HomeMy WebLinkAboutPermit Plumbing 2009-11-9
Pl,umbing Permit Application
IF~it;D~~tRTME~T1'u~E"'6~[r~]1
I ~ermitno,C"I- /?J? I
I Date: '/1/1/1/; I
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 ..FAX(541)726.3689
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.
1'}"'i.~i:i?i,%::;~lIoCAlltCGOVERNMElIllWA~~ROVAI!(~;g'~i~tib11 1:~jj':"j;;\;','~~+l'f~i~1\it~"EEliSc:HEDUIdEfil;f~;(%'#!-m1'?!l1i~'lS:.\'1f'fLl!$~!
I Zoning approval verified? DYes D No I li;D'is;~riPti6~~~i!it;~..~~j,.~;~~i1~fd~~1IQt~~I~.~f9~i~!~$11~fn)t~!1~.
I Sanitation approval verified? 0 Yes 0 No I I"~:~";'~':i;:~~-:' ~1",,,,~,,,,~~~,~,,;,,(; "~,,..,,' '!M,~a-J.~'" "".tc.o~(,,,,,
I CATEG.oRY'OF: CONSTRUCTION '\ I 1 balhroom/I kitchen (includes.. first
I I l I 100 feet of water/sewer lines, hose ~
D Residential D Government D Commercial bibs, ice maker. under floor low,point '~' $238,00 $
It~~;i~1JOBi'SI:tE ';INF.J)RMA'I!IQN~,e;IIlD~ILOCATION~!Jl;lNiJ.~';~1 drains and rain,drain packages) J
I Job sIte address: it 51 (, ~ ~ I 1 2 bathrool11s/l kilehen $374,00 $
I ) P / / L d1 I q I 3 bathrool11s11 kilehen $439,00 $
City: ~ State:\.Y'L- ZIP: '7+1'7 1 Eaeh'additional bathrool11 (over 3) $95,001 $
I Referencd: \'1 03'l:J..,(X) I Taxlot.:ClZkcr.J 1 Each additional kitchen (over I) 1 1 $95,00 1 $
1::w-;t';i1it:'il'\lk;~~;DESCRII?"TloN;'.OFnw.ORK;~~~ff,.m\R~'I!WJ.1'~!:;J I Residential fire sprinklers (includes plan review)
I Ie ~ ~ ~_'7., 10 to 2,000 square feet $58.00 $
l-t,r:a-,-~ ~ =<- clo ./1 2,001 to 3,600 square feet $116,00. $
I,: ,,_;.v. .<--.. ,PRO~ERTY<;OWN ".",,,;;'.i;1f,?C'~'f;,I\'J!AI3,60I t07,200squarefeet $174,00 $
I Name: ~ ~~~. [)(~~- _ 17,201 square feet and greater $232.00 $
I I ~..-4! #~; - 1 \ _A o..t' I Manufactured dwelline or pre-fab (circle one)
Address: ~ ' r(\ lYv- I Conneetlons to building sewer and I I $5800 I $
I C / I S ~<I~ I water supply ,
I Ity: /' tlate: v j' ~ I I Commercial, industrial, and dwellings other than one- or
Phone/ - Fax:, \ ~o-famIly
I E-n\ail: k' tf(Minil11ul11 fee ~ ~ I I $58,00 I $ . I
This installation is being made on residential or farm property',I,\;1 Ea,Ch fixture ~Jfu'-AL ':"""<-<)._1 ( $19.00 $[ I 1
owned by me or a member of my immediate family, and is ,\: I Miscellaneous fees I
exel11pt from licensing requirements under OAR 918-695,0020, 1 ]00' 51orl11, sewer, water line $76,00 $ 1
Signature: I Each fixture, appurtenance, and piping $19.00 $ I
_, ..CONTRACT:OR,,1NSTALLATION..,, ,:;";,,,,Ni,,..,,,.,1 1 Storm water retention/detention facililJ' $19.00 $ I
Businessname:{ - ~ p~ _ I Ilrrigationsy51el11s .1 $19,00 $ I
~ , {I Piping or private storm drainage I $ I
Address: I 'S'~ ~ U, I svstems exceed in. the firsllOO feet $19,00
I City, f1.. _ ~ L- I Slate: Uk. I ZIP: 17'-fe>+ I I Specially fixtures $19,00 $
I Phone: I Jh ,0 I / Q C" I Reinspection (no, of hrs. x fee per hr,) $58,00 $
'" "15" ('+'+4- Fax: 10'" 0- CJZ-l"Z- I Special reque51ed inspections (no. of
I I $58.00 $
E-mail: hrs, x fee per hr.) ,
I CCB license no,: I 70 <]." I BCD license no,: I I Each additional inspection: (I) $58,00 I $
I Plumbing license no.: 2-&'So..JP l~ij~:~ii<f;Ilgis~pfpi1g~~~~1?d~\t?~;t~fb~~~~) Mjnimum fee I $
I Print name: It{ IC+(AU ?': c.A fC..Jo,J. I Enter value of installation and equipmenl $_.
I Signature: ~~ ~ ~ [;~;;~~i;;;~~~~~?;NtiQ~;;_~~:
/ I (A) Enter subtotal of above fees "71 ~;"! 'tOf
(Minimum Permit Fee $58,00) $ ~;f---I
i (B) Investigative fee (equal to [AJ) $ 1
I (C) Enter 12% surcharge (,12 x [A+BJ) $ .0"1~--1
1 (D) Technology Fee (5% of[AJ) $ :2 '7 v 1
1 TOTAL fees and surcharges (A through D): $ /.: '1 b 41
440-2500.) (11/08/COM)
1
I
I
1
I
1
1
I
1
1
I
I
"i :~3
CITY OF SPRINGFIELD'
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, ?R,;;;\,iL
541-726-3753 Phone,,; " ,ii,.:.' :,'CS '" ,,1(;,:"i.:f,
541-726-3676 Fax. ,\1<;;'." -;, ..,\' .
541-726-3769 In~pe~tioii Line .
<)
PERMIT NO: COM2009-01636
ISSUED: 11/09/2009
APPLIED: 11/09/2009
EXPIRES: 05/09/2010
...~Y-ALUE:
J,
""~'."'y!"'-n-L"'" ,"'",
,~::L .. ..~, . >
SITE ADDRESS: 886 HARLOW RD Springfield TYPE OF WORK: Plumbing Only
ASSESSOR'S PARCEL NO.: 1703220002206
ATTENTION: Oregon law rElj1W",M'.F~~: Alteration
PROJECT DESCRIPTION:, Relo';;.te ba~kt<r.)'w\lllvi~!itIffl~fe~ li'ltelIW.QW\lll,gelitltlfllhltYrth
. . '"'ofi,, ' - Notification Center, Those rules are se 0
, ;'.~. ....." ..',~ -." ........ -;-E .......... ............r" ..I-.P-'"i.... r't^O nI:l') fln1_
". ., ~'. \ .......,\.....__ __. --.-'. --oJ
Owner: CLOVERDALE LLC 0090. You may obtain copies of the rules bV
Address: ,840 BELTLINE RD STE 202 calling the center. (Note: the telephone
., SPRINGFIELD OR. 97477 number for the Oregon Utility Notification
':::'_~:~:':" ~ nr.",., O"='r') ()O/L-1)
Commercial
I CONTRACTOR INFORMAT~ON I
Contractor Type
Plumbing ".""
Contractor
., ,i!; TWIN RIVERS PLUMBING INC
,y
License
17695
Expiration Date
03/11/201l
Phone
541-688-1444
';'. ~,.
~. . ~
'. .
,
# of Units: .H: r.,:i, .{:;.
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
'. ~U1LDlNG INFORMA T1~N ,
';:-,nr.r:.
; - , , '-'.... # of Stories:
.::is PERMITiiJi"gI1tlofStn'2fuJf THE WORK
'JrHORIZEDWp~Qfillii~iS PERMIT IS NOT
. %i~\ENCED'Y,~\erST~e~\NDONED FOR
.:v 1;30 DAy~a,!',llfjFJpe:
':;:..:~:' .... - Energy i'ath:
" -;':, \7; " Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
.,,'1;,
;1 :.
n/a
-" . t'
.....t~ .'1 A ' ~t_.
;
, DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks: '" ," ";-
- .
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage,
Total:
Handicapped:
Cum pact:
"
"
":'.A~
.~' -~~': ',~~. ..
Street Improvements:
Storm Sewer Available:
Special Instruction:
,
t--. ,I.
.
',,, ~\,.
}' .'!'
I ~UBLlC IMPROVEMENTS I
Sidewalk Type: .
Downspouts/Drains:
u
Notes:
..;.
,
-;; '~.l.
'. t I'
.,
I Valuation Description I
'.{F~ ~., {.:
$ Per Sq Ft
. or multiplier
Square Fuotage
or Bid Amount
Value
Date Calculated
Description Tvpe of Construc(ion
,)
~ I~~
Paee I of 2
f '\f'. in '0'
';",on
,
.' .
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01636
ISSUED: 11/0912009
APPLIED: 11/0912009
EXPIRES: 05/0912010
VALUE:
Status Issued '.
~ ':i;:..-:\.';'.:,,,:
225 Fifth Street;Spr.ingfjeld,9R~j;"'.;"":.:
541-726-3753 ptione",;"J~.: ,.. ....,. ';:
)~' ,~
541-726-3676 Fax - '
541-726-3769InspectioI\Line
. /".,~,; (;, o~'
".,: ;1;:.
".,,'" ;\"
Total Value of Project
"i~'" :
t,' .:'
..
. Fee Description! " ".
+ 12% State Slitcharge;';, ,J'. ?
+ 5% Technology Fee." '.',.;-. ':',
Backflow Device '.
Minimum/Adjustment Plumbing
Fees PaidJ
Amount Paid
Date Paid
Receipt Number
$6.96
$2.90
$19.00
$39.00
11/9/09
11/9/09
11/9/09
11/9/09
2200900000000001266
2200900000000001266
2200900000000001266
2200900000000001266
Total Amount Paid ,.:'-
, !'.',-'::'.
$67.86
~' ',J T' "
t'l :
I Plan Reviews I
't
. ~1~, , ,>
~;
,. .:
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day. _";.!'-' ..,
.. . . ....::; , ,!~
~f 'j ~ ; 0
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
- .
I ~~(]~ir~d Insneeti,ons,'
Water Lin": Prior to filling trench and including required testing.
By signature, I state and agree, tbat I bave carefully examined tbe completed application and do bereby certify tbat all
in'formation bereon is true and correct, and I furtber certify that any and all work performed shall be done in accordance with
the Ordinances of tb'e City of Springfield and the Laws of the State of 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 certifytbat 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 require4 inspections are requested at the propel' 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 rel11ain on the site at all
times during construction.
~~~"
Owner or Contracto'J{Signatnre
1(/9/ ocr
Date I
i' 0 t1~:u} ..,'~
.' ~' t
,.'" ,.,0;_;
,'d. ".f'; ':.7..\
,
. ,; I.
Pa2e 2 of 2
.'
RLID Detailed Property Report
Page I --=-
Site Address 886 HARLOW RD Springfield, OR 97477-1137
Map & Taxlot #1703220002206
SIC N/A
Tax Account # 105289]
~,~
Uroperty Owner 1
CLOVERDALELLC
840 BEL TUNE RD STE 202
SPRINGFIELD, OR 97477
Approx. taxlol acreage 0.41
Tax account acreage 0.41
Detailed Property Report
Related Accts 5510266
Maps
Map & Taxlot # 1703220002206
~
--..J
Harlow Rd
.s
c
.
€
.
I
~Ct!l
~
I
View Larger Map
Improvements
Photos & Sketches for Tax Account
.
~ "'<OJ,
~..
-'1.,...
, . ~ ^ ~
'.-~~~~:
Site Address Information
886 HARLOW RD
Springfield, OR 97477-1137
House # 886 Suffix N/ A Pre-directional N/ A
Street Name HARLOW Street Type RD Unit type I # N/ A
Mail City SPRINGFIELD State OR Zip Code 97477
Zip + 4 1137 Create Date Sep 25,1986 Update Date Mar 30, 2006
Land Use6152 Real Estate Agents, Brokers & Management Services
USPS Carrier Route C003
http://v2.rlid.org/property_searchlindex.cfm?do=property_search.detailedreport&dsp=&a... 11110/2009
225 Fifth. Street
Sp;ingfield, Oregon 97~77, .i .:'
541-726-3759 Phone
V...~.'.':'I"
~
IlL...
City of Springfield Official Receipt
Development Services Department
Public Works Department
, . ,
" >!t,i'.!;'~\'..RE'. CElp. T #,
"." ". .' - .
2200900000000001266
Date: 11/09/2009
9:39:08AM
Job/Journal Number'
COM2009-0 1636
COM2009-0 1636
COM2009-0 1636
COM2009-01636
. Description \~.r
Backflow Device
Minimwnl Adjustment Plumbing
.",', .+.5% Techn<\logy I'ee
V ~\:+-r2% St;;i~'S~;:charge
:~ .: .;: )
~;~;no~n~:~ment -, .~i~~~i~~~~i1~i~ .
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
19.00
39.00
2,90
6,96
$67.86
Amount Paid
Check
TWIN RIVERS ",
cjc
31156
In Person
Payment Total:
$67,86
$67.86
. "'n
" . ",:!...",;~...:,;,
.~;:.;: .
;1'= -; ..'t;,~...;:'.;"'"
.....l;;'
...~~<k:,j:;~, .
-. L~' . ...~~~~ !1t"..
n
:',
.:A:> , 1:
,
i.
'1'- .,"
;
. 'rl~~,.;f'
.-. -~.... 'r:" ,
"
\,
~!
,'.,1.
I
, .
." .L 1'>.:.11
C .
,
,.
. _...~. ~.,_.:.,:.._..~.:-~ d. ;f~ ,:..:
f " \i'" i~~ \ . .. t,
'.")
"
~ :~1i:
-.-- _..~.. "_.
.>
;:
,
.'
If
;:
,
!'
.
~.f ~._L
:i
I
~;
.
f
.
cReceintl
"
Page I of I
11/9/2009
..i.. ;L~