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Home My WebLink AboutPermit Plumbing 2014-07-29SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 { V>% Phone: 541-726-3753 oBec°" Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01561 w v.springfield-or.gov permitcenter@spdngfield-ocgov PROJECT STATUS: Issued ISSUED: 07/29/2014 EXPIRES: 01/24/2015 STATUS DATE: 07/29/2014 APPLIED: 07/21/2014 SITE ADDRESS: 3333 RIVERBEND DR, Springfield, OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703220004102 PROJECT DESCRIPTION: P- MedGas- But OWNER: PEACEHEALTH ADDRESS: 1115 SE 164TH AVE TYPE OF STRUCTURE: Commercial Phone Number: VANCOUVER WA 98683 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lie Exp Phone General Contractor GREENBERRY CONSTRUCTION LLC CCB 166612 09/26/2015 541-752-0381 Plumbing Contractor 03/11/2015 541-688-1444 INSPECTIONS REQUIRED Inspections 3800 Medical Gas Piping 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 1 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 Slate 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 front76� the property, and the approved set of plans will remain on the site at all times during construction_ n Owner or Contractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001.0010 through OAR 952.001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1.800-332.2344). i l'iCE: ITIS PERMIT SHALL EXPIRE IF THE WORK JJ Il IORIZED UNDER THIS PERMIT IS NOT ( OK,IMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield Building Permit 7/29/2014 1:43:31PM Page 1 of i SPRINGFIELD CITY OF SPRINGFIELD t TRANSACTION RECEIPT 225 Fifth St Spdngrield,OR 97477 541-726-3753 OREGON 811-SPR2014-01561 mm.spdngfeldacgev 3333 RIVERBEND DR permitcenter@spdngfield-ocgov RECEIPT NO: 2014001625 RECORD NO: 811-SPR2014.01561 DATE: 07/28/2014 Continuing Education Fee 224-00000-425606 2.50 Medical Gas Permit fee (based on value of work) 224-00000-425603 1005 260.84 Medical Gas Plan Review (30% of medical gas fee) 224-00000-425603 1086 78.25 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 31.30 Technology fee (5% of permit total) 100-00000-425605 2099 13.04 TOTAL DUE: 385.93 t M, Check GREENBERRY CONSTRUCTION LLC 385.93 22710 TOTAL PAID: 385.93 SPRINGFIELD "" CITY OF SPRINGFIELD TRANSACTION RECEIPT 225 Fifth St Springfeld,OR 97477 541-725-3753 OREGON 811-SPR2014-01561 v .spdngfieldvr.9ov 3333 RIVERBEND DR permitcenter@spdngfield-ocgov RECEIPT NO: 2014001625 RECORD NO: 811•SPR2014.01561 DATE: 07/28/2014' CRP s Continuing Education Fee 224-00000-425606 2.50 Medical Gas Permit fee (based on value of work) 224-00000-425603 1005 260.84 Medical Gas Plan Review (30% of medical gas fee) 224-00000-425603 1086 78.25 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 31.30 Technology fee (5% of permit total) 100-00000-425605 2099 13.04 TOTAL DUE: 385.93 �A- Check GREENBERRY CONSTRUCTION LLC 385.93 22710 TOTAL PAID: 385.93 Plumbing Permit Application OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689 DEPARTMENT USE ONLY 9PHINGFiELG Permitno.: VG—/s— Date: JULY 17, 2014 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 APPROVAL Zoning approval verified? ® Yes ❑ No Sanitation approval verified? ® Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential I ❑ Government ® Commercial JOB SITE INFORMATION AND LOCATION ' Job site address: 3333 River Bend Way City: Springfield I State. Oregon I ZIP: 97477 Reference: Gamma Knife I Taxlot.: DESCRIPTION OF 'WORK Plumbing of sinks and medical gas Manufactured dwelling or pre -fab (circle ore) PROPERTY OWNER None: Sacred Heart Hospital at Riverbend Address: 3333 Riverbend Drive City: Springfield State: OR ZIP: 97477 Phone: Fax: E-mail: This installation is being made on residential or farm property owned by nae or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature: CONTRACTOR INSTALLATION Business nanne: Twin Rivers Plumbing Address: 1626 Irving Road City: Eugene State: OR ZIP: 97404 Phone: 641-688-1444 1 Fax: 641-688-9272 E-mail: Gerry@twinrp.com CCB license no.: 17696 BCD license no.: Plumbing license no.: 20-96PB Print name: Gerald S. Bush Signature: 440-2500-J (5/21/2014/COM) FEE .SCHEDULE DescriptionQty. . Cost ea. Total cost New residential 1 bathroom/I kitchen Qnchrdes: first 100feet ofwaten✓sewer lines, hose $266.00 S bibs, ice maker, underfloor low -point drains and rain -drain packages) 2 bathrooms/] kitchen $420.00 $ 3 bathrooms/1kitchen $494.00 S Each additional bathroom (over 3) $107.00 S Each additional kitchen (over 1) $107.00 $ Residential fire sprinklers (includes plan review) 0 to 2,000 square feet $82.00 $ 2,001 to 3,600 square feet $131.00 $ 3,601 to 7,200 square feet $196.00 $ 7,201 square feet and greater $261.00 $ Manufactured dwelling or pre -fab (circle ore) Connections to building sewer and water supply $82.00 $ Commercial, industrial, and dwellings other than one- or two-family Minimum fee $82.00 Each fixture 7 1 $21.00 1 $147 Miscellaneous fees 100' stonn, sewer, water line $85.00 $ Each fixture, appurtenance, and piping $21.00 $ Storm water retention/detention facility $21.00 $ Irrigation systems $21.00 S Piping or private storm drainage systems exceeding the first 100 feet $21.00 $ Specialty fixtures $21.00 $ Reinspection (no. of firs. x fee per hr.) $82.00 $ Special requested inspections (no. of Ins. x fee per hr.) $gy,00 $ Each additional inspection: (1) $82.00 $ Medical gas piping Minimum fee $82 Enter value of installation and equipment $18.400:00 Enter fee based on installation and equipment value. $ APPLICANT USE (A) Enter subtotal of above fees $ h (Minim20 um Permit Fee $82.00) (B) Investigative fee (equal to [A]) $� (C) Enter 12% surcharge (.12 x [A+B]) $ (D) Technology Fee (5% of [A]) $ U (E) Continuing Education Fee $2.50 $2.50 TOTAL fees an surcharges (A through E): $