HomeMy WebLinkAboutPermit Building 1994-4-5
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RE~IDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
J~02
ASSESSORS MAP'
LOT: -+
/'1,,~v 1:::c:.,c"'CTL/N
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S/r<tJ
OWNER'
ADDRESS'
CITY'
DESCRIBE WORK'
.sr~
NEW >C
REMODEL
CONTRACTOR'S NAME
J Jk..1::::.
-
SPRINGFIELD
MT. VE:iQN61. J
,
.-<').:; -z.,
BLOCt<'
L4~L
STATF'
o~
ADDITION
DEMOLISH
OTHER
~
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JOB NUMBER
9402b5
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT: a~?_ {-:pI),
SUBDIVISION: NtT V~} Lt:>>1'JOS
PHON'"
7Y"7-~Y.,IJ~
ZIP:
:97y;:, 8
. _ CONST.
CONTRACTOR'
'S- ~o/,
A ,I C?Cfj
,5Sl(JAfJ
t2C\ ~
-e.
ADDRESS
K .:..cAtJ'7T/tfr
GENERAl'
PLUMBING:
MECHANICAl'
ELECTRICA' '
C ""..rr#A,
lI~v,ey
L..rL
-!- S_AJ
e,(~c:: TL..c-
,tJ~., ~A/NL
~PIRES
~/o/'/?....- 7"'7-000
, l)./~,q ( 0 4ff) '/141 /)
~{) ,', V'
(5.~. ,_~,
PHONE
,-
QUAD AREA: \. ~'Q 8' / - OFFICE USE -
LAND USE: It V FLOOD PLAIN'
. OF BLDGS: ~'"?J\- 1'-1\ . OF UNITS' ZONING CODE:...LDV
OCCY GROUP: CONSTR. TYPE: VN . OF BDRMS: ~
. OF STORIES: ~ I HEAT SOURCE: ~q SECONDARY HEAT: )=!J
(l (:] , . SQUARE FOOTAGE:rO~~()a.
WATER HEATER: RANGE:
To request 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 same working day, Inspections requested after 7:00 a.m. will be made the following work day.
. . . ~ ~
.
".
. .
Xi-emporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlca"
Mechanical - PrIor to cover.
rv1 Footing - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
k:7( Foundation - After forms are
~rected but prior to concrete
placeme~t.
D Underground Plumbing - Prior
to filling trench.
1":71' Underfloor Plumblng/Mechanlcal
~ - Prior to Insulation or decking,
'f'\7f Post and Beam - Prior to floor
~ Insulation or decking,
'K""'7f" Floor Insulation - Prior to
JOJ deckl ng.
K:7( Sanitary Sewer - Prior to fllll~g
~ trench.
~ Storm Sewer - Prior to filling
~ trench. .
f'\/rWater Line - Prior to filling
~ trench.
r"i7f Rough Plumbing - Prior to
~ cover.
REQUIRED INSPECTIONS
K7l' Rough Mechanical..,... Prior to
JAlcover, ~ ~M, I"~.
.
-c7I Rough Electrical - Prior to
~cover.
rc-:;( Electrical Service - Must be
~ approved to obtaIn permanent
electrical power.
D Fireplace - Prior to'faclng
materials and framing lnsp.
~ Framing - Prior to cove~. .
1'<;7( Wall/e'elllng Insulation"':' Prior to
~ cover.
C8:(DryWall - Prior to taping, .
D Wood Stove - Alter Installation,
D Insert - After fireplace approval
and Installation of unit,
rc;;( Curbcut & Approach - Alter
~forms are erected but prlor.to
placement of concre~e.
'K/f'Sldewalk & Driveway - After
~excavatlon Is complete, forms
and sub-base material In place.
D Fence - When completed.
.'.
~S'treet Trees - When all required
. . trees are planted:. . . :
,
M Final Plumbing - When all
plumbing work Is complet,e.
~ Final Electrical - When all
~electrlcal work Is complete.
M Final Mechanical - When all
~ mechanical work Is complete.
~Inal Building - When all
equired Inspections have been
approved and building Is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete,
D Plumbing Connections - When
home has been connected to
water.and sewer.
.
D Electrical Connection - When
blocking, set.up, and plumbing
inspections have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have.been Installed.
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Lot faces ~ Lot Typee Setbacks '. THEPROPOSED WORK I~THE it
~O ~Interlor I P,L. HSE GAR ACC I -~HISTORICAL DISTRICT, OR ~N tln
Lot sq. ftg, IN I THE HISTORICAL REGISTE 1_
Lot coverage 27$ Corner Is I If yes, this application must be signed
.c. and approved by the Historical
Topography Panhandle Iw, I Coordinator prior to permlt.lssuance.
Total height Cul.de.sac IE I
,APPROVED:
/-/YI'/ 3C/2.. Q-< ,
15S'~
22,(,,~
47c;.1/
SYSTEMS DEVELOPMENT CHARGE (SDC) ~
~ (B) :/t"2-1 <1-0 eh
BUILDING PERMIT :
ITEM SQ, FT,
Main
;~/5
.f.5/
X $/SQ, FT,
5k,~
;+!D
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
2.
SanItary Sewer
FT,
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Fu mace
Exhaust Hood
Vent Fan
N'
:5
Wood Stove/lnser~Place un!i)
Dryer Vent
G/KL/,;(~ f Uf//I
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
"7'0
3D
It
It
Curbcut
Demolition
State Surcharge
VALUE
/tJ2t%>~
&>359.-
FEE
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: _ "2-"5'4'. (i I
,
'3 -L-::2...4-
Date Paid:
Receipt Number:~~ ~
ReCeIVe~y: ~ ~,
~~
Pla~"s Reviewed By ~
3'/2~/~
/' ;atel f
Systems Development Charge Is due 'on all undeveloped
properties within th~ City limits whl~h are being Improved,
ADDITIONAL COMMENTS
/ tb{).t:H:> \. s;\+ T:J] ~ ~~
c.ciDfl tr lnT(),)~- rq.rl~
PA7r1 1
9, ,":0 ,
ffi~~
~.~
450
1-t')0
/5.6-0
s,btJ
5,tm
42710
/0,0'0
.z/3
.0,1&>3
-::ZD.~
J 4,"50
. .
~ s.w
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) JZ9->74.1O
(A, B, C, D, and E Combined)
~/k'~ ~=cr..bE';fANT /05 AEdJj0.
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 Building Safety Division,
I further certl!y 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 each address Is readable
from the street, that the permit card Is located at the iront '
of the property, and the approved set of plans will remain
on the~1I times during Co~uctlon. _ ~~
XslgnaV~ L-K~ ~
Date (,/ sj5'1
VALIDATION:
RECEIPT NUMBER . /,21 h '1
DATE PAID _ -f/S- /)'<f
AMOUNT RE~IVE _:,d~2,:7'0
RECEIVED BV U ~y
" ./ --
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_OB NO. 9'-102.~5
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: MA~Y KU;;MSic.IN
LOCATION: t./-377 Mr. Vt:::!?-NON 51.
DEVELOPMENT TYPE: LDt!- - NeW SrI<.
/'30"2.0521 - ~Si'O"2...
BUILDING SIZE:
LOT SIZE
SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. ZBBO X $0.203 PER SQ. FT. ("' s e,L\ ~~
.......... ../
2. SANITARY SEWER-CITY
NO, OF PFU'S \'6 X $42.08 PER PFU (;<Sl4-h
(See Reverse) '-- ..-/
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
/
X 1,0 I
X $424.31
X $424.31
X $424.31
(;2B S~ ')
.......... .-/
$
$
X
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S 1<6 x $15.125 PER PFU + $10 MWMC ADM FEE $ Z'O"2. ~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ {3"2
TOTAL-MWMC SDC ~
'- ~
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ '2.o?5 ~
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~ ~ Lck.. 3/ I<t- fct+
(J Kip -Burdick I I
SDC Coordinator
G IOI9l:)
'-- .../
TOTAL SDC .$ ZHo ~
/
1
FIXTURE UNIT ,CALCU I anN TABLE: Numb~r of New Fixture_nit Equivalent = Fixture Units (NOTE:
For remodels, calculate only the ~~tional fixtures) " .
NUMBER OF UNiT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub" ,..,',...,',..,~"~..,"""'~""" ~"'" """"""",..",.,'"
Drinking Fountain,~""~",,, ~""""""""",,~ ~"" ~"""" ~,~"
Aoor Drain~"".,.."...""""""".~",.~,~"", ",...." """".'",
Interceptors For Grease/Oil/Sollds/Etc....,............
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub /Ootheswasher".....,..,..,....".........,.....
Ootheswa~er - 3 Or More.....................,....,........,.
Mobile Hdme Park Trap (1 Per Trailer),....:........,...
Receptor Filr Refrigerator /Water Station/Etc,.,.....
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single 'Stall... .....,.... ............. ,..."..' ,....,....~...
Shower, Gang~................,.....,....,',.."........,"'..,......,.,
Sink, Bar, CommerciaL..........,......,.,........".,..........,.
Urinal, Stall/Wall.......................,.......,.......,.,.....,.,....,
Wash Basin/Lavatory, Single...................~.~,...........
Water Oose~ Public Installation...................,........,
Water Ooset, Private,..,...,.,.....,.,.,~"....,..,.,..,...,..,~'"
Miscellaneous:
2
t
2
3
6
2
6
6
1
3
2
l/Head
2
2
1
6
4
TOTAL FIXTURE UNITS
CREDIT CALCUlATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credhs separates,
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
1981
1982
1983
1984
'1985
$3.21
3.13
3.08
2.96
2,82
2.68
2.51
1986
1987
1988
1989
1990
1991
1992
$ 2.24
1,93
1.57
1.18
0.79
0.44
0.28
J
Credh for Parcel or Land Only If Applicable '3. 7.- I X $ <I. 3 5' '2
(Rate X Assessed Value)
Improvement Cd after annexation date) X $
(Rate X Assessed Value)
CREDIT TOTAL
=
1"6'12-
=
~
=$ 13qy.
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Residential.. .,........... ......... ,., ..... .......... ,............. 0.4
CommerciaL..,.......,........,......................,..."... 0.9
tndustriaL...... ......, ,....... ......... ... ....'.... ........ ...... 0.45
GovernmentaL.,....,.......,.,.....,....,.....,......,...,.., 0,5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
.
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@ ~i!IJ!!!!!!t!~~
Job No. Q102kb
SYSTEMS DEVELOPMENT CHARGE
, WORKSHEET
NAM< mn ll1J( · ~I 0 Jffik f\ PHONE !J4 i") ~ldiK'K
ADDRESS o,q[)'Fft- f~N\f!f4S- STArr~1P qn7i1
LOCATION OF PROPOSED BUI'qN<..G SITE: \ \.l. \""'\ _ / \
Street Address if Known: ~'l '\ "-^-"V. \ U2 J\...f\f'r\\ ...I}L) 1
Platt Name: W;.\')lO'\\f\N\U~x Lot Number: 190~{)C::/rlJ.~
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the backJ
A. Sinl!le Familv - Detached
~ Single Family home
NO OF UNITS I
B. Sinl!le Familv - Attached
NO OF UNITS
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufadured Home Park
NO OF UNITS
WPRD SDC
Manufadured home not in a park
$ 4N)
X $400 PER UNIT =
X $370 PER UNIT =
$
X $277 PER UNIT =
$
X $280 PER UNIT =
$
A N"'\. CD
$'-ttA ],
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
$0
'w
$4N),
--
~ -6~~~ 94
uate ----+-+t
\ f'(\ 1 J f)o fL.
Community SerVIces Div~i n
City of Springfield
,..
.
Th..foll~w;n~,proj.ct as submitted hoo the followl
zonrn~, ~l.la aoes not require specific land use ng
approval.
225 FIFTH STREET '
SPRINGFIELD, OREGON 97477 Zonino We.
INSPECTION REQUEST: 7iYd-37l(L<::..-Q{j;
OFFICE: 726-3759 ----, . ,
Authorized Slgnalur. 11. Vl,\ 3 .
1. LOC~ION O~~T~LATION S
4'"}., /'7 ~...LY~ 7:
LEGAL DESCRIPTION
dt~ 2. I'J:> C; 2- /
~ ~2- lA&?,
"
"
JOB DESCRIPTION
AI,.;..; S,r: A?as.
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor ih'</.....y ("{..-c7':?1C 7.-<:-
Address If).. :5,:;",,1. ~L~.-;;z..r.:r ,*"y
/
Ci ty _vA'~w'cr=t'c"-,{) Phone x-/C'" ,) ?y';-
Supervisor License Number / Y7 / S
Expiration Date
/c}'- ~. 3
C. Temporary Services or'Feeders
Installation, Alteration or Relocation
Constr Contr., Number /'?'t'7,?--
Expiration Date //- 5" 3
Si?Z~ r, of ~ervi~ing Electrician
~ /:t..L' - k
. ,
Owners Name
Address
City Phone
01lNER INSTALLATION
The installation is beirig made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE~--------~~~~j~-------------
RECEIPT I: '/2./~"
RECEIVED BY: 1:~ _
ELECTRICAL PERMIT APPLICATION
Ci ty Job Number
COMPLETE FEE SCHEDULE BELOY
A.
New Residential-Single or
Multi-Family per dwelling
Service Included:
Items
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Hodular Dwelling
Service or Feeder
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
200 amps or less / ..--
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D. Branch Circuits
CJ4DZfo5
unit.
Cost
Sum
..--- $ 85.00 ~C'O
7, $ 15.00 ~()CJ
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
$ 40.00 ~DO
$ 55.00
$ 80.00
see "0" above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
'One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00
$ 2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
/ 7 ZJ, (}o{)
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