HomeMy WebLinkAboutPermit Building 1993-12-10 (2)
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726,3759
.
SPRINGFIELD ,..I.,
. '.
..
JOB NUMBER C\~ \~
225 Fifth Street
Springfiel<l, Oregon 97477
LOCATION OF PROPOSED WORK: iLL.:;l..~:-2_8. Q ~'.s:"XJiJ A-,(}Je;, V $/ Jf~/- f.;{,l ,
)<ASSESSORS MAP:J g - (;) 2 - (:; t/ ;LJ D...Lf:..~: .:..:J._ TAX LOT' e>/f!O CJ
LOT'
~t@
BLOCK'
HU3mA-
0((.. ,
OWNER' J'"f-J(l'lt",
ADDRESS 5::' "7i- i:OQS 1. rl (fr
<::;r ~If-.Jo; Pi ~ Id
-
DESCRIBE WORK' A [) C -0 rJ . ~ y I J.(
REMODEL 'x'
CITY:
NEW
ADDITION
(
S'I.PI-.,
CJ ~_~
STATE:
TO f:rA~Atrf:..
DEMOLISH
OTHER
SUBDIVISION'
PHON~'
7'1t - 8{,2S-
ZIP:
!
/ ;
,~ ' CONST,
CONTRACTOR'S NAME ", . ADDRESS CONTRACTOR" EXPIRES PHONE
GENERAL: _114.;) L y,'_< ColI.:~ > .-:;-Ib 3 I Vile. '" lJV 04, Atlf CC 8 ql/~' / OC.7--N-ff?J./J.!-26'1
P</45r/?/6/7f?t-.J " Q-17/~' - >,
PLUMBING: I
MECHANICA"
ELECTRICA' '
QUAD AREA: ...3~~
\
OCCY GROUP' f'.-.\.
\
" OF BLDGS:
" OF STORIES:
WATER HEATER'
- OFFICE USk
LAND USE \ \ r::!j ~
" OF UNITS:
CONSTR, TYPE: V ~
HEAT SOURCE:
RANGE:
-.0..
1.
FLOOD f'LAIN:
ZONING CODE: ill~
" OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
11'rJ...
To request an inspection, you must cali 726.3709. T~i5 Is a ~4 hour recording. All inspectlC'ns requested before 7:00 a.m. will be
made the snme working day, Inspectfons requested after 7:00 a.m. will be made the following work day.
o Temporary Electric
o
Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electricall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o
Masonry - Steel location, bond
beams, grouting.
[KJ
Foundation - After (orms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
_ Prior to Insulation or decking.
o Post and Beam - PrIor to floor
insulation or decking.
o Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trencll.
o Storm Sewer - Prior to filling
trench.
, \
O Water Line - Prior to filling
trenctl. . . .
o Rough Plumbing - Prior to
cover. .
,
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - PrIor to facing
materials and traming Insp.
00 Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
o Wood Stove - After installation.
o Insert - After fireplace approval
and installation of unit.
D Curbcut & Approach - fdter
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - Alter
excavation is complete, forms
and sub-base material in place.
o Fence - When completed.
D Street Trees - When all Jcq'uired
trees are planted.'. ~ .';,. .:..
o
Final Plumbing'- When all
plumbing work is complet.e.
o
Final Electrical -.When all
electrical work is complete.
D
Final Mechanical - When all
mechanical work is complete,
KJ
Final Building - When all
required inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blockin!] and Set-Up - When all
blockinU 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.
D Final - After all requIred
Inspections are approved and
porches, skirting, decks, and
venting have been installed.
Lot faces Lot Type. Selb"cks ,_S THE PROPOSED WORK IN THE
I PL I HSE GAR I ACC I HISTORICAL DISTRICT, OR ON
Lot sq, ftg, Interior IN I THE HISTORICAL REGISTER?
Lot coverage Corner II yes, this application musl be signed
Is I and approved by the Historical
Topography Panhandle Iw I Coordinator prior to permit issuance.
Total height Cul-de-sac IE I
APPROVED' .
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT,
VALUE
Main
Garage
~~\
\ \9\\J,
\\..\_~ \ c:::.~\
~ (\1 t-\.-
Total Value.
Building Permit Fee ~~ ~
Stale Surcharge -I- -:J ~
Total Fee (A) ';l?' s,'3
SYSTEMS DEVELOPMENT CHARGE (SDC)1't5
. . (B) lk~~
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT,
Storm Sewer FT.
Mobile Horne
Plumbing Permit
State'Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood'
Vent Fan
N'
Wood StoveflnsertfFireplace Unit
Dryer Vent
Mechanical Permi t
Issuance
State Surcharge
Total Permit
(D)
,',
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
,.
.'"
,
Curbcut
ft
Demolition
Stale Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding eleclrical)
(A. B, C. D, and E Combined)
5"1. ?/
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
adopled by Ihe Cily of Springli_eld, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of an~rov~f said ordinances.
Plan Check Fee: \ ~ \ -
\a-7\l-C\~
Receipt Number \(''1'')(',\ \
~
Date Paid:
/:). ,? -~
Date
Systems Development Charge is due 'on all undeveloped
properlies 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 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 Slale of Oregon pertaining to the work described
herein, and thaI NO OCCUPANCY will be made of any
structure without pormission of the Building Safely Division.
I further certify thai 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
)::,~:~:~YY1<~n: '7J:{;~
Date
VALIDATiON:
RECEIPT NUMBER
///2 5'
,I2-/()-j.J
C;-/,7/
~~
DATE PAIl"'
AMOUNT RECEIVEr>
RECEIVED BY
.
.6 NO. '13ICo'?S
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: r~KKY J-I1!3N1A
LOCATION: 517z Fa~Sy'n..nA
DEVELOPMENT TYPE: Lp!?- - At>-DI1'1 () N
BUILDING SIZE: 9 t r.J
1"6 a 1-0'-/2./ - 0/8'00
LOT SIZE
SQ. Ft.
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X $424,31
X $424.31
X $424.31
~-)
~
$
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)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) ..~-
TOTAL-MWMC SDC I~~
\,......
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ 22 1~
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~ ~L...k..- fa /7.-<1 /q,!:>
U Kip Burdick I I
SDC Coordinator
<G9
TOTAL SDC $ Z ? ~