HomeMy WebLinkAboutPermit Building 1994-3-4 (2)
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~ESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726,3759
_. SPRINGFIELD
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~ATIO_N OF PROPOSED Wg.B,K: 1\!l3"'71 DO<<-Mot.1
ASSESSORS MAP' '100...:)<'1\ (, ~A..., ^
LOT:
t
CONTRACTOR'S NAME
GENERAl' ~.N",.e-~
PLUMBING' --'
MECHANICAl .~
ELECTRICAl' -
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
\R~)w
);
\
\
. OF STORIE'"
WATER HEATER:
.-
JOBNUMBER~~
225 Fifth Street
Springfield, Oregon 97477
<-fJRINf1=lcLd) nfJ't '
, TAX LOT: ./ ~~
SUBDIVIS!ON: -#.. M ~.A'"
BLOCK'
PHONE: 7'j/ -/7.< F:
STATE:
f),Qr-NntJ
ZIP:?, 7t 7 7
DEMOLISH
OTHER
ADDRESS
CONST. ..
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cove~ .
lZl Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
QtJ Framing - PrIor to cover.
o WalltC'elllng Insulallon - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - After Installs,tlon.
o Insert - Atter fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
. excavation Is complete. forms
and s.ub.base material In place.
o Fence - Whe." completed.
o Street Trees - When 'all required
. ' trees are planted. . .
EXPIRES
i
FLOOD PLAIN'
ZONING CODE: ll1tL.-/
. OF BDRMS'
SECONDARY HEAT: )
SQUARE FOOTAGE: \. f5:!:)!
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.
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, - OJl[FF.ICE ,\SE -
LAND USE: I
. OF UNITS:
CONSTR. TYPE:
HEAT SOURCF'
,
VfV
OWNER: R.oW! --r r",vLnr:t
I .
ADDRESS:',,", '37Ci OoJ2AJor:A J'T
CITY: )fril.)~r Fl(;'Ld, ~
DESCRIBE WORK' f.r '" it..A1 IE'
NEW ~ REMODEL ADDITION
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
~ Footing - After trenches are
excavated.
o Masonry - Steel location, bond
.beams, grouting.
GrI Foundation - After forms are
. erected. but. prior to concrete
placemer'!t.
o Underground Plumbing - Prior
to filling trench.
o Underfloor PlumblngtMechanlcal
-.Prlor to Insulation or decking.
o Post and Beam - Prior to floor
Insulatfon or decking.
o Floor 'hisui'atlon - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. .
o Waler Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
RANGE:
o Final Plumbing - When all
plumbing work Is complet.e.
[E] FInal ElectrIcal - When all
electrical work Is complete.
o FInal MechanIcal - When all
mechanical work Is complete.
rI7I Final Building - When all
)4-J required Inspections have been
approved and building is
completed.
I
o Other
MOBILE HOME INSPECTIONS
o Blocking and Sel-Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
o Final - After all required
inspections are approved ,and
porches, sklrtlng, decks. and
venting have been Installed.
Receipt Number: '
~y: ~~ /
Pp.IIJ eviewed y~~
SYSTEMS DEVELOPMENT CHARGE (SDC)<$-.
(B) ~\<+'2...~
Lot faces ~
Lot sq. Itg. t~
Lot coverage
Topography
Total height l1....
ITEM'
Main
Garage
Carport
~
Total Value
Building Permit Fee
State Surcharge
Total Fee
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PlumbIng Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
Lot TY'
Interior
./ Corner
Panhandle
'.'
Cul,de.sac
X $1 sa. FT.
14,10
(A)
N'
FT.
FT.
FT.
(C)
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
MechanIcal Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
I P.L,
IN
Is
I'w
IE
VALUE .
\ '
~~?jk--
,
/ ~ S<!=>
~ 7. ~
7/.9~
FEE
Total Mlsceilaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrICal)-:;?L"Y. s-3
(A, B, C, 0, and E Combined)
Setbacks
HSE GAR Accl
/7' I
I
I'
\.:..
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1~
. ." .. I
~ IS THE PROPOSED WORK IN THE r '
'....HiSTORiCAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appilcation must be signed
and approved by the Historical
, \9oordinator prior to permit Issuance.
. .
. '
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERIVIIT
This permIt Is granted on the express condition'that the saId
constructIon srall, In all re~pects. 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 rev.oked at a'ny time
upon violation of any p'rovlslons of said ordinances.
Plan Check Fee: 1.1 .:~ ~
/, fJB Lf1=
.,
Date Paid:
....
"?--~y
Date
S stems Davelopment Charge Is due on all undeveloped
properties within 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 that all
Information hereon Is true and correct, and I further certif~
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 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 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
on the site at all tImes during con/~Ion.
Signature 0~-r_M.~/
~. V -
Date J - ~ Ii? ~9Y ,
VALIDATION: \'~~q?,-
. RECEIPT NUMBER _ f
DATE PAIP '=) L\-..q Y
AMOUNT RECEIVED 1/\ 1..\' '0-~
jJ ^ ^ ^- ~
, ^" -
RECEIVED BY
-/. .
.
.B NO. 9<4009 '2..-
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: Roe>E:.lC--r :J', IAYL..Of<..
LOCATION: 'Z.'?'1'1 Do~~cc.i-\ S.,-,
DEVELOPMENT TYPE: LDf!- - A-DPITlOl-t
BUILDING SIZE: ~,('Z;'Z..?;i~,(INC:LUDEO? ""AYe!>) LOT S~ZE
\"'i o?:> '2.:1'2..:2. - 01 ,",oS
SQ, Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ, FT. Co"''''' X $0.203 PER SQ. FT. ~??8~
.......... .-/'
2. SANITARY SEWER-CITY
NO, OF PFU'S X $42,08 PER PFU ( ~
(See Reverse) .-/
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $15,125 PER PFU + $10 MWMC ADM FEE $
(Use PFU Total From Item 2 Above)
X $424.31
X $424.31
X $424,31
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$
$
-
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $
TOTAL-MWMC SDC ~
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ \ -:l:Jr::. ~ .
5, ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
12_~LuL ~h,')/qt.j-
6' Kip Burdick '!
SOC Coordinator
((' Co 1~
~
TOTAL SDC $ \ '-\ 7. (.,~