HomeMy WebLinkAboutPermit Building 1994-9-29
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RESIDENTIAL
PERMIT APPLICATION
Cf4'\~'15
JOB NUMBER
Inspections: 726.3769
Ortlce: 726.3759
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WOf)ll:' "10'0 f~G<)CoTf
ASSESSORS MAP' \ f'\ 0 3' ~ \ ~ '
m cyyj
TAX LOT:
SUBDIVISION:
LOT:
BLOCK:
OWNER: I-IovVN-o f\r-JO {'.A..;-\l..IS ~\lsfl,..
ADDRF""" <:10'0 'Pf..E5cotr
CITY' t:;Pl2-llJ6F1 G\,;Q STATF'
14 7 -~&t;~
. PHONF'
vf2.-
CJ14,1
ZIP:
DESCRIBE WORK' KI,,::HB0
NEW REMODEL I/"
~"'HPOEL. .
lZE::;\ {)(,.J&
Wt lIJoow 1'5Vl.~loNS
V'
ADDITION
DEMOLISH
OTHER
CON ST.
A~~:D+ .
CONTRACTOR'S NAME
GENERAl' DENNIS ('-.ARNEY
ADDRESS
EXPIRrn .I
\\ -7J ~
PHONE
PLUMBING:
MECHANICAl'
ELECTRICAl.
\ ~\\J\0 - OFFICE USE -
QUAD AREA- LAND USE: \ \\ \ FLOOD PLAIN:
· OF BLDGS' \ · OF UNITS: \ ZONING CODE' LD\.L
OCCY GROUP: ~~ CONSTR. TYPE: \) t.J . OF BDRMS:
. OF STORIES' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER' RANGF' SQUARE FOOTAGE:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons 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
D Temporary Electric
rv1 Rough Mechanical - Prior to
r cover.
m Final Plumbing - When all
'\ plumbing w9rk Is complet,e.
I
'-
rf1 Rough Electrical - Prior to
\ cover.
D Site Inspecllon - To be made
after excavation, but prior to
\ setting forms.
'v
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
r\Jl Final Electrical - \^J,hen all
., electrical work Is complete. C
r\fJ Final Mechanical - When all
J mechanical work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
r'iT1 Fooling - After trenches are
L.+J excavated.
r\Il Final Building - When all
1 required Inspections have been
approved and building Is
completed.
D Fireplace - Prior to facing
materials and framing InsPo
D Masonry - Steel location, bond
.beams. grouting.
r\Tl Foundation - After forms are
~ erected but prior to concrete
placement.
[}J Framing - prior: to cover.
fYl Wail/Ceiling Insulation - Prior to
r cover.
o Other
D Underground Plumbing - Prior
to IIIl1ng trench.
~ Drywall - Prior to taping.
D Wood Stovo - After I~stallatlon.
MOBILE HOME INSPECTIONS
m Underlloor Plumbing/Mechanical
, - PrIor to Insulation or decking.
m Post and Beam - Prior to floor
'-t'-' Insulation or decking.
D Blocking and Sel.Up - Whep all
blocking Is complete.
D Insert - After fireplace approv41
and Installation of unit.
m Floor Insulation - Prior to
'-t" decking.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sanitary Sewer - Prior to filling
trench. .
D Electrical Connecllon - When
blocking, sel-up, and plurT,lblng
Inspections have been approved
and the home Is connected to
the service panel.
D Sidewalk & Driveway - Afler
excavation Is complete, forms
and sub-base material In place.
D Storm Sewer - Prior to filling
trench.
D Fence - When completed.
D Water Line - Prior to filling
trench.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Rf\l Rough Plumbing - Prior to
T cover.
D Street Trees - When all required
trees are planted.
J
,~.":t..,.,
r.
,
Lot Type (/I .:~.
Lot faces
I P.L.
Lol sq. ltg. Interior IN
Lot coverage Corne r Is
Topography Panhandle \W
Total I1.elght Cul-de-sac IE
.;;.;,"
. . ~ "1;: . ,;. ':I'~ I,
.( .~ \ ,.y ::;1.{~,'~J-
...-:1, ,
-_HE PROPOSED WORK IN THE.
""HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Setbacks.
HSE GAR ACC'
BUILDING PERMIT
ITEM sa. FT.
X $/SO. FT. ~
S{...<UL
\fA 1111:::
1.L\\~ 1(,0
. I
Main
\~&-.
Garage
"
t~
~6 .m-
Tolal Value
Building Permit Fee
\ \.~+UO
State Surcharge
Tolal Fee
(A)
(B)
PLUMBING PERMIT
ITEM
FEE
lO,foAL
Flx~ures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
\ S. S/U--
l.~
~b .!:SL
Stat~. Surcharge
Total Charge
,15+ .~s
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
.t\~~-\ \>ulUt)
..
Co, <;&?
-LS. 0-0
LO em.
I~
~.?-C
Mechanical Permit
Issuahce
State'Surcharge
.15" *" ! 4S"
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk II
Curbcut II
Demolition
State Surcharge
(~h~~ ~~~. .( - ~ \.70 '>
Tejtal Miscellaneous Permits (E)
T~TAL AMOUNT DUE (excluding electrical) ml,..
(A,)B, C, 0, and E Combined)
/
APPRov~n.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, In all respects, conlorm to the Ordinance
adopted by the City, 01 Springfield, Including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of a\\~~ISIOnDf said ordinances.
Plan Check Fee: . f\
Date Paid: .B:!) Q -~
Receipt Numbe~. AA-\ \j)
:lZIE..~~ YI~h1
Systems Developmenl Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
./ A::'?! 7
~~~~
/< A"~,JZ;,\
.J/1~..(r-
,. ,
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 perlalnlng to the work described
heroin, and that NO OCCUPANCY will be made of any
structure wlthoul permission of lhe Building Safely 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
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
onth~slte~,~.
Xgnature ~ ,'~r~. :=- r
Date~G!~ '7cf ~
VALIDATION: ~~
RECEIPT NUMB~ ,\~ ._
DATE PAin L-f ~ Lt
AMOUNT REqeIV~D - ~q! . I~
RECEIVED ByM).IL~-
, ,
. . . ;..~,.. '1 ,'- ... .
-
ATIACHMENT B1
_B NO. 9-1/275
,.
CITY OF SPRINGFIELD SYSTEMS'DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY:,~; ~ ~
, .
LOCATION: 9/)(") ;? /tM--,,-d-
DEVELOPMENT TYPE: ~ ~
BUILDING SIZE:
LOT SIZF
C:;Q. Ft.
1. SJDRM nRATN~
IMPERVIOUS SQ. FT. 10-1 tll ~'./
~~
2. SANlIARY SFWFR-CTTY
X $0.209 PER SQ. FT. ~ 2/,0
NO. OF PFU'S .
(See Reverse)
3. TRANSPORTATTON
NO OF UNITS X TRIP RATE X COST PER TRIP
X $43.26 PER PFU
sA14
/
X
X
X
X $436.19
X $436.19
X $436.19
S A~
/
s
s
SUBTOTAL (ADD ITEMS 1.2. & 3) $ .2/.;e~
4. SANlIARY SFWFR-MWHC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN.FEE s /1~
(Use PFU Total From Item 2 Above) ~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
IOlAI -MWMr. SOr.
SUBTOTAL (ADD ITEMS 1.2,3 & 4)
$
$ d)
;
$ ;;.1. -r?"
5. AOMTNTSTATTVF FFFS
-BASE X CHARE S BTOTAL ABOVE) X .05
~~ -'
~~ Date'
/ . ry Hornijg. ,.p.L .
DC Coord1Thrtor
C/,~V
9'-/ f- r~
:IOJE.I snr.
$ 22.?2
B2.SDC .
~_...-'..__. ..
FIXTURE UNIT CALCUL.N TABLE: Number of New FixtA Unit Equivalent c Fixture Units
(NOTE: For remodels, calculate only the liEI additional fixtures! ' . .
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub.......... ..,..... .......................... ................. .........
Drinking Fountain, ........................ ,............................
Floor Drain.... ............................................................
Interceptors For Giease/OiIlSolids/Etc.................
Interceptors For SandlAuto Wash/Etc..................
Laundry Tub/Clotheswasher.................. .......... .......
Clotheswasher - 3 Or More....,................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator/Water Slation/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall.................................................
Shower, Gang. .............. ........................... ........ ........
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall/Wall.. :...........:.................. .......... ..... .......
Wash BasinlLavatory, Single..................................
Toilet, Public Installation........................................
Toilet , Private............:..........................................
Miscellaneous: ,TANI TtJ.I!'.s SINk'
2
1
2
3
6
2
6
6
1
3
2
l/Head
2
2
1
6
4
~
TOTAL FIXTURE UNITS
=
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits ,separates.
Rate per $1,~
Assessed Value j
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
J
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
1979 or before
1980
1981
1982
1983
1984
1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
1985
1986
1987
1988
1989
1990
1991
1993
Improl(ement (if after annexation date)
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=
Credit for Parcel or Land Only If Applicable
=
CREDIT TOTAL = $