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Permit Plumbing 2013-10-17
• • SPRINGFIELD 225 Fifth St "• CITY OF SPRINGFIELD Springfield,OR 97477 • 1.:,c •. Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02316 www.springfeldbcgov - penniteenter @spdngfield-ar.gov • PROJECT STATUS: Issued ISSUED: 10/17/2013 EXPIRES: 04/15/2014 STATUS DATE: 10/17/2013 APPLIED: 10/17/2013 SITE ADDRESS: 2591 GRAND VISTA DR,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703243100702 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Connect to city sewer OWNER: UMENHOFER JOHNS&KATHIE A Phone Number: ADDRESS: 2591 GRAND VISTA DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor ROYAL FLUSH ENVIRONMENTAL SERVICES INC COB 153694 12/23/2013 541-895-2072 INSPECTIONS REQUIRED - Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 7160 Sewer/Septic Cap 7170 Septic Tank Abandonment 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. ll / / • . Owner or Co tr- .r Signature Date I • ATTENTION: Oregon law requires you to • foilow rules adopted by the Oregon Utility 1 i i r: • Notification Center. Those rules are set forth IS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- THORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by f ENCED OR IS ABANDONED FOR calling the center. (Note: the telephone number for the Oregon Utility Notification Y 1S0 DAY PERIOD. Center is 1-800-332-2344). Springfield Building Permit 10/17/201 3:20:53PM Page 1 of 1 • Plumbing Permit Application DEPARTMENT USE ONLY : tg.:Ei t _ik :r a 1 , SPRINGFIELD -_ —Q Z 3I l� ' r CIT O RINGFIgELDu r O GON Me._ Permit -S73 t._#_ 7 • PH51726t 3r9' . 3-� ,0R // / 3 225 Huth Street• Springfield,OR 97477 • PH(�41)726-3713 FAX(541)726 3689 A,OREGON Date: 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 clays of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Description Qty. Cost Total ea. cost Sanitation approval verified? ❑Yes ❑No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:firs! _._ 100 feel of a alerlso er lines, Imse Residential ❑Government ❑Commercial bibs, ice ranker, wider/Inor lay-palm $262.00 $ JOB SITE INFORMATION AND] LOCATION drains crud rain-drain packages) Job site address: 25c1 t �IAr�. vts}a 2 bathrooms/I kitchen $411.00 $ City: you .(t'd Stater ZIP: �( -t-/ 3 bathrooms/I kitchen $483.00 S - �>1 : ti Each additional bathroom(over 3) $104.50 $ Reference: /763z-1475 ( "I axlolO070Z_ Each additional kitchen(over I) $104.50 S 1 DESCRIPTION OF WORK Residential ire sprinklers(includes plan review)_ __ IA-04C tr? -E J U'L Se-weft 0 to 2,000 square feel _ $80.00 $ 2.001 to 3.600 square feet $128.00 $ PROPERTY OWNER 3.601 m 7,200 square feet $192.00 $ Name: 7.201 square feet and greater $255.00 $ � � u�������� Manufactured dwelling or pre-lab(circle one) Address: 15 C-IYAttd V45,-I-'Jer Connections to building sewer and ZIP: water supply �I $80.00 $ City: cl State: c5V ZII : Commercial,industrial,and dwellings other than one-or Phone: - q68. 481 , Fax: - - two-family E-mail Minimum fee $80.00 $ This installation is being made on residential or farm property Each fixture _ 521.00 $ owned by me or a member of my immediate family,and is e us fees qA'3 So exempt from licensing requirements under OAR 918-695-0020. 1 omi,sewer.water line r $83.50 $ v Signature: ..CL� Each li.xture,appurtenance,and piping $21.00 $ TRACTOR INSTALLATION Sturm water retention/detention twilit' $21.00 $ Business name: /-aHa i F74S In igulinn systems _$21.00 $ -`�-/ Piping or private storm drainage $21.00 $ Address: PO tj� 4-7 systems exceedine the first 100 feel City: C.-Ate-SW 0../K Slate: (JV ZIP: / 7'12_s Spacialty fixtures $21.00 $ p!1 Reinspeclion(no.of hrs.x fee per hr.) $80.00 S Phone: _ (.�45-7o'?Z. Fax: I o/S 2 31_ Special requested inspections(no.of , LEN 1 t / E-mail: Do a/ P ush. J a GMAf l e CJl ee per hrl C, o —-$8000 $ 8 CCB license no.:75304f BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no.: Medical gas piping Minimum fee $ Print name: Gy$ Enter value of installation and equipment$ Enter fee based on installation and equipment value. Signature: — ------....._..... APPLICANT USE • (A) Enter subtotal of above fees / 3 0 (Minimum Permit Fee 580.(10) (B)Investigative fee(equal to IA ) .$ (C)Enter 12%surcharge(.12 x[A+13]) $ i y4L (D)Technology Fee(5%of[A]) $ VS' TOTAL fees and surcharges(A through D): .$ / /, 2_ .140-2500-!t-I/IQ013/COM) SPRINGFIELD -" CITY OF SPRINGFIELD *- - 225 Fifth St - , TRANSACTION RECEIPT Spdngfield,OR 97477 541-726-3753 • 811-SPR2013-02316 • www.spnngfield-ar.gov 2591 GRAND VISTA DR permitcenter©spnngfield-ar.gov RECEIPT NO: 2013002303 RECORD NO:811-SPR2013-02316 DATE: 10/17/2013 . 'ACCOUNTCODE/TRANS-CODE,: '-z..- ,.-"AMOUNT DUE 14 Sanitary sewer 224-00000-425603 1005 83.50 • Sewer cap/septic tank demolition 224-00000-425603 1005 80.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 19.62 Technology fee(5%of permit total) 100-00000-425605 2099 8.18 TOTAL DUE: 191.30 .,, �"-. . ..°`W. ., . `AMOUNT,PAIR.` �`.PAYMENT.TYP.E,_.�.`,F PAYOR :�:casxlea:�oeowLSer-. ,�„w;:COMMENTS �...-" , �.; ,..�:�� Credit Card Royal Flush 2591 Grand Vista 191.30 • 025711 TOTAL PAID: 191.30 • • • • • • • • • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St OREGON TRANSACTION RECEIPT Springfield,OR97477 541-726-3753 811-SPR2013-02316 www.springfeld-or.gov 2591 GRAND VISTA DR permitcenter©springfield-or.gov RECEIPT NO: 2013002302 RECORD NO:811SPR2013-02316 DATE: 10/17/2013 ' P 1 0 � a n '.`., i`r;"�t�" ; r;74„ r.3.4:F. ;,y_ACCOUNT'CODE/TRANSICOD .' ''str .�r�AMOUNT DUE.' SDC:Administrative Fee-MWMC Regional Wastewater SDC 611-00000-426604 1189 10.00 SDC: Compliance Cost-MWMC Regional Wastewater SDC 444-00000-426607 1113 22.58 SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 1,741.00 SDC: Improvement Cost-MWMC Regional Wastewater SDC 445-00000-448025 1187 1,448.64 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 3,567.00 SDC: Reimbursement Cost-MWMC Regional Wastewater SDC 444-00000-448024 1186 114.41 SDC:Total MWMC Administration Fee—Local 719-00000-426604 1121 79.78 SDC:Total Sewer Administration Fee 719-00000-426604 1175 265.40 TOTAL DUE: 7,248.81 9PAYMENTaTYP-E. PAY.OR caswER`:aeon ev COMMENTS -,�„ Kia ham. i..i AMOUNT PAID - o-x pi Credit Card John Umenhoffer System development Charges 7,248.81 09582B TOTAL PAID: 7,248.81 • CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: 0 NAME OR COMPANY: 0 _ . LOCATION: 0 • u TAX LOT NUMBER: 0 0 . DEVELOPMENT TYPE: Sinele Family Residence U I1 NEW DWELLING UNITS u I UBUI.DING SIZE(SF): u 0 II LOT SIZE(SF):u 0 I- v, I.STORM DRAINAGE o - DIRECT RUNOFF TO CITY STORM SYSTEM C A.REIMBURSEMENT COST • AREA DRAINING TO __ IMPERVIOUS S.F. x COST PER S.F. DRYWELL CHARGE 0.00 50.251 = 0 $0.00 I 50.00 B.IMPROVEMENT COST . • IMPERVIOUS S.F. x COST PER SF. CHARGE 0.00 50.365 = 0 $0.00 I $0.00 1070 ITEM 1 TOTAL-STORM DRAINAGE SDC $0.00 . 2.SANITARY SEWER-CITY A.REIMBURSEMENT COST: NUMBER OF DAYS x COST PER DFU • 25 $142.68 = I $3,567.00 1091 B.IMPROVEMENT COST: NUMBER OF DFLTs x COST PER DFU • 25 $69.64 = I 31,741.00 1092 ITEM 2 TOTAL-CITY SANITARY SEWER SDC = $5,308.00 3.TRANSPORTATION • A.REIMBURSEMENT COST: ADT TRIP RATE x NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR 9.57 1 56.26 1.00 = I 1093 H.IMPROVEMENT COST: ADT TRIP RATE x NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR ' • 9.57 1 $205.04 1.00 = I _ 1094 ITEM 3 TOTAL-TRANSPORTATION SDC = $0.00 4.SANITARY SEWER-MWMC . A.REIMBURSEMENT COST: NUMBER OF FEUs x COST PER FEU I $114.41 = J $114.41 1054 B.IMPROVEMENT COST: NUMBER OF FEUs x COST PER FEU • 1 51,448.64 = I 31,448.64 1055 C.COMPLIANCE COST: NUMBER OF FEUs x COST PER FEU 1 $22.58 = $22.58 MWMC CREDIT IF APPLICABLE(SEE REVERSE) = $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL-MWMC SANITARY SEWER SDC = $1,595.63 SUBTOTAL(ADD ITEMS 1,2,3,&4) = ' 56,903.63 5.ADMINISTRATIVE FEE: SUBTOTAL x ADM.FEE RATE CHARGE $6,903.63 5°%a $345.18 TOTAL STORM ADMINISTRATION FEE I $0.00 TOTAL MWMC ADMINISTRATION FEE-LOCAL $79.78 TOTAL SEWER ADMINISTRATION FEE: (. 265.40 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: • I 50.00 1078 TOTAL SDC CHARGES = I $7,248.81 PREPARED BY DATE