HomeMy WebLinkAboutPermit Building 1995-7-6
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726,3759
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BLOCK:
LOCATION OF PROPOSED WORK: 2-7.5:"
ASSESSORS MAP: / _703 ?, S
LOT:
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OWNER:
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DESCRIBE WORI<:__M_4~5 ;. ~.r / A?~ ~77-1 k/~
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NEW A4:?t: REMODEL L--- ,ADDITION t - DEMOliSH OTHER
ADDRESS:
CITY:
z - rZO
JOB NUMBER
/.S0 92.~
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
/0 d- rrt20
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Mdc&1'Zic. ~.... ~ -Md,
SUBDIVISION:
~
PHONE~/"""" ?dt: - /:.~ 9'1":-.)
~ 'P" ' Q.:"~ -=-~
92277
STATE:
ZIP:
-
CONTRACTOR'S NAME
GENERAL:-L!)~A ,~_
PLUMBING:
MECHANICAL:
ELECTRICAL:
ADDRESS
,CONST.
CONTRACTOR It
PHONE
EXPIRES
~~\\ ')\l ') - OFFICE USE -
QUAD AREA: LAND USE: \\ \ \ __ FLOOD PLAIN:
- II -- - - LDi/
II OF BLDGS: \ It OF UNITS: 1\J f\) ZONING CODE:
\\'0 .
OCCY GROUP: CONSTR"TYPE: II OF BDRMS:
1I:0F STORIES: .\ . ", re;-
HEAT SOURCE: SECONDARY HEAT:
WATER HEATER:__ 4' (6<-c+szlij RANGE: -C:;J~~ ) , SQUARE FOOTAGE:!a5+
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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.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms,
D Underslab Plumbing/Electrical!
Mechanical - Prior to cover,
, ,
1'v1 Footing - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting,
"AFoundatlon - After forms are
~ erected but prior to concrete
placement.
o Underground Plumbing - Prior
, to filllnQ trench.
K/'t'" Underlloorct5iumbln~chanlc~
~ - Prior to ~3;-~<;;<..;t\fn'9.
K71 Post and Beam; - Prior to floor
~insulatlon or decl<ing,
~ Floor Insulation - -Prior to .
~decking,
o Sanitary Sewer - Prior to filling
'trench,
f');:7f Storm Sewer - Prior to filling
~ trench, ,
o Water Line -:-' Prior to filling
trench. ' '" ,,'
rYl Rough Plumbing - Prior to'
~cover,
REQUIRED INSPECTIONS
. .
I~ Rough Mechanlcar - P!lor to
~cover. 4AS r'l?~
. ' '
, K/r Rough Electrical - P~~~ to
~ cover, , ~
.'.
o Electrical Service - Mu~t. be
approved to obtain permane'nt
electrical power.
o Fireplace - Prior to facing
materials and framing Insp,
~ Framing - Prior to cover,.
1'\7( Wall/Cel/ing Insulation - Prior to
~cove~ ,
K7f Final Plumbing - When all
~Iumbing W9rl< Is complete,
r\/r Final Electrical - When all
~ electrical work Is complele,
~ Final Mechanical - When all
~ mechanical work Is complete.
M Final Building - When all
~ required Inspections have been
approved and building is
completed,
DOc!f'~
..
VI Drywall - Prior to taping,
" '
. &;A;-S ,L/VE f r/~ q;f-S MOBILE HOME INSPECTIONS
~ \A,:.,.......J...-.)I..." .. After Installation.
o Insert - After fireplace approval
and Instal/atlon of unit.
~Curbcut & Approach - After
~ rorms are t)rected but prior to
placement of. concrete,
o Sidewalk & Driveway - Afler
excavation Is complete, forms
and sUb.base material In place.
o Fence - When completed,
o Street Trees - When all _requ!red
trees are planted. '. '. .-: . '_
o Blocking and Set-Up - When aI/
blocking Is complete,
o Plumbing Connections - When
home has been connected to
water and sewer.
4.''''
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, skirting, decks, and
venting have been Installed.
Lot faces
Lot Type
Lot sq. ftg.
_ Interior
$ Corner
Lot coverage
Topography
Total height /~,5"
( :2[;) r -t-)
J
BUILDING PERMIT
Panhandle
Cul-de-sac
\",'.
Setbacks
HSE GAR ACC
I P,L.
IN
Is
Iw
IE
ITEM sa, FT, x $/SO. FT, VALUE
Main ~SL< ~~..4.&> /~1/s
Garage .3 2... ~ /4, /P "_4s~
, ,
Carport
~ffj~( ,/fhr .15c;cnl
Total Value
Building Permit Fee
State Surcharge / IPS + 1,0/
Total Fee
(A)
PLUMBING PERMIT
ITEM
Fixtures
o
Residential Bath(s) ,
NO
Sanitary Sewer FT.
I ,f.._'
Water
,FT,
Storm Sewer
FT, L SD
Mobile Home
Plumbing Permit
1-'?::-S,+ 'f/9}~
(C)
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
NO
2..
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
6A-$ L./AJ~ ; _ .~
Mechan'ical Permit
Issuance'
State Surcharge ;, IS- f- I tP '1
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
"3fJ
ft
Demoll tlon
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
tOD.t:TO
?-5,cW
~s:trO
" /:.. tJO
.' : -1.L?r"
"I ,.' -:-
. q/,'gt)
Lo~O'
cj.bO
~/OO
~_~O
2.:S 0-0
/0.0-0
/1$1-
.s~.B4
/f.5'''
.J ",;}-O
)1-'
lo2'/~~
.;:3 THE PROPOSED WORK IN THE,
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Histori.cal
Coordinator prior to permit issuance,
APPROVED:
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 tR'C', City of Springfield, including the
DeveloPl11ent Code, regulating the cOlJstruction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee: / SI, 7-2>
-_n6/~A ;-
Receipt Number:__" I /;;I6~ ('
'~
l. l
Date Paid:
';(/s1 )
! ~t:
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being improved,
ADDITIONAL COMMENTS
P/t7/f 1.
571~~ ~/T /s dBr;j,
. .,- "
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 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
re,quested at the proper time, th~~ 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 remai~
on the site at all times during construction,
X(" ~ ",?-z. ""/ ' "
Signature ~.......P'''''''''''''''''7~
Date
VALIDATION:
/~2/tJ
DATE PAID 7/~/7F
AMOUNT RECEIVED __~___ IS g I ~ 2
~p~
/~ ,.
RECEIPT NUMBER
,. RECEIVED BY
18 NO. Q5oQ').,Co '
. .. . '~~"'\. . - ,
'. ;), .~~; ,.;.,}, ;"'-y_ "j;"." i ~~;
. i- .". f - . , .< ~ ~ - t" .
CITY OF SPRINGFIELb SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: f(; I? D IAIA&N 1E.-f!?-
LOCATION: 'Zr? Al-l-CN Ave.
DEVELOPMENT TYPE: l-OR.. - AOI?ITllMI/r<EM6PtZL
BUILDING SIZE: LOT SIZE
1. STORM DRAINAGE
SQ. Ft .
IMPERVIOUS SQ. FT.
<6?~
X $0.209 PER SQ. FT. ~1'1"'V
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
X $43.26 PER PFU
C;--6-)
............. ------
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADM FEE
(Use PFU Total From Item 2 Above)
X $436.19
X $436.19
X $436.19
cl-e-~
$
$
$
TOTAL-MWMC SDC
SUBTOTAL (ADD ITEMS 1,2,3 & 4)
$
~
'-- ~
$ '1Q '?.:
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05 ~ ~~ ~
-~. .2~Lc.k. Date: Co/25/15 ~
\lKipBurdick '( 'TOTALSDC $ I~~-z.;_
SOC Coordinator