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HomeMy WebLinkAboutPermit Backflow Test 1999-12-17 SPRINGFIELD , '. -, . Page 1 RESIDENTIAL PERMIT APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION BUILDING SAFETY Job Number: 991563 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location of Proposed Work: 955 FUCHSIA ST Assessors Map #, 17032613 t"l'.i1 Lot, 3 Block: Tax Lot #: 04200 Subdivision: FUCHSIA GARDEN Owner: GENE HIATT Address, 55868 KING RD. Phone #: 822-3509 City/State/zip, MCKENZIE BRIDGE OR,97413 Describe Work: S.F.RESIDENCE NEW Contractor Const. Contractor # Expires Phone General: GBH CONST 0068798 55868 KING RD E MCKENZIE BRIDGE OR 10/20/03 822-3509 QUAD AREA: 2RNW OCCY GROUP, R3 HEAT SOURCE, FE OFFICE USE -- LAND USE, 1111 CONSTR. TYPE: VN INSUL PATH: PI # OF BLDGS, 1 # OF BDRMS, 3 SQ FOOTAGE: 3064 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 --- SITE - To be made after excavation but prior to setting forms. FOOTING - After trenches are excavated. FOUNDATION - After forms are erected but prior to concrete placement. UNDERFLOOR PLUMBING - Prior to insulation or decking. UNDERFLOOR MECHANICAL - Prior to insulation or decking. POST AND BEAM - Prior to floor insulation or decking. INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover WATER LINE - Prior to filling trench. SANITARY SEWER LINE - Prior to filling trench. STORM SEWER LINE - Prior to filling trench. UNDERFLOOR DRAIN - Prior to cover or placement of concrete. 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. CURBCUT - 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. Lot Faces: N Lot Sq. Ft., 8800 Lot Coverage, 35.27% SPRINGFIELD Job Number: 991563 Page 2 Topography: 2 Total Height: 18 Lot Type, INTERIOR N Setbacks S W 5 E 5 House Garage 18 Item Main Garage Total Value BUILDING PERMIT --- Square Feet x 2440 624 $/square Feet 69.64 18.34 Value 169,922.00 11,444.00 181,366.00 Building Permit Fee Surcharge/Admin 617.50 61.76 TOTAL FEE (Al 679.26 PLUMBING PERMIT --- Item Residential Bath(s) 4 Fee 320.00 Plumbing Permit Surcharge/Admin 320.00 32.00 TOTAL CHARGE (Cl 352.00 MECHANICAL PERMIT --- Exhaust Hood Vent Fan Dryer Vent 4 9.00 12.00 6.00 Mechanical Permit Issuance Surcharge/Admin 27.00 10.00 2.70 TOTAL PERMIT (D) 39.70 --- MISCELLANEOUS PERMITS --- Surcharge/Admin Sidewalk WILLAMALANE SDC CITY SDC 0.00 60.00 1,848.00 4,194.95 TOTAL MISCELLANEOUS PERMITS (E) 6,102.95 (Excluding Electrical) unless otherwise noted TOTAL AMOUNT DUE (A, B, C, D, and E combined) 7,173.91 --- 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. . SPRINGFIELD Job Number: 991563 Page 3 Plan Check Fee, Received By: Plans Reviewed By: DON Building Site Reviewed 401.38 Date Paid: 11/15/99 Receipt Number, 036180 MOORE Date: 12/16/99 By, BOB BARNHART --- ADDITIONAL COMMENTS --- PATH 1; SEPARATE ELECTRICAL PERMIT IS REQUIRED. NO SEWER CONNECTIONS UNTIL CITY ACCEPTS INFRASTRUCTURE. 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 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 construction. S~~ .JcJ lci....c. W- It;. - 1'7-_ 91 Date - -- VALIDATION Date Paid, 7 ~ Ie:, f!, /)./(7/75' -(JE, Receipt Number: Amount Received: Received By: r/ . . ATTACHMENT A CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET JOURNAL OR JOB NUMBER 991563 NAME OR COMPANY: GENE & DORTHY HIATT LOCATION: 955 FUCHSIA TAX LOT NUMBER 17032613-04200 DEVELOPMENT TYPE: DUPLEX BUILDING SIZE: 3688 LOT SIZE 8800 , STORM DRAINAGE IMPERVIOUS SQ. FT. 4080.0 x $0.232 PER SQ. FT. $946.56 I 2. SANITARY SEWER-CITY NUMBER OF PFU's (SEE REVERSE SIDE) 32 x $48.27 PER PFU $1,544.64 I 3. TRANSPORTATION NUMBER OF TRIPS x TRIP RATE x COST PER PM PEAK HOUR TRIP 2 x 1.01 x $486.73 PER TRIP x x $486.73 PER TRIP TOTAL TRANSPORTATION SDC 4. SANITARY SEWER- MWMC A. REIMBURSEMENT COST, NUMBER OF FEU's 2 x $242.76 PER FEU B. IMPROVEMENT COST: NUMBER OF FEU's 2 x $22.05 PER FEU $983.191 $0.00 $983.191 $485.52 1 I I I TOTAL MWMC SDC I SUBTOTAL (ADD ITEMS 1,2,3, & 4) , $44.101 ($18.82)1 $10.00 1 $520.80 1 $3,995.19 I MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE 5. AD~TNISTRATIVF "FFS: BASE CHARGE (SUBTOTAL ABOVE) x 0.05 $199.76 I -- . ~--- S~IN R - /euM1 'i5A'ffi'{ TOTAL SDC CHARGES I $4,194.951 . . PLUMBING FIXTURE UNIT (PFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = PLUMBING FIXTURE UNITS !NOTK FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) FIXTURE TYPE BATHTUB DRINKING FOUNTAIN FLOOR DRAIN INTERCEPTORS FOR GREASE/OIUSOLIDS/ETC. INTERCEPTORS FOR SANDI AUTO W ASH/ETC. LAUNDRY TUB/CLOTHESW ASHER/MOP SINK CLOTHESW ASHER - 3 OR MORE MOBILE HOME PARK TRAP (I PER TRAILER) RECEPTOR FOR REFRIGERA TOR/W A TER ST A TION/ETC. RECEPTOR FOR COMMERCIAL SINK! DISHW ASHER/ETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK, BAR, COMMERCIAL, RESIDENTIAL KITCHEN UR1NAL,STALLAVALL WASH BASIN/LA V A TORY, SINGLE OR DOUBLE TOILET, PUBLIC INSTALLATION TOILET, PRlV A TE INSTALLATION MISCELLANEOUS: FIXTURES NEW OLD 2 2 2 4 4 UNIT EQUIVALENT 2 I 2 3 6 2 6 6 I 3 2 1 2 2 1 6 4 PLUMBING FIXTURE UNITS 4 o o o o 4 o o o o o o 4 o 4 o 16 o o o TOTAL PLUMBING FIXTURE UNITS=I 32 CREDIT CALCULA TION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATEL YEAR RATE PER $1,000 YEAR RATE PER $1,000 ANNEXED ASSESSED VALUE ANNEXED ASSESSED VALUE - 1979 or before $4.47 1989 $2.18 1980 $4.38 1990 $ 1.75 1981 $4.32 1991 $ 1.35 1982 $4.20 1992 $1.17 1983 $4.03 1993 $1.03 1984 $3.88 1994 $0.86 1985 $3.68 1995 $0.71 1986 $3.38 1996 $0.57 1987 $3.03 1997 $039 1988 $2.62 1998 $0.18 CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE $4.47 .x 4.211 .1. $18.82 I IMPROVEMENT (IF AFTER ANNEXATION DATE) x 1 $0.00 CREDIT TOTAL $18.82 . Job. No. <1.1.. \5'-3 PHONE: ~-~SO, STATE: ~IP: ~1'U:3 LOCATION OF PROPOSED BUILDING SITE: Street Address: ~ C;;S r. l ~ .~" ~: ta. ~ Pial Name: \.1C)~b r~ Tax Lot Number: O~C.O 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwelfing t ype definitions are on the back.) A Rinole-F::!milv Det::!cherf . , Single Family home NO. OF UNITS Manufactured home not in a park X $1,000 per unit =$ B. Rinale'-F::!milv Att::!cherf NO. OF UNITS ~ X $924 per unit, = $ \~~b ~ C. Multi-Farnilv Ao::!r1rnen\ NO. OF UNITS X $692 per unit = $ D. /i1anufacturerf Home Park NO. OF UNITS X $699 per unit c $ WILLAMALANE SDC $ 2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WiUamalane Credit approval. See SOO Credit Worksheet. $ 3. TOTAL WILLAMALANE NEf SDC ASSESSED (if SDC reduced for Credit) , $ ~~. . ~Iopment Services Department City of Springfield ;2 I ;7 I 97 Date