HomeMy WebLinkAboutPermit Plumbing 2010-7-23
Plumbing Permit Application
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225 F;f\h Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726.3689
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Date:
Permit no.:
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.
'~;;':';.,)Jli,\';I::OC).L;GOVERNMENJ.;APPROVAl!f~,\;c~'.;~~;!:~,\'
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEG,ORY'OF CONSTRUCTION'
Residential D Government D Commercial
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Phone:
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: .-r
Address:
-.'ff.,,_,"
City:
Phone:
E-mail:
CCB license no.:
Plumbing license no.:
Print name:
ZIP:
BCD license no.:
Signature:
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440-2500-J (I 1/08/COM)
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New residential
1 bathroom! I kitchen (includes: first
J 00 feet of water/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms!1 kitchen $374.00 $
3 bathroomsll kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over I) $95.00 $
Residential fire sprinklers (includes plan review)
o to 2,000 square feet $58.00 $
2,001 to 3,600 square feet $116.00 $
3,601 to 7,200 square feet $174.00 $
7.201 square feet and greater $232.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and $58.00 $
water supply Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee I $58.00 $
Each fixture I $19.00 $
Miscellaneous fees
100' storm, sewer, water line \ $76.00 n~'
Each fixt.ure. appurtenance, and piping $19.00 $
Stonn water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
svstems exceeding: the first 100 feet
Specialty fixtures $19.00 $
Reinspection (no. ofhrs. x fee per hr.) $58.00 $
Special requested inspections (no. of $58.00 $
hrs. x fee per hr.)
Each ad~itional inspection: (])0JPrf. t $58.00 $<::::a---
~'M~afc~Fg~s:"pipiiig:ri~::i~~t\:~\.j~M\j Mi.nimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value. $
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(A) Enter subtotal of above fees $ O'lc;5:.
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $ J ("U..!-
(D) Technology Fee (5% of [A]) $ (,,~
TOTAL fees and surcharges (A through D); $ /~f. ?'I..
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00975
ISSUED: 07/2312010
APPLIED: 07/2312010
EXPIRES: 01123/2011
VALUE:
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 811 S 38TH ST
ASSESSOR'S PARCEL NO.: 1802061102400
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Connect to sanitary sewer and tank abandonment
Owner:
Address:
BROWN JAMES R & LONNA M
811 S 38TH ST
SPRINGFIELD OR 97478
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# of Stories:
Height of Structnre
Type of Heat:
Water Type:
Range Type: ' .
, 'Energy Path:'
Sprinkled B'.iilding:
Contractor Type
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
.' ' ,n/a
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
N(llriF;~ELOPMW-l,N,~_R1\
THI::, r 1'\1'111 :", THIS PER OT
AUTHOR\76Pl\r~NtiDE.\BANDONED FOR
COMMENwslt fAl(li Rqd: .
ANY 180 i!~ D %'Rqd: '
" "~~o_of ~.t E~~er,,~?~:
.
I PUBLIC IMPROVEMENTS ~
Residential
, '
Expiration Date Phone
Lot Size:
Sq Ftlst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
, REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I V aluati~n Des,cription ~
Description
$ Per S'fFt
or multiplier
;" Square Footage
or Bid Amount
Tvpe of Construction
Paee I of 3
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Sanitary or Storm Sewer Cap
Sanitary Sewer - 1st 100 Feet
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Compliance Charge
SDC MWMC Compliance Charge
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
Total Amount Paid
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00975
ISSUED: 07/23/2010
APPLIED: 07/23/2010
EXPIRES: 01/23/201]
VALUE:
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Total Value of Project
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Amount Paid
./
Receipt Number
Date Paid
$16.08
$6.70
$58.00
$76.00
$660.74
$1,104.80"", :.' : '.' '..",
$10.00 ....
$22.63;,~:. /' ,1",~..
$22.63HJ"": '. ',,,,;, ~ ,
$1,333.57'"
$101.97
$161.69
7/23/10
7/23/10
7/23/10
7/23/10
7/23/10 .
7/23/10
7123/10
7/23/10
7123/10
7123/10
7/23/10
7/23/10
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
2201000000000000864
$3,574.81
Plan Reviews ~.
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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.
l...-PenllirerUnsnections ~
Sanitary Sewer Line: Prior to filling trench a.~.~..in.c1~di~.g .requi~ed testing.
Septic Tank Pumped; After septic tank has' been p1iinlfed and filled. Please provide the inspector with receipt and
verification from company performing pU"!I!I.~9.d .fill:.;;.,.. :
,': '.:').1~'/', ' "!'
Sanitary Sewer Cap: Capped within five (5). reet oi' the property line and capped with an approved material as
required by the code.
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00975
ISSUED: 07/23/2010
APPLIED: 07/23/2010
EXPIRES: 01/23/2011
VALUE:
Sta tus
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax'
541-726-3769 Inspection Line
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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 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 of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission oftbe 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 tbe front of the property, and the approved set of plans will remain on the site at all
times during construction. .
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
JOURNAL OR JOB NUMBER: Com 2010-00974
NAME OR COMPANY: Jim Brown '"
LOCATION: 811 S 38th ST ~
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TAX LOT NUMBER: 0 0
DEVELOPMENT TYPE: Single Family Residence U
NEW DWELLING UNITS 1 BUILDING SIZE (SF: 0 LOT SIZE (SF): 0 ~
~
I. STORM DRAINAGE '"
~
DIRECT RUNOFF TO CITY STORM SYSTEM c:J
gj
A REIMBURSEMENT COST AREA DRAINING TO
I IMPERVIOUS S.F. x I COST PER S.F. I DRYWELL I CHARGE I
I 0.00 I $0.094 I = 0 , $0.00
$0.00
B. IMPROVEMENT COST
I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I
$0.336 =1 0 I I $0.00 1070
0.00 $0.00
ITEM I TOTAL - STORM DRAINAGE SDC I $0.00 I
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBE~OOF DFU's I x I COST PER DFU I
I $55.24 I ~ I $1,104.80 1091
B. IMPROVEMENT COST:
I NUMBE~OOF DFU's I x I COST PER DFU I
I $33.04 I ~ I $660.74 1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $1,765.54 I
3. TRANSPORTATION
A REIMBURSEMENT COST:
I ADT TRJP RATE I x I NUMBER IOF UNITS I x I COST PER TRJP I x I NEW TRIP F ACTORI
9.57 29.97 1.00 ~ I $0.00 1093
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER IOF UNITS I x I COST PER TRJP x INEW TRIP FACTORI
9.57 I $122.24 I I 1.00 I ~ I $0.00 1094
ITEM 3 TOTAL - TRANSPORTA nON SDC = I $0.00 I
4. SANITARY SEWER. MWMC
A REIMBURSEMENT COST:
INUMBER ~F FEU's I x ICOST PER FEU I
I $101.97 I = I $101.97 1054
B. IMPROVEMENT COST:
INUMBER ~F FEU's I x ICOST PER FEU I
I $1,333.57 I = I $1,333.57 1055
C. COMPLIANCE COST:
INUMBER ~F FEU's I x ICOST PER FEU I
I $22.63 I = $22.63
MWMC CREDIT IF APPLICABLE (SEE REVERSE) ~ $0.00 1054
MWMC ADMINISTRATIVE FEE ~ $10.00 1056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~ I $1,468.17 I
SUBTOTAL (ADD ITEMS 1,2,3, & 4) -I $3,233.71 I
5. ADMINISTRATIVE FEE:
I SUBTOTAL I x I ADM. FEE RATE I- I CHARGE I
$3,233.71 5% $161.69
TOTAL SANITARY ADMINISTRATION FEE: I 161.69 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: I $0.00 1078
TOTAL SDC CHARGES -I $3,395.40 I
PREPARED BY DATE
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAJNAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 3
DRINKING FOUNTAIN 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
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 1 0 3 = 3
CLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 - 0
MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRlG / WATER STATION /ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. I 1 0 3 = 3
SHOWER, SINGLE STALL 0 0 2 - 0
SHOWER, GANG ER OF HEADS) 0 0 2 - 0
SINK: COMMERCIAL/RESIDENTIAL KlTCHEN 1 0 3 = 3
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 - 0
SINK: SINGLE LA V ATORY/RESIDENTIAL BAR 2 0 1 = 2
URINAl", STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 - 0
TOILET, PRIVATE INST ALLA TION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S ,
20 = 0
TOTAL DRAINAGE FIXTURE UNITS I 20
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 l'allons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I fnrYes, 2 for No)
BASE YEAR
o
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE/lOaa CREDIT RATE
$0.00 x $5.29
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE /1000 CREDIT RATE
$0.00 x $5.29
o
TOTAL MWMC CREDIT
$0.00
=
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Publie Works Department
RECEIPT #;
2201000000000000864
Date: 07/23/2010
10:09:56AM
Job/Journal Number
COM20 I 0-00975
COM20 I 0-00975
COM2010-00975
COM20 I 0-00975
COM20 10-00975
COM20 I 0-00975
COM2010-00975
COM20 I 0-00975
COM20 I 0-00975
COM20 I 0-00975
COM20 I 0-00975
COM20 I 0-00975
Payments:
Type of Payment
Check
cReceintl
Description
Sanitary Sewer - I st 100 Feet
Sanitary or Storm Sewer Cap
+ 12% State Surcharge .hi ; :1;'"
Sanitary Sewer - Reimbursement" . .
Sanitary Sewer - Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC MWMC Compliance Charge
SDC MWMC Compliance Charge
+ 5% Technology Fee
SDC Sanitary/Storm Admin
Paid By
JAMES BROWN
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'Received By
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Item Total:
Check Number Authorization
Batch Number Number How Received
8363 In Person
Payment Total:
Amount Due
76.00
58.00
16.08
l.I 04.80
660.74
101.97
1,333.57
10.00
22.63
22.63
6.70
161.69
$3,574.8\
Amount Paid
$3,574.81
$3,574.81
,
7/23/20 I 0