection - To be made after excavation, but prior to setting forms. D Undcrslab Plumbing/Electrical1 Mechanical - Prior to cover. M Footing - Aller trenches are ~excavated. o Masonry - Steol location, bond beams, grouting. o Foundation - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o Underlloor Plumbing I Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulation - Prior to decking. 1"'\71 Sanitary Sewer - Prior to filling ~ trench. ~ Storm Sewer - Prior to filling ~trench. 'I"57f Water Line - Prior to filling ~ trench. o Rough Plumbing - Prior to cover. I '"_'_M.__'. o Sidewalk & Driveway - After excavation Is complete, forms and sub.base material in place. o Fence - When completed. o Street Trees - When all required trees are planted. ' o Final Plumbing - When all plumbing work Is complete. fV1 Final Electrical - When all ~Iectrlcal work is complete. D Final Mechanical - When all mechanical work Is complete. "TV1 Final Building - When all ~equired inspections have been approved and building is completed. o Other , MOBILE HOME INSPECTIONS '.. , rvf'Blocklng and.Scl'UP - When all ~Iocklng Is complete. ~ Plumbing Connections - When ~ome has been connected to water and sewer. 1':71" Electrical Connection - When ~ blocking, sel'up, and plumbing inspectJons have been approved and the home is connected to the service panel. 15<f Final - After all required /' :..spectlons are approved and porches, skirting, decks, and venting have been Installed. Lot faces lot Type. ~ Interior -- ~ ?2~% /?~ ill ( ?6.) BUILDING PERMIT ITEM 'SO. FT. X $/SO. FT. lot sq. fig. Lot coverage Corner Topography Panhandle Total height Cui-dc-sac Main Garage Carport ~9, -1.,4/0 ~o ~ Md=!. Total Val ue Building Permit Fee State Surcharge ~.7'J+- :z.z,{ Tolal Fee (A) I PL. IN Is Iw IE Setbacks 'HSE'GAR'ACC\ 20 zs fj n I s &, THE PROPOSED WORK IN'THE ~ISTORICAl DtSTRtCT, OR ON THE HISTORICAL REGISTER? If yes, this application musl be signed and' approved by the Historical Coordinator prior to permit Issuance. i VALUE 4~f;,z.90 .p!332..~ ~ {E"'7f&o 74_~-O s:n i:;f) ,-17 SYSTEMS DEVELOPMENT CHARGE (SDC) tf> (B) 4/Cff.Sse PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' Sanitary Sewer FT. .c.. $'<9 ' Water FT, ~ $"0 / Storm Sewer FT. ~ :rO I Mobile Home Plumbing Permil State Surcharge {-:GO + :z..?D Tolal Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Dryer Vent Wood Stove/Insert/Fireplace Unit Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge s:~rr 3, I$" Ai.,f~'1 It Sidewalk fI Curbcut fI Domollllon State Surcharge .J?/~) dlh/IEuJ . Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) FEE :?.-5',(7) 2.. 5', <<> 2-5: 87) /5.00 90.&>Q -7. 20 97.2-0 / J OG.<<' ? /') Oil 8>. .;0 I-AI -er If -& -41S.~J ;?i' ? ~ 4-S.. og , .. ~s.':. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT 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 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. Plan Check Fee: (f!>. 'fJ Date Paid: Receipt Number. Received By: /~~ Pla;tlR~e1ve'5 ~" ~"" .<J~p~t; 7'ry..te Systems DevclopmentCharge Is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS JhLI: 1/ I/) fCJIJ. ~ I {i.rtJ1.fWHH, lhd1: Ii/JL;J.. ~ )),;YlhltlJ iJ1.tit1JJ1LU- SQ/AtMtF ~I",AL ptl~~r ..1.5' ,;t?~/.vP~. By signature, I state and agree, that I have carefully examined the completed application and do hereby cerllfy that all Information hereon Is true and correctt and I further certify that any and all work performed shall be done In accordance with the Ordlnanc~s 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 struclure without permission 01 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 lime, that each address Is readable from the street, that the permit card Is located at tho front of the property, and the approved set of plans will remain on the site at~s during construcllor. Xgnature~~-- /' ~_!'-~ Date~A"'~ ///c /'IJt7~ -~ /' / // VALIDATION: RECEIPT NUMBER /?"3~/ -5'~/ /. "3 >- .~;.~ .--- - 1./" It.- r -.// . AloT III~. .....,~T DATE PAID AMOUNT RECEIVED RECEIVED BY .. . , ~ @ !!.'!.iR~!!!~!~!!;~ Job No. 4Q)c:J.1-0 SYSTEMS DEVELOPMENT CHARGE WORKSHEET NAME: Dnr is r,. l1trr'-I'F/ . ADDRESS: %&'0 Dtl{~ PHONE: :74-1... en ()q STATE: (Jf.- ZIP Cf1Lhg '. . . LqCATION OF PROPOSED BUI~DING SITE: "I" " . Street Address if Known: I-/~~ I VV\ fr __ V.{I;YVI 1m Platt Name: I~ D'l M? 911 Tax Lot Number: (}gg(JQ 1. DEVELOPMENT TYPE (Check appropriate dwellirig(sl. SDC Calculations and dwelling type definitions are on the back.l . '. . A. Sinl1le Family - Detached . Single Family home NO OF UNITS Manufactured home not in a park S'.l/M.OD - . X $400 PER UNIT .:;=, B. Sinl1le Family - Attached . NO OF UNITS X $370 PER UNIT = '$ C. Multi-Family Aoartment . NO OF UNITS X $~77 PER UNIT = $ D. Manufactured Home Park NO OF UNITS X $280 PER UNIT = $ WPRD 5DC $ U01J, (){J 2. SDC CREDIT (If applicable) SDC-payer must furnish proof ofWPRD Credit approyal. See sac Credit Worksheet. ' $ $_titJ(} ,00 3. TOTAL WPRD NET SDC ASSESSED (I( SDC reduced (or Credit! ~~ r",..-.:........n'h' <:('\f"";"'''''' ~'('i"n 6 I (/ ,Cf~ nAIl' . SP'-FIELD 225 FIFTH STREET SPRINGFIELD, OR 97477 (503) 726,3753 FAX (503) 726,3689 MANUFACTURED HOME SET-UP AGREEMENT As required by the City of Springfield Development Code, I understand and agree that with the approval of the attached peJ.mits, one of the following manufactured homes will be placed at +32./ Air: V~,u1'JiU Springfield, Oregon, City Job Number . ~ Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed tloor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting performance standards which reduce heat loss to levels equivalent to the performance standards required of single family dwellings constructed under the State Specialty Codes. Type II Manufactured Home. A unit of not less than 12 feet in width WIth an enclosed tloor area of not less than 500 square feet, that has a nominal roof pitch of 2 feet in height for each 12 feet in width and that has no bare metal siding or roofing. I further state, by my signature below, that I have been provided with the following information: - Manufactured Home blocking - Yater line connection - Street tree standards - Sanitary sewer connection - Electrical connection - Minimum requirements for permanent steps I also understand that if I am installing a Type I Manufactured Home, the home shall be enclosed at the perimeter with stone, brick or other masonry materials, and with no more than 12 inches of the enclosing material exposed above grade. ~~/ z;;:~ / SignaturV ~ /~. (,tfs- \