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SPRINGFIELD
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Page 1
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
Job Number: 970650
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 4119 FORSYTHIA ST 4121
Assessors Map #: 18020522
Lot: 94 Block:
Tax Lot #: 02900
Subdivision: WYATT MEADOWS 2
Owner: KEYS HOMES INC.
Address: P.O. BOX 25083
Phone #: 292-6378
City/State/Zip: PORTLAND, OR 97225
Describe Work: DUPLEX
NEW
Contractor
Const.
Contractor #
Expires
Phone
General: KEYS HOMES INC. 0094105
7185 SW Sharon Portland OR 97225000
Plumbing: M.P.1. 0094105
7185 SW Sharon Portland OR 97225000
Electrical: FAR NORTH ELECT 0100894
155 B Ave Ste 330 Lake Oswego OR 97
09/29/97
292-6578
09/29/97
292-6578
06/29/97
636-4115
QUAD AREA: 3RSC
# OF UNITS: 2
CONSTR. TYPE: VN
WATER HEATER: E
SQ FOOTAGE: 3340
OFFICE USE --
LAND USE: 1120
ZONING CODE: MDR
# OF BDRMS: 6
RANGE: E
# OF BLDGS: 1
OCCY GROUP: R3
HEAT SOURCE: WH
INSUL PATH: PI
To request an inspection, call the 24 hour recording at 726-3769.
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.
REQUIRED INSPECTIONS ---
FOOTING - After trenches are excavated.
FOUNDATION - After forms are erected but prior to concrete placement.
UNDERFLOOR PLUMBING - Prior to insulation or decking.
POST AND BEAM - Prior to floor insulation or decking.
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
SANITARY SEWER LINE - Prior to filling trench.
STORM SEWER LINE - Prior to filling trench.
WATER LINE - Prior to filling trench.
ROUGH PLUMBING - Prior to cover.
ROUGH MECHANICAL - Prior to cover.
ROUGH ELECTRICAL - Prior to cover.
ELECTRICAL SERVICE - Must be approved to obtain permanent power.
SHEAR WALL NAILING - Before covering sheathing with finish materials.
FRAMING - Prior to cover.
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
DRYWALL - Prior to taping.
CURB CUT - After forms are erected but prior to placement of concrete.
SIDEWALK - After excavation is complete, forms and sub-base material
in place.
FINAL PLUMBING - When all plumbing work is complete.
FINAL MECHANICAL - When all mechanical work is complete.
FINAL ELECTRICAL - When all electrical work is complete.
FINAL BUILDING - When all required inspections have been approved and
the building is complete.
SPRINGFIELD
Job Number: 970650
Page 2
Lot Faces: N
Solar Approved: Y
Total Height: 26
Lot Type: INTERIOR
Setbacks
S W E
60 13 13
Setbk From NPL: 20
N
House 28
Garage 20
Item
Main
Garage
Total Value
BUILDING PERMIT ---
Square Feet x
2940
400
$/Square Feet
64.66
16.27
Value
190,100.00
6,508.00
196,608.00
Building Permit Fee
Surcharge/Admin
651.25
52.10
TOTAL FEE
(A)
703.35
--- SYSTEMS DEVELOPMENT CHARGE (SDC) ---
(B) 4,618.76
Systems Development Charge is due on all undeveloped properties within the City
limits and the Citys Urban Growth Boundry which are being improved.
PLUMBING PERMIT ---
Item
Residential Bath(s)
4
Fee
320.00
Plumbing Permit
Surcharge/Admin
320.00
25.60
TOTAL CHARGE
(C)
345.60
MECHANICAL PERMIT ---
Exhaust Hood
Vent Fan
Dryer Vent
4
9.00
12.00
6.00
Mechanical Permit
Issuance
Surcharge/Admin
27.00
10.00
2.16
TOTAL PERMIT
(D)
39.16
--- MISCELLANEOUS PERMITS ---
Surcharge/Admin
Sidewalk
Curb Cut
WILLAMALANE SDC
PLAN REVIEW FEE
0.00
19.75
15.40
1,848.00
60.00
TOTAL MISCELLANEOUS PERMITS
(E)
1,943.15
(Excluding Electrical)
unless otherwise noted
TOTAL AMOUNT DUE
(A, B, C, D, and E combined)
7,650.02
SPRINGFIELD
Job Number: 970650
Page 3
--- 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.
Received By:
Plans Reviewed By: BOB BARNHART Date: 05/16/97
Building Site Reviewed By: BRENDA JONES
--- ADDITIONAL COMMENTS ---
SAME AS 970638 615/617 S 41ST CT
DRIVEWAY REQUIRED TO BE PAVED
2 STREET TREES REQUIRED
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
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 front of the property, and the approved set of plans
will remain O~h s~ :t~ times during construction.
. I f \
\J VALIDATION
Signature
Date
Date Paid:
~~'6
tn . \0 .q,'
-\<6C\~~ -/
~.mJ -:\ I
Receipt Number:
Amount Received:
Received By:
Job. No.
C{rO&CJ:J
...
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME: ~~ t!W1(.t,. 1:11;('./. PHONE(~?;) 2tit ; W?cB
, ADDRESS: POOax-1.c?O~0 j rctrHa1llfL STATE: (}v: Zlp:q'1";r~
LOCATION OF PROPOSED BUILDING SITE:
Street Address: 411q- Lj/~J HTYC,/;+ru'tL
. ---.
\,
Plat Name: l ~ 6~ tF;1/1./
'-
O'V1(J7)
Tax Lot Number:
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwelling t
ype definitions are on the back.)
A. ,Sinale-Familv Detached,
Single Family home
Manufactured home not in a park
X $1,000 per unit = $
~:.
, NO. OF UNITS
B. .sinQle-Familv Attached
NO. OF UNITS
~
X $924 per unit = $ ffig. O.Q
C. Multi-Familv Aoartment
NO. OF UNITS
X $692 per unit = $
D. Manufactured Home Park
NO. OF UNITS
X $699 per unit = $
$ I ~4~.-
WILLAMALANE SDC
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See SDC Credit Worksheet.
$
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
.~(\wV/
Development se;.Department
City of Springfield
~I
Date
$ I ~ljK-
'~I (f~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
(RESIDENTIAL)
Name or Company: KEYS HOMES INC.
Location: 4119 FORSYTHIA ST 4121
Developement Type: R Building Size:
Job No.: 970650
Lot Size:
1. STORM DRAINAGE
Impervious Sq Ft 2604 X 0.216 Per Sq Ft
2. SANITARY SEWER - CITY
Number Of PFUs 46 X 44.75 Per PFU
(see Page 2)
3. TRANSPORTATION
Number Of Units
2 X
X Trip Rate
1. 010 X
X
Cost Per Trip
451.26
$911.55
Transportation Total
4. SANITARY SEWER - MWMC
Number Of PFUs
46
Per PFU +
20.690 +
MWMC Admin Fee
10.00
X
X
MWMC CREDIT If Applicable (see Page 2)
TOTAL - MWMC SDC
SUBTOTAL - (Add Items 1, 2, 3 << 4)
5. ADMINISTRATIVE FEES
Base Charge (Subtotal Above) X
0.50
TOTAL SDC
Reviewed By: DENNIS ERNST
Date: 05/06/97
Page 1
Sq Ft
$562.46
$2,058.50
$911 . 55
$961.74
$95.43
$866.31
$4,398.82
$219.94
$4,618.77
Job Number: 970650
FIXTURE UNIT CALCULATION TABLE
Page 2
Fixture Type
Bathtub
Drinking Fountain
Floor Drain
Interceptors For Grease/Oil/Solids/Etc
Inteceptors For Sand/Auto Wash/Etc
Laundry Tub/Clotheswasher
Clotheswasher - 3 Or More
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
Water Closet, Public Installation
Water Closet, Private
Miscellaneous
TOTAL FIXTURE UNITS
Number of
New Fixture
Unit
Equivalent
Fixture
Units
4
o
o
o
o
2
o
o
o
o
o
2
o
6
o
6
o
2
1
2
3
6
2
6
1
3
2
8
o
o
o
o
4
o
o
o
o
o
4
o
6
o
24
o
2
2
1
6
4
46
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occured
after annexation date, credits are calculated separately.
(calculations are by $1000)
Year Annexed: 1969
Credit For Parcel Or Land Only If Applicable:
Improvement (if after annexation date) :
27,500
x
3.47
95.43
o
3.47
x
0.00
CREDIT TOTAL =
$95.43
(If land value is multiplied by 1 then the parcel/land credit is not accurate.)