HomeMy WebLinkAboutPermit Plumbing 1999-4-5
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~OB NUMB~R 9''1'0 '-177
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
225 Fifth Street
Springfield, Oregon 97477
TAX LOT: d6r'oo
LOT'
SUBDIVISION'
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Sz-II-G'iiCo -N I Y
OWNER'
ADDRESS'
CITY'
PHONF'
177'0 S
STATE: _r~
ZIP'
. .. . -. ~ . '_1 ".VI ttyur I IClW reqUires you to
follow rules adootArl hll tho n...,~~_ , '''''I .
Notificati~n Center. Tho:.e rules ~r~ s;;'i~~h
DEM9lJtS/;I "" -v- -'OOQlHER _ .___ _ -
_:._~.': ~~~ 1111' - n U inrougn UAn "o~-U01'
--... ..-~ '''''y CO'Nstyoples ollne rules by
calling the C€C0Nl\I'lAmrOlil~teleph~PIRES
number for the Oregon Utility Notification
....... .
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DESCRIBE WORK'
NEW REMODEL
ADDITION
CONTRACTOR'S NAME
IJ w ,A/.f ;t.
ADDRESS
PHONE
t.::\
GENERAl'
PLUMBING'
MECHANICAl'
ELECTRICAl'
\\'''''.:.. _ ~lIplQI= IFTHE WORK.
.\'11 :,11"LL-". -- __~,....,.,c ;,nT
.....t'"". ''''''1\:)''' '......
-'OF'FleE USE' - - ~D "OR
At ;'JON~ .-
LAND USF' FLOOD PLAIN'
...:,..-\10.
t~\OF UNITS: ZONING CODE:_
CONSTR. TYPE: . OF BDRMS'
QUAD AREA:
. OF BLDG!"
OCCY GROUP'
. OF STORIES:
HEAT SOURCE: SECONllARY HEAT:
RANGF' SOUARE FOOTAGE:
WATER HEATER:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons 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.
REQUIRED INSPECTIONS
o Temporary Electric
o Rough Mechanical - Prior to
cover.
o Final Plumbing - When all
plumbing worl( Is complete.
- -
O Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
D Final Eloctrlcal - When all
electrical work Is complete.
o Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
o Final Mechanical - When all
mechanical work Is complete.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Footing - After trenches are
excavated.
o Final BUilding - When all
required Inspections have been
approved end building Is
compleled.
o Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
beams, grouting.
o Framing - Prior to cover.
OOthor
o Foundation - After forms are
erected but prior to concrete
placement.
o Wail/Ceiling Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Drywall - Prior to laplng.
MOBILE HOME INSPECTIONS
o Wood Stovo - After Installation.
o Blocking and Set.Up - When all
blocking Is complete.
o Post and Beam - Prior to floor
Insulation or decking.
o Insert - After fireplace approval
and Installation of unit.
o Floor Insulation - Prior to
decking.
2Janltary Sewer - Prior to filling
(b){~nch.
o Plumbing Connections - When
home has been connected to
waler .lnd sewer.
o Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
o Sidewalk & Driveway - After
excavation Is compiete, forms
and sub-base material In place.
o Storm Sewer - Prior to filling
trench.
o Fence - When cor"lpletcd.
O Water Line - Prior to filling
trench.
o Final - After all required
Inspections are approved and
porchos, skirting, decks, and
venting have been Installed.
O Rough ':'I~mblng - Prior to
cover.
o Strest Trees - When all required
trees are planted.
~
.",' . " ri: ~ .,;:', , ,. ~..
LOI Type. ',: . 1& THE PROPOSED WORK tN THE.
Lot faces Setbacks
LOI sq. fig. Interior I P.L. HSEIGAR Accl HISTORICAL DISTRICT, OR ON
IN I THE HISTORICAL REGISTER?
Lot coverage Corner --I If yes, this application must be signed
Is and approved by the Historical
Topography Panhandle '{
~-,- Coordinator prior to permit Issuance.
Total height Cul.de.sac
APPROVED:
'1 .t
BUILDING PERMIT
ITEM SQ. FT. X $/sQ. FT.
VALUE
Main
Garage
"
Carport
Total Value
Bul/ding Permit Fee
Slate Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Balh(s) N'
Sanitary S~wer FT. / Sf)
Water FT.
Storm Sewer FT.
Mobile Home
7'(jW
Plumbing Permit
10 ...
},()tJlL1':!
I-{ ~ LP
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood slovellnsertlFlreplace Unit
Dryer Vent
MechanIcal Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
It
Curbcut
Demollllon
Sh', ~"~e
fA! l./J V
S{)C.
~
/ 3C.7. "1/
2-5??::J.J
1l,)C"'" .
Total Miscellaneous Pennlls (E)
TOTAL AMOUNT DU!' (excluding electrical)
lA, B, C, 0, and E Combined)
BUILDING VAL(/E,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
adopled by the Cily of Springfield, Including the
Development Code, regulating the construction and use of
oulldings, and may be suspended or revoked at any time
upon vIolation of any provisions of said ordinances.
Plan Check Fee:
Date Paid:
Receipt Number.
Received By:
PI~ns Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties wllhln the City limits which are being Improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify Ihat all
Information hereon Is true and correct, and I further certify
thai any and all work performed shall be done In accordance
with the Ordlnanc~s of lhe City of Springfield, and the Laws
of the State of Oregon perlalnlng to tho work described
herein, and thai NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contraclors 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 pormlt card Is located at the front
of the property, and the approved set of plans will remain
on the site at all times during construction.
Signature
Dat<-
VALIDATION:
RECEIPT NUMBER. ~ 5) 3 g '5
DATE PAID '-f fr- /51
I ,
AMOUNT RECEIVED;; ~
RECEIVED BY IJI 0J
37 :r1L/
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CITY OF SPRINGFIELD
IMPROVEMENT AGREEMENT AND APPLICA nON FOR SEWER HOOKUP
We, the undersigned property owners, request permission to connect the following described
property to the sanitary sewer owned and maintained by the City of Springfield. We therefore agree to
pay a charge of $0.28 per square foot of the bene filling property for the first 150 feet of depth as a deposit
against future assessments for sanitary sewer. Area in excess of the above mentioned 150 feet of depth is
charged $0.14 per square foot.
PROPERTY DESCRIPTION:
Receipt No. 0 ~ 3 ;. ~ 3>
Address .yO 7/ AiLdJ ..2:.f-,-,--
Tax Lot No. 18-02-06-1-4-06500
See Attached EXHIBIT A
Fee Calculation:
9065 Sq Ft. at $0.28 per Sq. Ft. =
~ Sq. Ft. at $0.14 per Sq. Ft. =
Total
$ 2.538.20
$ 0.00
$ 2,538.20
This agreement does not include the cost of a house connection to said City Sewer, sewer user
charges, connection fees, plumbing permits or other such costs to be assumed by the property owner.
The applicant agrees to waive all right to remonstrate against an improvement project for sanitary
sewer to be duly initiated by the City Council, but not the right to protest the amount or manner of
spreading the assessment thereof, if the same shall appear to Applicant to bear inequitably or unfairly
upon said property of Applicant.
NOW THEREFORE, the City agrees that if Applicant complies with the terms of this agreement
and with all other applicable laws of the State of Oregon, Lane County, and the City, the said Applicant
shall be entitled to connect the existing residence to the public sewer systems.
The covenants herein contained shall run wilh the land herein described, and shall be binding
upon the heirs, executors, assigns, administrators, and successors of the parties hereto, and shall be
construed to be a benefit and a burden upon the property herein described. This agreement shall be
recorded in the Lane County Deed Records.
WHEREFORE, the parties have set their hand and seal this _ day of
.19_.
CITY OF SPRINGFIELD
APPLICANT
JU~--r/N LJ/-u.ofi,/
By
Dan E. Brown
Director of Public Works
~QpQ;;;,
STATE OF OREGON)
) SS
COUNTY OF LANE)
On this 5~ day of ...8/)'" /(_ 19'tj, the applicant personally appeared before me and signed the above
document.
.- .-'
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OFFICIAL SEAl. j
PATmCIA GAULT I
NOTAllY PUBLIC. OREGON I
COMMISSION NO. 053306 j
IIr COiIUI181Oll WIRES MAY.!':.. ~o.: ~
I)tu~(1 (p//g
Notary Public for Oregon
My Commission expires :5'-274"1
Finance Department Information:
Trunk Sewer Lateral Sewer
RETURN TO:
CITY OF SPRINGFIELD - PUBLIC WORKS DEPT - 225 FIFTH STREET - SPRINGFIELD, OREGON 97477
"
'.,
. JOURNWR JOB NO. f.t~ fl17
ATTACHMENT A'" ,
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME OR COMPANY: :](1 S 7' III Of /10 It)
LOCATION: '#7/ . ,A/ol..TfI
DEVELOPMENT TYPE:
BUILDING SIZE:
LOT SIZE
SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
~ SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse Side)
X $0.227 PER SQ. FT. $
X $47.14 PER PFU
1181 ;!-1
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X X $475.32
$
X X $475.32
Q SANIT'ARY SEWER-MWMC
A. REIMBURSEMENT COST:
$
NO. OF FEU'S
X
PER FEU
$
0'
10/
NO. OF FEU'S
X
PER FEU
$
B. IMPROVEMENT COST:
MWMC CREDIT IF-8PPLICAB~~.(SEE REVERSE)
MWMC ADMINISTRAt1"VE FE~
TOTAL-MWMC SDC
<$ - >
$ 10.00
L1/2 (, y
Date:
1./ 3~-g
$ &S, /3
TOTAL SDc!' <r8l1 /3('7-.7-:l
~SUBTOTAL (ADD ITEMS 1.2.3 & 4)
5. ADMINISTRATIVE FEE~:
BASE CHARGE (SUBTOTAL ABOVE) X ~5
SDC Coordinator
ATTACH' A. WPD
FIXTURE UNIT CALCUI,.A.TION TABLE: Number of New FieS X Unit Equivalent = Fixture Units
(NOTE: For remodels. calculate on.e NET additional fixtures)
. NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub..................................................................... .
Drinking Fountain................ .....................................
Floor Drain.......................... ......................................
Interceptors For Grease/Oil/Solids/Etc.................
Interceplors For Sand/Aulo Wash/Etc..................
Laundry Tub/Clotheswasher. ....... ... """"""" ..........
Clotheswasher. 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
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:
I
2
1
2
3
6
2
6
6
1
.3
2
l/Head
2
2
1
6
4
'<
01..
d
,3
d
d
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d:ll
CREDIT CALCULATION TABLE: Based on assessed value. If improvemenls occurred afler annexation date in table,
calculate credits separates. -
r Year Rate per $1 ,000 Year Rate per $1,000
Annexed Assessed Value Annexed Assessed Value
1979 or before $4.27 1989 $1.98
1980 4.18 1990 1.55
1981 4.12 1991 1.15
1982 3.99 1992 0.96
1983 3.83 1993 0.83
1984 3.68 1994 0.67
1985 3.48 1995 0.52
1986 3.18 1996 0.38
1987 2.82 1997 0.21
1988 2.42 .1
Credit for - Parcel or Land Only If Applicable
I
I
&.
~
TOTAL FIXTURE UNITS
=
X $ =
(Rate X Assessed Value)
X $ =
(Rate X Assessed Value)
CREDIT TOTAL = $
Improvement (if after annexation date)
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimatin9 Purposes Only)
Residential.. ... ...... ..... ... ........ 0.4
CommericaL........................ 0.9
InduslriaL........................... 05
GovernmentaL....__............... 0.5
FIXUNIT.WPD
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT