HomeMy WebLinkAboutPermit Plumbing 2019-09-04B u ild in g P e rm it
Residential Plumbing
Permit Number: 811-19-002043-PLM-01
IVR Number: 811057768840
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-726-3753
Web Address: www.springfield-or.gov Email Address: permitcenter@springfield-or.gov
P e rm it Is s u e d : September 04, 2019
C a te g o ry o f C o n stru ctio n : None Specified
S u b m itte d Jo b V a lu e : $0.00
D e s c rip tio n o f W o rk : Demo main building 3678sqft {1st floor and basement) 4 bathrooms
T y p e of W o rk: None Specified
W o rk site A d d re s s
7406 MAIN ST
Springfield, OR 97478
P arcel
1702354200202
O w ne r:
A d d ress:
SANDERSON DEAN
2403 DALKE RIDGE DR NW
SALEM, OR 97304
B u s in e ss N a m e
OWNER - Primary
Licen se
CCB
License N u m b er
000000
Pho ne
In s p e ctio n
3999 Final Plumbing
In s pe ctio n G ro u p
Plumb Res
Inspectio n Status
Pending
Various inspections are minimally required on each project and often dependent on the scope of work. Contact
the issuing jurisdiction indicated on the permit to determine required inspections for this project.
Schedule or track inspections at www.buildingpermits.oregon.gov
Call or text the word "schedule" to 1-888-299-2821 use IVR number: 811057768840
Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store
F e e D e sc rip tio n
Technology Fee
Fixture cap
State of Oregon Surcharge - Plumb (12% of applicable fees)
Q uantity
1
Total Fees:
Fee A m oun t
$5.10
$102.00
$12.24
$119.34
Permits expire if work is not started within 180 Days of issuance or If work is suspended for 180 Days or longer depending on
the Issuing agency's policy.
All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not.
Granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
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 at (503)
232-1987.
All persons or entitles performing work under this permit are required to be licensed unless exempted by ORS 701.010
(Structural/Mechanical), ORS 479.540 (Electrical), and ORS 693.010-020 (Plumbing).
Printed on: 9/4/19 Page 1 of 1 C:\myReports/reports//production/01 STANDARD
,:, ~ t I' M > - G> a~~~& co "<t 0 ~ ~ a
I;: :::, 0 N .•.. _1
:= V) :;; "? ~
0 . N '° oi Cl E 8 ai Q.
C z; ~ .•.. "ii
·c: ~.ca:~-b ftl .••• .•.. .•.. ii
0. :C ~O "a i "Cl~
.•.. tit
en :::, LL. .•• ~ ~
~ a:
·; C - o.Ltl:!::!ve>
0
0 -oNCIJL/l-E 11.
,.. u
~ C N <.: Q .
.,
Ill g, Ill
.,
u C
~ ·c @
I!!
QJ a. L.
I-
E vi s I z
Q . C .•.. ii:
0 CIJ
aj ~
C i
> -
:::,
cu E 0 ~
C ~ E
a. <( - CL c ·; - Ii u
C 0 "<t 0 ! :::, 0 N .•..
0 . N '° E 8 .•.. ~
ftl .••• ~
CD ~
CD
LL
••• C. ·a;
(.)
G)
0:::
C
0 ;
(.) ca
0
C ca ••• I-
•..
9 :&
.J
0.. I
~
N
0
9 al •..
I •.. •.. co
•... co
N
N •...
'Iii'
i.:
Cl) .ca
E :::, z
C. ·;
u
&!
(0 r--
"<t r--
0>
0::
0
> 0 Cl ..:
0 -6
G> I;:
Cl
C ·c
0.
i
,:,
'iii
0..
m
Cl) u..
~ .•..
cJi
0 CD
CD IO
"Cl N 86
-o C 0
:::, 0 09 u "<t :l~
l! ::-:- :50
0
0
.!l
ftl "Cl
C
0 ~ u
: O> C ..-
as - ~~
0
0
9
~
0 IO .•..
N
0
8
0
9 .•..
N
(0
.J:l
E :::, a:
(1) w
~
0
0
0
0 I IO
0 CD IO
N
6
0
0
0
9
0
0
a:
LL
>,
C)
0
0
C .s= 0
~
0
~
E .s :::,
<(
~
O> .•.. - ~
z
~
0
z
0 en 0:: w
0 z
~
~
(1) c..
- C
Q)
E >,
(1) c..
0
C
~ Q) ,:,
C
<(
(1)
C ·c:
~
L.: Q) :c
fl)
(1)
(.)
E .,
CD
a,
Plum bing Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth Street+ Springfield, O R 974 77 + PH (54 1)726 -3753 + FA X (54 1)726-3689
· O EPARTME_NT U S E O N L Y -
Permit no.:
Date: q
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.
LO CAL G O VERNME NT APPRO V AL
Zoning approval verified? D Yes D No
Sanitation approval verified? D Yes D No
.C ATEG O RY O F CO NSTR UCTIO N
D Residential I D Government I D Commercial
JO B -srre INFO RM ATIO N AND LO CATIO N
Taxlot.:
DESC RIPTIO N O F W O RK
INSTALLATIO N
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.: BCD license no.:
Plumbing license no.:
Print name:
Signature:
FEE SCHED ULE :~ , ..
. -· Cest Total Description- Qty. ea. coat
New residential
l bathroom /I kitchen (includes:first
I 00 feet of water/sewer lines, hose 5333.00 $ bibs, ice maker, underfloor low-point
drains and rain-drain packages)
2 bathroom s/I kitchen 5521.00 $
3 bathroom s/I kitchen 5613.00 $
E ach additional bathroom (over 3) 5132.00 $
E ach additional kitchen (over 1) U32.00 $
Residential fire sorinklers (includes olan review)
0 to 2,000 square feet 102.00 $
2,001 to 3,600 square feet 5163.00 $
3,601 to 7,200 square feet 243.00 $
7,201 square feet and greater lS324.00 $
M anufactured dwelling or pre-fab (circle one)
C onnections to building sew er and 102.00 $ w ater supply
Com mercial, industrial, and dwellings other than one- or
two-fam ily
M inim um fee i102.oo $
Each fixture ~25.00 $
M iscellaneous fees
100' storm , sew er, w ater line U06.00 $
E ach fixture, appurtenance, and piping 525.00 $
Storm w ater retention/detention facility U06.00 $
Irrigation system s/B ackflow 525.00 $
P iping or private storm drainage 525.00 $ svstem s exceedinz the first 100 feet
Specialty fixtures 525.00 $
R einspection (no. of hrs. x fee per hr.) 5102.00 $
Special requested inspections (no. of 5102.00 $ hrs. x fee per hr.)
Each additional inspection: (1) 5102.00 $
M edical gas piping M inim um fee $
E nter value of installation and equipm ent$
E nter fee based on installation and equipm ent value. $
- . DEPARTMENT USE "~ . ...
. ' , .. .
(A ) E nter subtotal of above fees $
(M inim um Permit Fee $102.00)
(B ) Investigative fee (equal to [A ]) $
(C ) E nter 12% surcharge (.12 x [A+B ]) $
(D ) T echnology F ee (5% of[A ]) $
TO T AL fees and surcharges (A through D): $ \ \9. ~~
Last edited 7/1/20 19 bjones
P r o p e r ty O w n e r S t a te m e n t
R e g a rding C o nstru ctio n R es po n s ib ilities
O re g o n La w re q u ires re sid e n tial co n stru ction perm it applicants w ho are no t licensed w ith the
C o n stru ctio n C o n tracto rs B oa rd to sign the follo w in g state m ent before a build ing pe rm it ca n be
is su e d . (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.
P le a s e che ck the ap propriate box:
D I ow n , re s id e in , or w ill re s ide in the co m p le te d stru ctu re and m y genera l contracto r is:
Name CCB# Expiration Date
D I w ill in fo rm m y genera l co n tracto r th a t all su b co ntracto rs w ho w ork on the structure m ust be
lic e n se d w ith th e C o nstruction C o ntracto rs B o a rd .
or
I w ill be pe rfo rm in g w o rk o n pro p e rty I ow n , a resid en ce that I reside in , or a resid e nce that I w ill
re s id e in . If I hire su b c o n tra ctors, I w ill hire on ly su bcontractors lice nsed w ith the C onstruction
C o n tracto rs B o a rd . If I cha n g e m y m in d and hire a general contracto r, I w ill sele ct a contractor
w h o is lice n s e d w ith th e C C B an d w ill im m e dia te ly give the na m e of the contractor to the office
iss u in g th is B u ild ing P erm it.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
P e rm it#:
Address:
Issued by: _ D ate : _
This Copy for Permit Offices