HomeMy WebLinkAboutPermit Building 2013-6-26 SPRINGFIELD 225 Fifth St
' CITY OF SPRINGFIELD Springfield,OR 97477
l Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01405
www.springfield-or.gov permacenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/26/2013 EXPIRES: 12/22/2013
STATUS DATE: 06/26/2013 APPLIED: 06/26/2013
SITE ADDRESS: 1527 16TH ST,Springfield,OR 97477 SCOPE: Bathroom
ASSESOR'S PARCEL NO: 1703253102600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Install bathroom in closet area
OWNER: QUICK BRENT T Phone Number:
ADDRESS: 1527 16TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
Plumbing Contractor OWNER CCB 000000 08/01/2025
L INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
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 or 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 701.005 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 locate a the front of the property, and the approved set of plans will remain on the site at all times during
construction.
Owner or Contractor Signature Date
.....:.......:.. . .... wires ou to
AT i ELATION: Ore 9d ba the Oregon Utility
NOTICE: foilc:v rules adop Y
THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001.00i o through OAR 952-001-
0090. You may obtain Copies of the rules by
COMMENCED OR IS ABANDONED FOR Calling the center. (Note: the telephciflo
•
ANY 180 DAY PERIOD. number for the Oregon Utility Notification
Center is 1.800-3322344).
Springfield Building Permit 6/26/2013 2:20:19PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
hr TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
811-SPR2013-01405
www.springfield-or.gov 1527 16TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2013001355 RECORD NO: 611-SPR2013-01405 DATE:06/26/2013
'DESCRIPTION; .. a :„>. _ '. '- IACCOUNT-CODE/TRANS CODE . . '''r v.:'AMOUNT'.DUE _J
First Appliance Fee 224-00000-425604 1006 80.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60
'. PAYMENT TYPE CnsHIER.CCARPENTER > °�COMMENTS r -AMOUNT PAID"= '
Check QUICK BRENTT 93.60
1755
TOTAL PAID: 93.60
Mechanical Permit Application 'DEPARTMENT USE ONLY ,<
CLTt:Y�OO F��SPRINGFIELDtOREGON -' � A.t .. Permit no.:
+' •afissl.S10i .0$i' :Pki'�+-W��bSrdt`Vtdxnrt3a3q ERM�..Hf..aS%vJL°r-9a'iiREEb.>e.St+4?§`KC-� //� /
225 Fifth Street♦ Springfield,OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689 r _ �. a Date: (O Z U// 7
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
::::. WACATEGORYsOF CONSTRUCTION, ,V,-. ;i'"' C &; ' ;_F,EE SCHEDULEa ,'ri
k� � s,
%Residential ❑Government ❑Commercial Residential Ae ' -° c s°' Qty<r\COS.. r' i lcostl
Vii:, JOB:SITE INF,O_RMATION'A/ND !LOCATIONiii..;: \' First Appliance / $80.00 $ed.}
Job site address: (,rj Z7 llv'` 6 Furnace/burner including ducts and vents
City: .j ec 4.. ckack State: (Dc& ZIP: �7 Up to 100k BTU/hr. $18.50 $
Over 100k BTU/hr. $22.00 $
Reference/70 2)-3/ Taxlot (JZ49c Heaters/stoves/vents
e_ ; DE/SAC"RIPTIION1OF W.0RK.`',. 0s,+'�_ „i1a Unit heater $18.50 $
Ajli,r`q tkLJ C7a.- Crd'O!`1 Wobd/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
, refrigeration unit or cooling system/ $80.00 $
t x 4� PRORER owNERaIt eti,
absorption system
Name: eZ�.� Evaporated cooler $14.50. $
Vent fan with one duct/appliance vent / $3
Address: \�2'"1 k,t¢ 5-E Hood with exhaust and duct $14.50 $
City: SPr,,,„§.�',lei State: o 2 ZIP: 9 7107 Z Floor furnace including vent $80.00 $
Phon$ ( 133- rj035 Fax: - - Gas piping
E-mail: 3S l es — a.Ln.c.- (J LaTh. One to four outlets $7.50 $
This installation is being made on property owned by me or a Additional outlets(each) $4.50 $
member of my immedi e family, and is exempt from licensing Air-handling units,including ducts
requirements under 0 001.000. Up to 10,000 CFM $12.00 $/
signature:C J J-'L.( / Over 10,000 CFM $22.00 $
Z„ J
,ar�> � ` mm.-bCONTRACTOR`INST'ALLATIONgM,,"�`n+q`U�-,,�' Compressor/absorption system/heat pump
i.�`. Up to 3 hp/100k BTU- $18.50 $
Business name: Up to 15 hp/500k BTU $32.00 $
Address: Up to 30 hp/1,000 BTU $47.50 $
City: State: ZIP: Up to 50 hp/1,750 BTU $62.50 $
Phone: - - , Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.: t #:
commercial�-s tr ° s, }, 3 x$ f j n,�* +
Print name: Enter total valuation of mechanical system
and installation costs$
Signature:
Enter fee based on valuation of mechanical system,etc. . $
<irsg',...A =-tisGC,u':^`, ,- :" ...t. i-'Cost 'Total�.t$
M-IScella eo„,ssit„d y cz ,?�,I,t,..,, ea ..cost i
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) - $14.50. $
Each additional inspection:(1) $80.00 $
't r v_: ` `',4OPLICANTyUSEa ".
(A)Enter subtotal of above fees(or enter set a-P
minimum fee of $80.00) $70
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ . 7
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $ V
440-2545-I(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ 360
l'
SPRINGFIELD 225 Fifth St
''` CITY OF SPRINGFIELD Springfield,OR 97477
.iddi
eat
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01404
www.springfield-or.gov pe rmitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/26/2013 EXPIRES: 12/22/2013
STATUS DATE: 06126/2013 APPLIED: 06/26/2013
SITE ADDRESS: 1527 16TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703253102600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Install bathroom in closet area
OWNER: QUICK BRENT T Phone Number:
ADDRESS: 1527 16TH ST
SPRINGFIELD OR 97477 •
_ CONTRACTOR INFORMATION
Il
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 06/01/2025
Plumbing Contractor OWNER CCB 000000 08/01/2025
L INSPECTIONS REQUIRED
Inspections
3170 Underfloor Plumbing Underfloor Plumbing: Prior to insulation or decking.
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3999 Final Plumbing Final Plumbing: When all plumbing work is complete.
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 or 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 701.005 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.
4r. ra (ZS i
Owner or Contractor Signature Date
NOTICE: ''_'= ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344). •
•
Springfield Building Permit 6/26/2013 2:19:25PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
It=1 a. 225 Fifth St
......_.... .dgi
rat
OREGON
TRANSACTION RECEIPT 225 Fifth St 97477
- '-',`µ 541-726-3753
811-SPR2013-01404
www.springfield-or.gov 1527 16TH ST permitcenter @springtield-or.gov
RECEIPT NO: 2013001356 RECORD NO: 811-SPR2013-01404 DATE:06/26/2013
IDESCRIPTION- .__' '__ _ _ -ACCOUNT CODEITRANS CODE AMOUNT DUE 1
Minimum Plumbing Fee(Three or Fewer Fixtures) 224-00000-425603 1057 80.00
SDC: Improvement Cost- Local Wastewater 443-00000-448025 1184 237.33
SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 486.26 •
SDC: Total Sewer Administration Fee 719-00000-426604 1175 36.18
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 853.37
PAYMENT TYPE _._ PAYOR MCASNIER:ccARFENTER-, °v COMMENTS - - • ` • . ;AMOUNT PAID `•
Check QUICK BRENT T 853.37
1755
TOTAL PAID: 853.37
•
•
Plumbing Permit Application DEPARTMENT USE ONLY ,
SPRINGFIELD _
4''$ CITI OFx SPRINGFIELD, frREG-ONt 1 - `" Permit no.: $ /3 '/4'/O e--/
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: / // 3
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work.Permits
expire if work is not started within 180 days of issuance or if work is suspended for 180 days.
:'LOCAL GOVERNMENT AP_PROVAIE ,7inal,: u it ti ,b=:_ "„ '`0.g:FEES,CI EDULrE:ri6 . 4 it -K'
Zoning approval verified? 111 Yes ❑ No AD se cn tion u -�""13 xTt,.'a `,r-;',TA-P. ],,Cost , +,Total�a
Via, .im. Prsc.lrtt. �w-:. ,-� �.wt�_kjiie Q Y'--,ea ' ^ -`/&
cost's
Sanitation approval verified? ❑ Yes ❑ No New residential
.;CATEGORY OF-;'CONSTRUCTION 'i `l7 y ''JP�_: 1 bathroom/1 kitchen(includes:first
/00 feet of water/sewer lines, hose
0.Residential El Government ❑Commercial $262.00 $
bibs, ice maker, underfloor low point
JOB=SITE';INFORMATION: AND LOCATION''s'4—ai drains and rain-drain packages)
Job site address: \SZ Z &.a 5 It 2 bathrooms/1 kitchen $411.00 $
Ci C State: OR ZIP: Si t/v'� 3 bathrooms/1 kitchen $483.00 $
ty' S nC'n °�� � Each additional bathroom(over 3) $104.50 $
Reference: /703 2y-3/ Taxlot.:O26CO Each additional kitchen(over l) $104.50 $
T f; ' \DESCRIPTION'OF :W ORK `T.E,: z
Residential fire sprinklers(includes plan review)
kir1 p,r ne .) \per kfc )M
0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
iPillialt3Z^tlllitlillaiRROP ERTY=OWNER .' :rrtrs3.,;'gffif 3,601 to 7,200 square feet $192.00 $
� 7,201 square feet and greater $255.00 $
Name: v ,,,,.LI.c..
Manufactured dwelling or pre-fab(circle one)
Address: \ 27 I(ci" 5k Connections to building sewer and $80.00 $
City: 5 c r' Sceltk State: OZ. ZIP: 17t-I 1 water supply
P Commercial,industrial,and dwellings other than one-or
Phonect(-(063- qo35 Fax: - - two-family
E-mail: Z;,kc.F_ au-4_4_ (, ye,,Lcio Lp(K Minimum fee $80.00 $
This installation is being made on residential or farm property Each fixture S $21.00 $4;3
owned by me or a-membe of my immediate family,and is Miscellaneous fees
exempt from licensing r uir ments under OAR 918-695-0020. 100' storm,sewer,water line -$83.50 $
Signature:` /� Each fixture,appurtenance,and piping $21.00 $
/CONTRACTOR'-'INSTALL'ATION cS#Ma Storm water retention/detention facility $21.00 $
Ot,J.n�(' Irrigation systems $21.00 $
Business name:
Piping or private storm drainage
Address: - systems exceeding the first 100 feet $21.00 $
City: State: ZIP: Specialty fixtures $21.00 $
Reinspection(no of hrs.x fee per hr.) , $80.00 $
Phone: - - Fax: - - Special requested inspections(no.of
E-mail: - hrs.x fee per hr.) $80.00 $
CCB license no.: BCD license no.: Each additional inspection:(]) $80.00 $
Plumbing license no.: Medical gassfpiptng ,Jy"5?r{A,V , A Minimum fee $
Print name: - Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature: ?j' ,t"" v' EAP_PLICANTiUSE' « `&« Y*ZWct'°k•
(A) Enter subtotal of above fees ap
(Minimum Permit Fee$80.00) $ D
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x [A+B]) $ 9 60
(D)Technology Fee(5%of[A]) $ yos
TOTAL fees and surcharges(A through D): $ 726:°---
440-2500-1(4/1/2013/COM)
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2)) .
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
•
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
.) I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify at the information on this homeowner statement is true and accurate.
- C
Print.Name of Pe Applicant
—Signature of Permit Applicant Date
•
Permit#: <(3 -7"(D I( /qe o
j �7 �6 ' Si (SF, , tn
Address:
p y7 UI •. �Anr4,: 2
S7I� d�C- S 7 / „+ ; .. .
Issued by: v° Date: ��ZG// e5�e'
This Copy for Permit Offices