HomeMy WebLinkAboutPermit Plumbing 2020-01-29OREGON
Web Address: www.springfi eld-or. gov
Building Permit
Residentia! Plumbing
Permit Number: 811-20-OOO185-PLM
IVR Number: 811042600654
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-726-3753
Email Address: permitcenter@springfield-or.9ov
SPRINGFIELD
,b
Permit Issued: January 29,2020
TYPE OF WORK
Category of Construction: Single Family Dwelling
Submitted Job Value: $0.00
Description of Work: Adding new bathroom inside master bedroom
Type of Work: New
JOB SITE INFORMATION
Worksite Address
3B4B OREGON AVE
Springfield, OR 97478
Parce!
t7023L4L03902
Owner:
Address:
ALTEMUS MATT
77601 HIGH PRAIRIE RD
OAKRIDGE, OR 97463
LICENSED PROFESSIONAL IN FORMATION
Business Name
OWNER - Primary
License
ccB
License Number
000000
Phone
PENDING INSPECTIONS
Inspection
3999 Final Plumbing
3500 Rough Plumbing
Inspection Group
Plumb Res
Plumb Res
SCHEDULING INSPECTIONS
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: 811042600654
Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store
Permits expire if work is not started within 180 Days of issuance or if work ls suspended for 18o Days or longer depending on
the issuing agency's policy.
All provisions of laws and ordinances goyerning this type of work will be complled 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.
ATTEilTION3 Oregon law requires you to follouv rules adopted by the Oregon Utiliw Notification Center. Those rules are set
forth in OAR 952-OO1-OO1O through OAR 952-OO1-OO9O. You may obtain copies of the rules by calliog the Center at (503)
232-t947.
All persons or entities performing work under this permit are required to be licensed unless exempted by ORS 7O1.O1O
(structural/tlechanical), oRS 479.54O (Electrical), and ORS 693.010-020 (Plumbing).
printed on: 1/29120 page 1 of 2 c:\myReports/reports//production/01 STANDARD
I ^-
Inspection Status
Pending
Pending
Permit Number: 811-20-000185-PLM Page 2 of 2
Fee Description
Technology Fee
Balance of minimum permit fees - plumbing
S ink/basin/lavatory
Tub/shower/shower pan
Water closet
SDC: Reimbursement Cost - Local Wastewater
SDC: Improvement Cost - Local Wastewater
SDC: Total Sewer Administration Fee
State of Oregon Surcharge - Plumb (LZo/o of applicable fees)
Printed onr 1/29120
Quantity
1
1
1
1023
503.94
76.35
Total Fees:
Fee Amount
$s.10
$27.O0
$25.00
$2s.00
$25.00
$1,023.00
$503,94
$76.3s
$L2.24
$L,722.63
Page 2 of 2 C :\myReports/reports//production/0 1 STAN DARD
PERMIT FEES
SPRINGFIELD
Transaction Receipt
811-20{00185-PLM
IVR Number: 81 1042600654
Receipt Number: 473670
Receipt Date:1129120
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-726-3753
permitcenter@spri ngfi eld-or. gov
,b
OREGON
www.springfield-or.gov
Worksite address: 3848 OREGON AVE, Springfield, OR 97478
Parcnl: 1702314103902
Transaction Units
date
1129120 1.00 Qty
1t29t20 1.00 Qty
1t29t20 1.00 Qty
1t29t20
1t29t20
1t29t20
1129t20
1t29t20
1129t20
Water closet
1.00 Automatic Balance of minimum permit fees -
plumbing
1.00 Ea State of Oregon Surcharge - Plumb
(12o/o ot applicable fees)
1,023.00 Amoun SDC: Reimbursement Cost - Local
Wastewater
503.94 Amount SDC: lmprovement Cost - Local
Wastewater
Description
SinUbasin/lavatory
Tub/shower/shower pan
224-00000 -425603- 1 034
224-00000 -425603- 1 034
224 -00000-42s603- 1 034
224-00000 -425603- 1 034
821 -00000-21 5004-0000
61 1 -00000-448024-8800
61 I -00000-448025-8800
Fees Paid
Account code Fee amount
$2s.00
$25.00
$25.00
$27.00
$12.24
$1,023.00
$503.94
$76.35
$5.1 0
Paid amount
$2s.00
$2s.00
$25.00
$27.00
$12.24
$1,023 00
$503.94
$76 35
$5.1 0
76.35 Amount SDC: Total Sewer Administration Fee 719-00000-426604-8800
1.00 Automatic Technology Fee 204-00000-425605-0000
Payment Method:Credit card
authorization: 829934
Payer: Micheal Aboumard Payment Amount:$1 ,722.63
Cashier: Katrina Anderson Receipt Total:$1,722.63
Ptinled: 1 129120 2:43 pm Page 1 of 1 Fl N_Tra nsactionReceipt_pr
Crry or SrnrNGFrELn, Onrcox
225 Fifth Street o Springficld, OR 97477 . PH(541\726-3753 . FAX(541)726-3689
tJ<.') '
Plumbing Permit Application DEPARTMENT USE ONLY
p",-itno.,}o - 00o169-
Date:\/)q E<)
SPFINGFIELO
h,flLll,r
gB,-'s{((po3 >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.
FEE SCHEDULE
Description Qt,'.Cost
ea.
Total
cost
New residential
I bathroom/l kitchen (includes : first
l00feet ofwater/sewer lines, hose
bibs, ice maker, underJloor low-poin'
drains and rain-drain packoges)
I s333.00 $
2 bathrooms/l kitchen 152r.00 $
3 bathrooms/1 kitchen t613.00 $
Each additional bathroom (over 3)1132.00 $
Each additional kitchen (over l)u32.00 $
Residential fire sprinklers (includes plan review)
0 to 2,000 square feet $r02.00 $
2,001 to 3,600 square feet u63.00 $
3,601 to 7,200 square feet t243.00 $
7,201 square feet and greater t324.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and
water supply 1102.00 S
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee $102.00 s
Each fixture $25.00 $
Miscellaneous fees
100' storm, sewer, water line il06.00 $
Each fixture, appurtenance, and piping b i25.00 s-(
Storm water relention/detention facility u06.00 S
Irrigation systems/Backfl ow t25.00 $
Piping or private storm drainage
systems exceedins the first 100 feet t25.00 $
Specialty fixtures i25.00 $
Reinspection (no. ofhrs. x fee per hr.)$102.00 s
Special requested inspections (no. of
hrs. x fee per hr.)$102.00 S
Each additional inspection: (l)$102.00 $
Medical gas piping Minirnum fee $
Enter value of installation and equipment $ _.
Enter fee based on installation and equiprnent value $
DEPARTMENT USE
(A) Enter sublotal ofabove fees
(Minimum Permit Fee $102.00)t /ba
(B) Investigative fee (equal to [A])s
(C) Enter l2o% surcharge (.12 x [A+B])$
(D) Technology Fee (5% of [A])s
TOTAL fees and surcharges (A through D):s i/g3L
doi L"-h(t)
$tV- ttl
(r)
LOCAL GOVERNMENT APPROVAL
Zoningapproval verified? ! Yes E No
Sanitation approval verified? ! Yes E No
CATEGORY OF CONSTRUCTION
E Residential ! Government E Commercial
JOB SITE INFORMATION AND LOCATION
Job site address:ue
State:zrP: Q 7q'79
Taxlot.:ReferenLe: (/
DESCRIPTION OF WORK
OWNER
lertuQ-
&4t", ffi'ztP:97q)t
Phone Fax
too,ArT
immediate
on orThis installation is
oraowned by me
exempt from
-/CONTRACTOR INSTALIATION
Business name:
Address a)
City:
Phone:Fax:
E-mail:
Plumbing license no.
Print name:
Signafure:
Last ediled 7/l/2019 bjones +\"7 ?>'G7
1
"tt tt )*7 I )st, lciltutt
.fu;tt siiltl- r4,oll TbJttr
Name: h ). ARnt/MP.+f)
Address: <fr
1
E-mail;
State:ZIP:
\
CCB license no.:BCD license no.:
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
I,OCATION:
TAX T,OTNUMBER:
DEVEI,OPMENT TYPE:
NEW DWELLING UNITS
IMPERVIOUS AREA
DIRECT RUNOFF TO CITY STORM SYSTEM
A. REIMBURSEMENT COST
IMPERVIOUS S.F,x
0.00
B. IMPROVEMENT COST
AREA DRAINING TO
DRYWELL
0
$0.00
COST PER TRIP
19.86
COST PER TRIP
$377.40
$0.00
$0.00
$1,526.94
CHARGE
$76.35
COST PER S.F.
s0.301
COST PER S.F.
$0.437
COST PER DFU
s I 70.50
COST PER DFU
$83.99
NI]MBER OF UNITS
0
NUMBER OFUNITS
0
COST PER FEU
s 13s.93
COST PER FEU
$ 1,620.8s
COST PER FEU
$22.82
ADM. FEE RATE
5%
CHARGE
$0.00
CHARGE
$0.00
NEW TRIPFACTOR
1.00
NEW TRIP FACTOR
1.00
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
Bathroom Permit
Michael R.
3848 Ave
1702314103902
Residence
I_FEEffiffil-66-x
ITEM I TOTAL. STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
NUMBER OF DFU'S
6
x
B. IMPROVEMENT COST:
NUMBER OF DFU'S
6
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
3. TRANSPORTATION
A. REIMBURSEMENT COST:
ADT TRIP RATE
9.57
x
x
x
B. IMPROVEMENT COST:
ADT TRIP RATE
9.57
ITENI 3 TOTAL. TRANSPORTATION SDC
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
NUMBER OF FEU'S
0
B. IMPROVEMENT COST:
NUMBER OF FEU's
0
C. COMPLIANCE COST:
xx
x
x
NUMBER OF FEU's
0
MWMC CREDIT IFAPPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL. MWMC SANITARY SEWER SDC
SLJBTOTAL (ADD ITEMS l,2,3, & 4)
SUBTOTAL
sl,526.94
x
TOTAL STORM ADMINISTRATION FEE
TOTAL SEWER ADMNISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
TOTALMWMC ADMINISTRATION FEE - I,OCAL
0
LOTSIZE (SF):I
MAX 45%
$0.00
$0.00
$0.00
$0.00
$0.00
763s
$1,603.29
1070
l09l
t092
1093
I 094
l 055
l 056
arI]o
O
&
ITJFa
I
d
079
077
078
-q
I@I
526.94
DATE u29t2020
TOTAL SDC CHARGES
\nt' \"1\
x
xx
DRAINAGE FIXTURE UNIT CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQT,IIVALENT: DRAINAGE FIXTURE TI}{ITS
FOR .TE ONLY THE NET ADDITIONAL
NO. OF FIXTURES
UNIT
FIXTURE TYPE NEW OLD ALENT
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
TOTAL DRAINAGE FIXTURE UNITS
tsa toa unit set at 167
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
20
DRAIN
FIXTURE
UNITS
0
0
1979
*EDU
$5.29
$5.1 I
$5.1 2
$4.98
$4.80
$4.63
$4.40
$4.07
$3.67
$3.22
$2.73
$2.25
$1.80
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
qBEDIT LOR LAND (IF APPLICABLE)
0
VALUE / IOOO
$0.00
CREDITRATE
$5.29x
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE/ 1OOO CREDITRATE
$0.00 x $5.29
TOTAL MWMC CREDIT$1.59
$1.45
$1.25
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
BATHTUB 0 0 3 0
DRINKING FOLINTAIN 0 0 1 0
FLOOR DRAIN 0 0 3 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0
LAI,rNDRY TUB 0 0 2 0
CLOTHESWASHER / MOP SINK 0 0 3 0
CLOTHESWASHER - 3 OR MORE (EA)0 0 6 0
MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0
RECEPTOR FOR REFRIG i WATER STATION / ETC 0 0 1 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC 0 0 3 0
SHOWER, SINGLE STALL 1 0 2 2
SHOWER, GANG (NUMBER OF HEADS)0 0 2 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0
SINK:COMMERCIAL BAR 0 0 2 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0
SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 1
URINAL, STALL / WALL 0 0 5 0
TOILET, PUBLIC INSTALLATION 0 0 6 0
TOILET, PRIVATE INSTALLATION 1 0 3 3
6
YEAR
ANNEXED ASSESSED VALUE
CREDIT
BEFORE I979
1979
1980
l98l
t982
1983
1984
1985
1986
1987
1988
1989 0
1990
l99l
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Conitruction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.32s (2ll
This statement is required for residential buitding, 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:
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 residq in, or a residence that I will
reside in. lf I hire subcontractors, I will hire only subcontractors liEiSe-a with the Construction
Contractors Board. lf 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 underctand the lnformation Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
of
Date
-<.rV\\J-,V*r,Li
39..tB@
lssued by:
2-O(
Permit #:ea
J
3n
st
Address
Date: i
This Copy for Permit Offices
L_l I own, reside in, or will reside in the completed structure and my general contractor is:
-L
lnformation Notice to Owners About
Construction ResPonsi bi I ities
(oRS 701.32s (3))
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 973095052
Telephone: 503-378-4621 - Fax: 503-373-2007
Website Address: www. oreoon. oov/ccb
or
Homeowners acting as their own general contractors to construct a new home
make a substantial iniprorement to in existing structure, can prevent many problems
by being aware of the following responsibilities:
a Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
Oregon,s Withholding Tax Law: Employers must withhold income taxes from employee wages
at th-e time employ"".ir" paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
unemployment lnsurance Tax: Employers are required to pay a tax for unemployment insurance
purposes
-on
the wages of all employees. For more information, call the Oregon Employment
Department at 503-947 -1 488.
Oregon,s Business ldentification Number (BtN): is a combined number for both Oregon
Withiolding and Unemployment lnsurance Tax. To file for a BlN, go online to the oregon Business
Registry. For questions, call 503-945-8091.
Workers Compensation lnsurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation lnsurance for their employees. lf you fail to obtain
Workers Compensation lnsurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division it tne Departmeni of Consumer and Business Services at 800452-0288.
Tax Withholding: Employers must withhold social security Tax and Federal lncome Tax from
employee wageJ. you'may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www'irs oov'
o
a
o
a
a
o
Other Responsibilities of Homeowners:
Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
propefi Damage and Liability lnsurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures fire, or work that must be
redone. Liabil'rty lnsuiance must be sufficient to cover injuries to persons on the job site who are not
otherwise coveied as employees by Workers Compensation lnsurance'
Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
a
a
f /nranarhr arernar :rlnntFrt q-rO16 This Copy for Permit