HomeMy WebLinkAboutPermit Sewer Connection Record 1997-10-10
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726.3759
ASSESSORS MAP'
LOT:
2-
2...
BLOCK'
OWNER: :J;r-tIM T ffi-....dS~)
ADDRESS: At?,.g..7X / 0g;~
CITY: _fJi:iv"})d~ )
STATE:
,9'"W ,
DESCRIBE WORK:
h)~~(_ <,f?U/tob<... J?1 ~~.6
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAL'
PLUMBING:
i/rlll 711 S7J'l>?
( , .
MECHANICAl'
ELECTRICAl'
QUAD ARE...
· OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER:
DEMOLISH
OTHER
,
JOB NUMBER
9ZL4tJ7
225 Fiflh Slreel
Springfield, Oregon 97477
TAX LOT'
SUBDIVISION'
CJO 9 I) '7
.
PHONE: ji:..tl- 2-?Zi> -0@,2-?)
ZIP:
q 7~ {) /
~/J-Prc.CYp,~
ADDRESS
CONST.
CONTRACTOR'
EXPIRES .~ PHONE
r.'/wtr[:
j),o,~ III/"$!,
E<I;;~ I Q)<.
M4 ~~...L
Vr'!
f~ - 4'7.-;"4'-
- OFFICE USE -
LAND USE: i"f"- ~D~IN'
NO \ \",... PIRE IF 1 tll: ..
· OF UNITS: ""'\'11 c.\.I~ .z,Qjlj.JM<>oIl'Y!;DE:
11-1\5 l"l:f' ;, - itllS PE~\v'" ,~""""
CONSTR. TYPE:....-.AQ\!EI"I' INOER '.QR:~P.RMS'
AU I nv' ,,- ABANOONl;LF
HEAT SOURCCO\lAMC".tI':l:n OR IS SECONDARY HEAT:
RANGE: ;..i~\' W~ n~.'I' PERIOO. SQUARE FOOTAGE: ..
To requesl an Inspection, you musl call 726-3769. This Is a 24 hour recording. All Inspections requesled 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.
o Temporary Electric
D Site Inspection - To be made
after excavation. but prior to
setting forms.
o Underslab Plumblng/Electrlcal/
Mechanical - Prior to cover.
o Fooling - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
.0 Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decKing.
~ Sanitary Sewer - Prior 10 filling
~rench.
o Storm Sewer - Prior to flIl1ng
trench. .
O Water Line - Prior to filling
trench.
D 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 obtai n permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wall/C'elllng Insulation - Prior 10
cover.
o Drywall - Prior 10 taping.
o Wood Stove - After I~sta"atlon.
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement ot concrete.
o SidewalK & Driveway - After
excavation Is complete. forms
and sub.base material In place.
o Fence - V\then completed.
o Street Trees - When all required
trees are planted. :
o Final Plumbing - When all
plumbing work Is complete.
. .
D Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building is
compleled.
DOther
MOBILE HOME INSPECfIONS
o BlocKing and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocKing, sel.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
LOl sq. Itg.
Lot coverage
Topography
Total height
L~l ~pe"
Interior
Corner
Panhandle ~:
Cul-de-sac
BUILDING PER~IT 'I] '~'t
ITEM SO. FT. X S/SO. FT.
Main
Garage
Carport
TOlal Value
Building Permit Fee
.
State Surcharge
Total Fcc
(A)
HSE GAR ACe' I
I
I
I
I
BUILDINh VhLOE, PLAN CHECK
AND BUILDING PERMIT
<', ':. " :.1
.'.' , ......\ rt'J' ," r,~ '.I I
.: "~:: " l ,
I PL.
IN
Is
Iw
IE
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Balh(s)
Sanitary S~wer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
TOlal Charge
" ...
. N' ,
'-,
FT.
FT.
FTtlPl>> ISO"
'. .
"
2-<:<' +- f ?oil
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
Wood SlovellnsertlFlreplace Unil
N'
Dryer Vent
MechanIcal Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobtle Home
State Issuance
Slale Surcharge
Sidewalk
Curbcut
Demolition
State Surcharge
SM.5&.!<< ~M.
It
It
Tolal Miscellaneous Permils (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
4.fJ .p-o.
-3..UJ
43/-0
//<;b'7.S0
/ ?"3/-!! 0
Selbacks .
';'/ ,I
., I"
.;t1'}" \,'."-1. '
11 :f1:n';N"~}'
, -...... ,.~..
.~THEPROPOSED WORK tN THE.
.-. ,
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
" yes, lhls application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
APPROVFn.
This permllls granled on the express condition lhallhe said
conslrucllon shall, In all respecls, conform 10 lhe Ordinance
adopled by lhe City of Springfield, Including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked al any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
Dale Paid:
Recelpl Number'
Received By:
Plans Reviewed By
Date
Syslems Development Charge Is due on all undeveloped
properties within tile Cily IImlls which are being Improved.
ADDITIONAL COMMENTS
..
YI. ,i
By signature, I state and agree, that I have carefully examined
the completed appllcalion and do hereby certify thaI all
Information hereon Is true and correct, and I further certify
lhal any and all work performed shall be done In accordance
with the Ordinances of lhe City of Springfield, and lhe Laws
of the Slate of Oregon pertaining to lhe work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certlfy 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 Inspectlons are
requested at the proper time, that each address Is readable
from the slreel, that the permit card Is located at lhe fronl
of the property, and the approved set of plans will remain
on the site at ~" times during cons~nftlon.
~alurej~/~y r ~~
j) \ .
DatejJ~/ ;tJ. /997
f
VALIDATION:
RECEIPT NUMBER
DATE PAID
2'l Co (0 I
/0/1t'J/'71
/ j/ tYP
'.4--1 .
AMOUNT RECEIVEP
RECEIVED BY
.'.
~
JUb NU.
.... ATTACHMENT A ~
CITY OF- S~NGFIELD SYSTEMS DEVE~PMENT CHARGE
WORKSHEET
E:" s 1',IVtA 7" E:,
NAME OR COMPANY:
LOCATION: 77/
DEVELOPMENT TYPE:
BUILDING SIZE
1. STORM ORA HIAc;F
IMPERVIOUS SO. FT.
2. <;ANTTARY <;FWFR-(TTY
NO. OF PFU'S } 8
(See Reverse Side)
3. TRANSPORTATiOM
J<.ol.iJ~J0 /J. liE
lOT SIZE <;0. Ft.
x $0.226 PER SQ. FT. $
x $46.86 PER PFU
$ X43.4R
.NO OF UNITS X TRIP RATE X COST PER TRIP
x
x
X
4. ~ANTTARY <;FWFR-MWM(
NO. OF ~
X $472.49
$
X $472.49
$
X $472.49
$
x 2n. 7(" PER FEU + $10 MWMC/ADM FEE $
?(?;7,7b
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $
TOTAL-MWMr sor $
SUBTOTAL (ADD ITEMS 1.2.3 & 4) Ll..IJ~ I .2..f
5. AOMTNTSTRATTVF FFF~
BASE CHARGE (SUBTOTAL ABOVE) X .05
&.
SDC Coordinator
$
S"6,n,.
Date: 10-lo.,.C,7
TOTAL 50C
$ }, /87.8D'
I
. t .",. VI U... ""'1\11' '-'I"""'\L..'-'U.'UI\I 'I"""'\L..IL.."-_ j-"'UIIIUt:f Ul .....t;:W rIX~^ unl[ equivalent = t'lx(Ur~.tJnitsC
(NOTE: For remodels. calculate on NET additional fixluresl" .
. NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table.
calculate credits separates._
Bathtub.......,............................................................. .
Drinking. Fountain.....................................................
Floor Drain.................................................................
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto WashiEtc..................
Laundry Tub/Clotheswasher ........ ..... ................. .....
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator/Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower. Single StalL...............................................,
Shower. Gang.... ......................................................
Sink: Bar. CommerCial. Residential Kitchen........................
Urinal, Stall/WaiL............................ ..................... .....
Wash Basin/Lavatory, Single..................................
Toilet. Public Installation............. ...........................
Toilet, Private...... ..............,............. .....................
Miscellaneous:
"J_
2
1
2
3
6
2
6
6
1
3
2
i/Head
2
2
1
6
4
z.
TOTAL FIXTURE UNITS
=
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1
1979 or before
1980
19B1
1982
1983'
1984
1985
1986
$3.97
3.89
3.83
3.70
3.55
3.39
3.20
2.91
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
$2.56
2.17
1.73
1.31
0.92
0.74
0.61
0.45
0.31
0.17
2-,
2...
'-
'2..
'2-
~
18
Credit for Parcel or Land Only If Applicable
=
X $
(Rate X Assessed Value)
X $
. (Rate X Assessed Value)
Improvement (if after annexation datel
=
CREDIT TOTAL = $
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimating Purposes Only)
Residenrial...:....................... 0.4
CommericaL........................ 0.9
IndustriaL........................... 05
GovernmenlaL..................... 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
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