HomeMy WebLinkAboutPermit Building 1993-12-27 (2)
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769.
Office: 726.3759
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~ TAX LOT: CJG~.\) R i
SUBDIVISION: \\90....- \-.>OJ\:(,J
PHONE/" b~~~-k=-D;.:-:\
STATE: l~ lD f\ on~ ZIP' C{ r 14(Y rL I
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DEMOLISH OTHER 0
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LOCATION OF PROPOSED WORK: , ' 4. \. \ ['
ASSESSORS ['An, -~l ~(YA.OS 'A. ~
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OWNER. ~ ,~=v:~JJ~~~~vx.~~.9~-Q,-,-.~.~__) -
ADDRESS \' _:C::l_ ~'<
CITY' t? DO'PD C -- .~ .
DESCRIBE WOR~' l\ '\ \\'\ f\ l.. tJ "\
NEW REMODEL AOOIT ~
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sP~56"
:i-4.~l? l04
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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EXP~_~ PHONE /
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CONST.
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CONtRACT~'S NAM? . JJ.. AOpRESS \
GENERAL:H{Y'Yl12f1 llJl.l)) I)l ~.s.m )
PLUMBING: ( "'")(Yy\ 0. f\ tlc\ \\ \\ 9.. ~
MECHANICA" ~ ~..c:. f 1 ,,!fit!) 0 f\ J-
ELECTRICAL, ~~~\f\'-\-S~,\'"
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QUAD AREA: ,~~~ - OFFICE Un
LAND USE: \ \ cAe FLOOD PLAIN'
# OF BLOGS' \ # OF UNITS' JtJ ZONING CODE: f J)f2---"
OCCY GROUP: (~~-,", tv, CONSTR, TYPE: # OF BORMS: ,~
# OF STORIES: \ HEAT SOURCE: ~L- SECONDARY HEAT:
WATER HEATER: P....... RANGF' c:z-, SQUARE FOOTAGE: J f) R,?.,
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To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections requested belore 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.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover. .
g Footing - After trenches are
. excavated. .
D Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
erected bu't prior to concrete
placement.,
D Underground Plumbing - Prior
to filling trench,
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
~ Rough Electric~ ~~or ./
cover. ~l.N-,~
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
l7J Fra~~r.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Underfloor Plumbing/Mechanical D W d S AI i i
_ Prior to Insulation or decking. 00 tove - ter nstallat on.
D Post and Beam - Prlor to floor
Insulation or decking. D Insert - After fireplace approval
and Installation of unit.
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D Floor Insulation - Prior to
decking.
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~ Sanitary Sewer - Prior to filling
trench. .
~ Storm Sewer - Prior to filling
trench. .
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~ Waler Line..., Prior to_filling
~ trench, , I' .
D Rough Plumbing - Prlor.to
cover. \ '
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rC7I Curbcut & Approach - After
'/.J forms are erected but prior to
'. placement of concrete.
~ Sidewalk & Driveway - After
excavation Is complete, forms
. and sub-base material In place.
D Fence":" When completed.
D Street Trees - When 'all required'"
trees are planted. , .
D Final Plumbing - When all
plumbing work Is complete.
~ FInal Electrical - When all
F.J electrical work is complete.
ctcu~
D Final Mechanical - When all
mechanical work Is complete.
1C7\) Final Building - When all
~ required Inspections have been
approved and building Is
completed. q'oAQ,o/....J
D Other
MOBILE HOME INSPECTIONS
d Blocking and' Set.Up - w~en 'all
I blocking Is complete.
~ Plumbing Connections - When
home has' been connected to
water and sewer. .
~ Electrical Connection - When
blocking, set-up, and plumbing"
Inspections have been approved
and the home is connected to
the service panel.
'leA Final - After all required ,
~ Inspections are..approved and .
. porches, skirting, decks, and '
venting have been. installed.
Lol Type . Setbacks
Interior I P.L. HSE GAR ACC
IN
Corner
Is I
Panhandle
Iw ~. I,
Cul-de-sac IE I
Lol laces
Lot sq, flg,
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM sa: FT:
t ...._ j - -.;l.:'
Main ' '," .
x ~fSa, FT.
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c VALUE
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Garage
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SYSTEMS DEVELOPMENT CHAR~E (SDC) 1/5
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(B) Z.IO~-
Tolal Value
Building Permit Fee
( ~4..'LA. ")
Slate Surcharge
Total Fee
(Al
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Slorm Sewer FT,
J:F, (JO
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AS.OU
Mobile Home
Plumbing Permit
Stale Surcharge
Tolal Charge
f)~ ,CD
~f)S
OF) , i).s
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MECHANICAL PERMIT
.
Furnace
Exhaust Hood
Vent Fan
N'
Wood Sloveflnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
o
Totel Permit
(D)
MISCELLANEOUS PERMITS
Mobtle Home
1m .00
.::s ,~')
cS({)OQ
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\L\ .~.r)
State Issuance
Stale Surch~e
Sidewalk L/j lo It
Curbcul -ID It
Demolition
Stale Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrICal)~4tliCf1
lA, B, C, D, and E Combined)
T.
\ .HE PROPOSED WORK IN THE "
'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
.. II yes, this application must be slg'ned
and approved by the Historical
qoordinator prior to permit Issuance.'
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APPROVE!'"
BUILDING VALUE, PLAN CHECK'
AND BUILDING PERMIT '
Thls'permit is,granled on the express condition lhat the said
constru'Ctf6n shall, In all/respects, confomlto'the Ordinance
ad9Pt{~ r~Y~;th'e/C)ty _.~f .Sprl,ngflel~. }'1rCludlng the
Development Code;"regulatlng 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'
Date Paid:
Receipt Number'
Received By:
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Plans Reviewed By
Date
Syslems Oevelopmenl Charge Is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
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\, -~ount(b: \C\\W
Jl\ ~r (jfYrl lion t 0,
By slgnalure, I slate 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 certHy
that any and all work performed shall be done In accordance
with the Ordinances 01 the City of Sprlnglleld, 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 of the ,Building Salely Division,
I further certify thai only cont",ctors and employees,who
are In compliance with ORS 701.055 will be used on'thls
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. an e approved set of plans will remain
on the site al all I es durl~ cons)~ucllo//7
X:lgnaturp ~p/.-1 Ie. ;::-~'
Datp 1'-/IO/cJ3_
VALIDATION:
- 1'1'/'\ j), ( n
RECEIPT NUMBER 1?l~1' LY
DATE PAI"\~ &(,:f1?
AMOUNT RECEIVF~~;..os I ~,Cf--1
RECEIVED BY , \f'f"'l.)
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S'P_FIELD
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DEVELOPMENT SERVICES DEPARTMENI,
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 attached1X' ~!Js, one of tP~ fbllowing
manufactured homes will be placed at ~ ..,:':-) tf)"CSL\'\:XL\n )
S~rgfield, Oregon, City Job Number -. \') ,lrft- ,- (\.
~ Type I Manufactured Home. A multi-sectional (double wide or wider)
unit with an enclosed floor 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.
TYDe 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.
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Slgna:lure
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.OB NO. Q3/2.roy.
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: JItM e s 'PIfULtJOiJ
S\
LOCATION: '-I/~ 'F()f1:,.SYTHIA / lio2-()5Z'2-- Ot!)t.j() "i '
DEVELOPMENT TYPE: L.o!l:. . NE.W MItAlo, fkJV1e."
!\-oM!: (,sAuuE. '!/.w .
BUILDING SIZE: Z?>,((,.C; . 7-4,t.Zof 17,( '2."Z LOT SIZE
SQ. Ft.
l. STORM DRAINAGf;
IMPERVIOUS SQ. FT. 'Z.,'f ~ ' X $0.203 PER SQ. FT. ~5CO 7 9'!)
'-- ..---'"
2. SANITARY SEWER-CITY
NO. OF PFU'S I~ X $42.08 PER PFU ~'57 '!::!~
(See Reverse) '-- ~
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
I
X /.0/
X $424.31
X $424.31
X $424.31
~L/-ZB ~
'-- ..---'"
$
X
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S If(, x $15.125 PER PFU + $10 MWMC ADM FEE $ 201)'2 z5
(Use PFU Total From Item 2 Above)
$
SUBTOTAL
$ ?~ "Z;
TOTAL-MWMC SDC ~
(ADD ITEMS 1,2,3 & 4) $ '200 ~ ~
'~;;k
MWMC CREDIT IF APPLICABLE (SEE REYERSE)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .Q5
K!.' A -;<. -L,...j._ !/~ /ti3
() Kip Burdick
SOC Coordinator
([;00 ~)
"- ---
/1"
TOTAL SDC ~ 2/0?-
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FIXTURE UNIT;CAlCUuesN TABLE, Number of New Fixture.it Equivalent = Fixture Units (N0TE: "
For remodels. calculate only the NET additional fixtures)
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
z.
2
1
2
3
6
2
6
6
t
3
2
t/Head
2
2
1
6
4
<f
Bathtub..,.....................,...,..,......,...,.".,..... ,....,..........
Drinking Fountain... ,....................,............................
Roor Drain.... ..,. ,............,................,.............,..... ,.....
Interceptors For Grease/Oil/Sollds/Etc.................
Interceptors For Sand/Auto Wash/Etc................,.
Laundry Tub/Ootheswasher"......".....".................,
Ootheswa~er - 3 Or More,....................................
MobUe Hdme Park Trap (1 Per Trailer).................,
Receptor F:or RefrigeratorjWater Station/Etc........,
Receptor For Commercial Sink/Dishwasher /Etc.. '
Shower. Single .Stall............, ,.. .........,. ...... ,.... ,.. ........
Shower, Gang..................,.,..........".........................
Sink, Bar, CommerciaL...........,.........,..........,....,....
Urinal, StalljWall.:...,........ .........."....,.....,... ...., ,...,.....
Wash Basin/Lavatory, Single..,...............................
Water Ooset. Public Installation.,.....,.....................
Water Ooset, Private..,........."....,....,.,...........,......,..
Miscellaneous:
2
.(
z.
'2.
'2..
-z..
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TOTAL FIXTURE UNITS
=
16
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
L
Year
Annexed
1979 or before
1980
1981
1982
1983
1984
'1985
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
11
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$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
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Cre<!it for Parcel or Land Only If Applicable
Improvement ('If after annexation date)
?1-1 X $ /O.3S=7l7'Z'=
(Rate X Assessed Value)
X $ =
(Rate X Assessed Value)
CREDIT TOTAL = $ ~? '2...=:
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Residential....................:....,....,..........., ,.:.."...... 0,4
CommerciaL.............,.............,.....,................, 0.9
Industrial..................................,.........,...,.......... 0.45
GovernmentaL.....................,......,................... 0,5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT