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Home My WebLink AboutPermit Plumbing 2014-07-28 (2)SPRINGFIELD - 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 txy Phone: 541-726-3753 -' OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01560 w .spm gfieldocgov - permitcenter@spdngfield-ocgov PROJECT STATUS: Issued ISSUED: 07/28/2014 EXPIRES: 01/23/2015 STATUS DATE: 07/28/2014 APPLIED: 07/21/2014 SITE ADDRESS: 3333 RIVERBEND DR, Springfield, OR 97477 SCOPE: Hospital ASSESOR'S PARCEL NO: 1703220004102 TYPE OF STRUCTURE: Commercial -------PROJECT-DESCRIPTION: — --P- MedGas. Tenant - OWNER: PEACEHEALTH ADDRESS: 1115 SE 164TH AVE Phone Number: VANCOUVER WA 98683 CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone General Contractor GREENBERRY CONSTRUCTION LLC CCB 166612 09/26/2015 541-752-0381 Plumbing Contractor TWIN RIVERS PLUMBING INC CCB 17695 03/11/2015 541-688-1444 INSPECTIONS REQUIRED Inspections 3800 Medical Gas Piping By signature, I slate 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 fr nl pf the property, and the approved set of plans will remain on the site at all times during construction. 1 ou'W24 Owner or Co actor Signature Date NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COf,AMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. 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). Springfield Building Permit 7/28/2014 3:10:54PM Page 1 of 1 SPRINGFIELD -- CITY OF SPRINGFIELD 13225 TRANSACTION RECEIPT Fh St Spr gfield,OR97477 OREGON 811-SPR2014-01560 541-726-3753 v .spdngfeidocgov 3333 RIVERBEND DR permitcenter@sp4ngfield-or.gov RECEIPT NO: 2014001618 RECORD NO: 811-SPR2014-01560 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 197.72 Medical Gas Plan Review (30% of medical gas fee) 224-00000-425603 1086 59.32 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 23.73 Technology fee (5% of permit total) 100-00000-425605 2099 9.89 TOTAL DUE: 293.16 Check GREENBERRY CONSTRUCTION LLC 293.16 22711 TOTAL PAID: 293.16 LOCAL GOVERNMENT APPROVAL Zoning approval verified? ® Yes ❑ No Sanitation approval verified? ® Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential ❑ Government ® Commercial JOB SITE INFORMATION AND LOCATION Job site address: 3333 River Bend Way City: Springfield State: Oregon I ZIP: 97477 Reference: MRI Project I Taxlot.: DESCRIPTION OF WORK Plumbing of sinks and medical gas Manufactured dwelling or pre -fab (circle one) PROPERTY OWNER Name: 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 me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695.0020. Signature: CONTRACTOR INSTALLATION Business name: 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.: 17695 BCD license no.: Plumbing license no.: 20-96PB Print name: Gerald S. Bush Signature: 440-2500-J (5121/2014/COM) FEE SCHEDULE Description1-1 Qty Cost ca. Total cost New residential I bathroom/! kitchen (inchrdes: first 100feel ofwater/sewer lines, hose $268.00 $ bibs, ice maker, nndeftoor Ion -point drains and rain -drain packages) 2 bathrooms/] kitchen $420.00 $ --3 bathromiisfI kitchen__-- ____-- __---------____- $494 00 $ Each additional bathroom (over 3) $107.00 S Each additional kitchen (over 1) $107.00 $ Residential fire sprinklers (includes idan 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 one) Connections to building sewer and water supply $82.00 S Commercial, industrial, and dwellings other than one- or two-family Minimum fee $82.00 $82 Each fixture 1 $21.00 Miscellaneous fees 100' storm, sewer, water line $85.00 $ Each fixture, appurtenance, and piping $21.00 $ Storm water retention/detention facility $21.00 S Irrigation systems $21.00 $ Piping or private storm drainage s sterns exceeding the first 100 feet $21.00 $ Specialty fixtures $21.00 $ Reinspection (no. of has. x fee per hr.) $82.00 S Special requested inspections (no. of firs. x fee per hr.) $82,00 S Each additional inspection: (1) $82.00 $ Medical gas piping Minimum fee $82 Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ APPLICANTUSE (A) Enter subtotal of above fees $ (Minimmn Permit Fee $82.00) (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ (D) Technology Fee (5% of [A]) $ (E) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through E): S