HomeMy WebLinkAboutPermit Plumbing 2010-8-9
"Plumbing Permit Application
I ccmC9>>~~ I~
225 Fifth Street + Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
. DEPARTMENT USE ONLY
Permit no.:
Date: g
This permit is fssued under OAR 918-780-0060. Permits a~eissu"ed only to tbe 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.
LOCAL GOVERNMENT .APPROVAL
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
City:
Reference:
lLfl7
-\\.1 e. VI
Name:
Address:
City: S
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:
Print name:
Signature:
~
ctp ~~,
~
440-250Q.J (II/OS/COM)
'1
. . FEE SCHEDULE "
Description Qty. . Cost Total
ea. cost
New residential
I bathroom!1 kitchen (includes:firs/
JOOfeet o/water/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms/l kitchen $374.00 $
3 bathrooms/1 kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over 1) $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 I $
Each fixture I $19.00 I $
Miscellaneous fees
100' stonn, sewer, water line $76.00 . $ '7(,a
Each fixture, appurtenance, and piping $19.00., .' $
Storm water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private stann drainage $19.00 $
systems exceedinp- 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 hI.)
Each additional inspection: (I) $58.00 $
Medi~a'l g~s'piping " "'" .., Minimum fee $
Enter value of installation and equipment $
Enter fee based on if!stallation and equipment value. I $
, APPLICANT, USE,
(A) Enter subtotal of above fees $ 7(",00
(Minimum Permit Fee S58.00)
(B) Investigative fee (equal to [A]) $ '11. ,no
(e) Enter 12% surcharge (.12 x [A+B]) $ \ ~L'J4
(D) Technology Fee (5% of [A]) $ ?.-;?n
TOTAL fees and surcharges (A through D): $1'JLJ,fl4
~~~/.;i J
~( ..-.....
';'''(,
.j'."-
S.~~INGF IEl~.
~'.\l_
.,~;; .~.
~::'o', . ~OREGON
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
www.ci.s.pringfield.or.us
Building I Commercial Permit.
PERMIT NO: 811-SPR2010-00017
IVR Number: 8111.7312~095
peflTlilcenler@ci.springfield.or.us
PROJECT STATUS: Issued
IS.SUED:
APPLIED:
0..< ,.
8/9/2010 '
8/9/2010
EXPIRES:
VALUE:
2/4/2011
$0.00
SITE ADDRESS: 1072 MAIN
ASSES OR'S PARCEL NO:
Springfield
1703354104900
SCOPE:
WORK INVOLVED:
TYPE OF STRUCTURE:
PROJECT DESCRIPTION:
Replace Sanitary Sewer
Phone Number:
OWNER:
ADDRESS:
SPFLD CHURCH OF THE BRETHREN
1082 MAIN ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION I.
Contractor Type
Contractor Name
BARON PLUMBING INC
Lic Type
CCB
BUILDING INFORMATION 1
Lie No
147744
Lic Exp
05/14/2011
Phone
541-344-4950
# of Units:
O'
# of Stories:
I Height of Struetur~:
Type of,~eat: ' '("~' \:
WaterTy:pe:, __}, :';",,!'
Range~Type: 'l,:,';;;!
"il,.f'
Hazmat:'
,,'
.,
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other:
Occupancy Load:
# of Bed rooms:
Sprinkled Building:
Fire Alarms:
Electrical Specialty Code Edition:
Springfield Fire Code Edition:
Mechanical Specialty Code Edition:
Municipal'l Development Code:
Plum~ingSpe.eia!ty fade Edition:
Residential S'p~~ialty Code Edition:
Stru,~~.~~LSI?~;}.~~~Code Edition:
i",;, ~,! J Site Information
I
Energy Path:
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall:
Soils Report Required:
: ~
:" ."
..,
.t j ~J.c.::"_~' !. .;' r, r;
" ,
Springfield Building Permit
8/9/2010 1:55:34PM
Page 1 of 3
..i;'-.'
,,~.(m:':. }(id':!llV i . ',~
.. ,........
CITY OF SPRINGFIELD
SrRIN.GFIEL~
.
. cJM.
..,'~
~:w:"'OREGON
'. ii'\Y"f ,:',i.~.~~,.~!~_~.!.' ~~ ; 1
Building hObnln'!ercial Permit
. ,,~.' ~;id . ., :::.:-.i; ,
PERMIT NO:'811~SPRi61 0-00017
IVR Number: 811173123095
www.ci.springfield.or.us
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@ci.springfield.or.us
PROJECT STATUS: Issued
ISSUED:
APPLIED:
8/9/2010
8/9/2010
EXPIRES:
VALUE:'
2/4/2011
$0.00
SITE ADDRESS: 1072 MAIN
ASSESOR'S PARCEL NO:
Springfield
1703354104900
'SCOPE:
i WORK INVOLVED:
TYPE OF STRUCTURE:
PROJECT DESCRIPTION:
Replace Sanitary Sewe~ :
DEVELOPMENT INFORMA nON ~
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure to
north property liri'e:~'
. -'~1;:i. '<><, '?;{:,."
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
PUBi'it: IIVlflFil:5VEMENTS ~
"::l~.,}?j ~;';F',;
Sidewalk Type:
Downspout/Drains:
"
I ~,';:",:~::~ .valuation pescription . ~
Descrietion
Tvee of Construction
Unit Amount Unit Tvee
Unit Cost
Value
Lf m~ ~."" " }:;;/?' ,<r-. :m~~ -~~~~::~~~~,:rSJ~>E(:_~.SjJt~~P~~J~o',:
Description Amount Paid
Sanita~ sewer . ~. $76.00 i
Technology fee (5% of permit total) ._:r~l :,~,_::~':,$~.?P:.
State of Oregon Surcharge (12% of applicable fees) !pl:\C ~~$9'121'"
Total Amount Paid ':7;;~:~?~ i"'~'.:.','llf8;92 '
~ f"
_,.,..~L~ H":Z;~"';,
il~' . . , ,"
~L...:..~J
Date Pa id
08/09/2010
08/09/2010
08/09/2010
ReceiDt #
224389
-"--~
224389
224389
[~"'-:~~~~",- ~ ~ r:~~~~i~;:.~ ~ ~~~ ",', -~; ,-~~~~~:~,<*b?;';' "~, ~":i:~~;p(iri'R~~i~~~t ,:~<'~~',;::?~r:~~ J '" ":' ,~ - -':~L -:t "~.~,' r "
Department Received Due Date Complete Result
Application Acceptance 08/09/2010 08/09/2010 08/09/2010 Application Accepted
Initial Review 08/09/2010 08/09/2010 08/09/2010 Expired
Permit Issuance 08/09/2010 08/09/2010 08/09/2010 Issued
Initial Review 08/09/2010 08/09/2010 08/09/2010 Over the Counter
Initial Review 08/09/2010 08/09/2010 08/09/2010 Over the Counter
Plumbing Review 08/09/2010 08/09/2010 08/09/2010 Over the Counter
Springfield Building Permit . 819/2010 1:55:34PM .
,. : ~ ~:;.:-:: ~"! . J;
::-:i,-,''f7l
,~'.'~":-~~=: "~--. ';,: j~iif~"'. '~'~'J
Reviewer
Kip Kaufman
Kip Kaufman
Kip Kaufman
Kip Kaufman
Kip Kaufman
K:ip Kaufman
Comments
Over the counter permit
Over the counter permit
Page 2 of3
\:.
...1 \ :~.
www.ci.springfield.or.us
:-
CITY'0F:SPRINGFIELD
Building I Commercial Permit'
PERMIT NO: 811-SPR2010-00017
IVR Number: 811173123095
225 Fifth SI
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541~726.3769
Fax: 541-726-3676
SP'fING. ,F IE~,D,
~"h--
'';'tlJI;
0000 . OREGON
permitcenter@cj,springfield.or.us
PROJECT STATUS: Issued
ISSUED:' 8/9/2010'
APPLlEP: ;,!l!9di>10'o,'
;;;;;'!",r.. t'.l> :r-_.: "~' . ;' ,
EXPIRES:
VALUE:
2/4/2011
$0,00
~:.:.r,;::;,;r,. .'
'2h~f
SCOPE:
WORK INVOLVED:
TYPE OF STRUCTURE:
SITE ADDRESS: 1072 MAIN
ASSESOR'S PARCEL NO:
Springfield
1703354104900
't,:~f;'t'
PROJECT DESCRIPTION:
Replace Sanitary Sewer
INSPECTIONS REQUIRED ~
Inspections
3200 Sanitary Sewer
Signature language:
By signature, 1 state and agree, that I have carefully examined thecomplet~dappljcation and do hereby certify that all information
hereon is true and correct, 'and I further certify that any a-':,d~allwcirk perfo'fmed shall be done in accordance with the Ordinances of
the City of Springfield and the Laws of the State or dre~o'ri!pe~aining 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 fro~t of the property, and the approved set of plans Will remain on the site at all times dUring constructIon
~Q_~-~,~ ,~,-C(aD/D
Owner or Contractor Slgnatu~- ,J' "'; ,Date'
~Jf!?: 'i,',~,,~,,' f,',_'~:~"""".'~~';:"'" '."
:J.~:-J'~lt '" -:. _ ,
...;;r.:.E:;':~" .,;,.,.'
,':,
',,~, .1.'
j ;):?-,.:
.;",.:!...t,."
t'i(\"r':,1
.~ "
~,JJ!}j,
.l:}:~~~'
~r;X{i:"
"l;,r;
,.~\ "
<'.,
Springfield Building Permit
8f9/2010 1:55:34PM
Page 3 of 3
S~~~~.~L~
~""r1*
.. :iiIl'
, ,,/;;;"." OREGON
~,..;:~. ..~."~ .:,(,U!
~~". ',',' "', ~".:.
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
TRANSACTION RECEIPT
W'MN ,cL sprin gfield. or.u S
,.
~ . .. ,,".
'" .-,..
" 'I
'.:...r
permitcenter@cLspringfield.or.us
t;~P,A YJ'ilENT TYPE'
Credit Card
RECEIPT NO: 2010000019 RECORD NO, 811.SPR20J 0.000 17 DATE: 08/09/2010
lbES'C:RIPTION-:<- .~\-:~'.:~~_ffY05'+;f:6)?j,H~'~~;8f?l5f51liittL%:-:"-:':.-":~:. - '(AC~C_6_LJ,Nt~C~ODE"- ;;-'~~-~,;~~~~:+~r~'tojJNT~pJj~--~~r~ ;' 'i\4
. Sanitary sewer 224.00000.425603 76.00
Technology fee (5% of permit total) 100.00000.425605 3.80
State of Oregon Surcharg.e (12% of applicable fees) 821.00000.215004 9.12
TOTAL DUE: $88.92
p.Ay.6ff.;;.tG.f\s.f[lER'KKAUFM!\N,~C'Cl1\ll1VlE:I'lIS~. . ,}t~..:.... '~I'~tQlJlI.JJ>AI!L~~. ...L.,:j
Baron Plumbing Inc 'P.O. Box 187 . $88.92
. Elmira, OR 97437
026709
" ~r""
"I
"~~;~'~~l.:
,-,
, '.
'W
:: 'L':',_ 'i
~~~;
:.,;.;': :),',
~:~_ . .; ':;{ .l.<"~~_.
\~~.~, :'3
~':J.G.~
.-.c:'
,..,