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Home My WebLink AboutPermit Plumbing 2010-8-25 Plumbing Permit-Application ..~!:;J'DEP'ARTMENTUsfONLy~1irli.~ Permit nosRt.I() ~ 60 g--"ZS-t C 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 Date: 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. ':!;iii'%1;X,j.IJ!Pc;Al,~'GOVERNMENl'rAI?I?Rd'VAI5;i1#'7;~~~!5;~i:? Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CATEG.oRYOF. CONSTRUCTION. i Residential D Government D Commercial i; .,t,;"jOsISIl7E' 'INFORMMlbNYAND,,;l:iOGA1'1()N.;~ji.~'.~:.< ..'>.,.,:".".....__ _.i,','.._ :...'. _...' _._______,-.'",', _....,.'_'.__,... ..-.........'.._....n.......,."."_'. <......, ,l 7 "1".:;. ,:;-"ir~ .. ".,' :~-,~'" Taxlot.: .OF:},WoRK"~~[f~~tl,Z~(\'i~~ff~:$t~t;; I c-C:!' Name: ". . PRO PER:rv;'owNER'?;i.' ;:.':,:...'..,,)f.~\g:fl\~i,t\ S~,. \(; * "ll{7'7 City: 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. -t" \L L.""" k . '., . "'".'~" ,"0',.;;: ).. E-mail: CCB license no.: 41 Plumbing license no.: Print name: BCD license no.: Signature: 440-2500-) (11/08/COM) <.,..,.; .~~!'!:<;..:::~{j~~:?~<%;%~f~~F-EE{~,s:tH E;_DUtEi,J:~,:~..'_.:<.:2{i~~\l~[~~1~~~~~~ir- ,.,--," ;,j'Rf~-~i!fiil~'2~:~~~~{;;~;~:~'i;i;t~.~\~;iiiti~.~tIT~~; gtti~ :!;"~4~~;ltXi &f,;~,~~Jl\ New residential I bathroomll kitchen (includes: first JOOleel 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 bathrooms/l 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 $58.00 $ Each fixture $19.00 $ Miscellaneous fees 100' storm, sewer, water line $76.00 $ Each fixt:ure, appurtenance, and piping . $19.00 $ Storm water retention/detention facility $19.00 $ jR-ifiltion s~ I $19.00 $/7 or private storm drainage . $19.00 $ systems exceedine: the first 1 00 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 additional inspection: (I) $58.00 $ ~~Me(JTt~'i~'g~1p.rpr*g:;t~i~~M',~:::,~i'~~:'::(;0,;~lj~;t~t~i Mjnimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ ,....,~"~...c;..y.. -_."....'....I;ii\1'el!i\\~'"~&! ~~t~~1~,~.~4._~:':..,~. '._ .J~~~~I,G~_~;r~,t;J,s,~"'-_f?l<;-,~~;N~!X', ~ ,', "4~ (A) Enter subtotal of above fees ~8 (Minimum Permit F,t$S8.1JJlY $ (B) Investigative fee (equal to [A]) $ -, (C) Enter 12% surcharge.(. 12 x [A+B]) $ f:::;>f- (D) Technology Fee (5% of [A]) $ Z7~ TOTAL fees and surcharges (A through D): $1-. 7 '-' G www.ci.springfield.or.us CITY OE:S~~.INGFIELD :;,i:.l ' b~EJ:.;:_" Buildingl.~e~'.~~ntial Permit PERMIT NO: 811-SPR2010-00145 IVR Number: 811154329696 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield.or.us PROJECT STATUS: Issued ISSUED: 8/25/10 APPLIED: 8/25/10 EXPIRES: 2/20/2011 VALUE: $0.00 SITE ADDRESS: 858 RIVER HILLS Springfield ASSESOR'S PARCEL NO: 1703341212100 . SCOPE: Backflow Device ,', ,\iVORK INVOLVED: New " ,.:' ,TY~E.oF,STRUCTURE: Residential ."-'. . . " PROJECT DESCRIPTION: Backflow device .\:,:it-.. "1":;..' ' :1' OWNER: ADDRESS: SHIPLEY RICHARD 858 RIVER HILLS DR SPRINGFIELD OR 97477 . ,,,:; Phone Number: Contractor Type Contractor Name CONTRACTOR INFORMATION I Lie Type Lic No / Lic Exp Phone # of Units: o BUI'~[)ING:i~~.qRMAlmN . : "J'",,'. : .:;, ...\ , i r:\ t. ;~,; ~ f..h;..'i . . # ot'Stories: ' ,'/t: . ~ I I Heighfof Structure: Type of Heat: Water Type: Range Type: Hazmat: I Sprinkled Building: ~ ' Lot Size: Sq Ft 1.t Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: # of Bedrooms: Fire Alarms: Electrical Specialrr, 9?~~ .i=:'lilion: Springfield Fire C.ode'Edition: ~e~~~a'h\cal specia~ty"code Edition: Munidp'.all Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Energy Path: Site Information , Engineered Fill: Fill Volume: :;'.::0 _: 'rl;;""1 ,_l' 1.- Flood Hazard Area: -.:rtD;~\ ~ I~J6ht( ~ I I' Land Hazard Area: ~~~~~ "~.~:-.....,,;:; 'l.1';, , , . 1,~ '. ....., \ Retaining Wall:ATTENTION: Oregon law requireei/LShh8~/;'.' SOIls Report 'Wll1lt'~:ules 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. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). NOTICE: -,"'"i''7''' THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield Building Permit . ;8i25(2010 : :.3~of:~~'~,M' .... .t-liX;;;:..~~" ~. ~~'\~l~;:~' ;-':~"'T; , Page 1 of 3 .;<:.->.. www.ci.springfield.or.us (;i!,::Hl.',', '!': CITY' of SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00145 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 SP~IAN~,~ ~.~, ," ., ---OREGON permitcenler@cLspringfield.or.us PROJECT STATUS: Issued IVR Number: 811154329696 -;.:.:'::.c;; ,,:. ..::,.... _ .1.' ~ : ISSUE~!i8/~,$Ito:""'; . \ !; -;,<.,.~"l<>. ......"_".._;!,~. APPLIED: 8/25/10. " .(,,~- -.'" ',' "..... EXPIRES: 2/20/2011 VALUE: $0,00 SITE ADDRESS: 858 RIVER HillS Springfield "" ASSESOR'S PARCEL NO: 1703341212100 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device DEVELOPMENT INFORMATION' REQUIRED PARKING Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Overlay Dist: # Street Trees Reqd: ". ,. I" Paved priv~ R~qd:',~ "".,1 % of~l:-o'~,~overage: -Y . Highest point on Sitructure to north property liri~: Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: '~;~~Ji~~~~:!;:~;, ':~;\:~ .'-.. .:L Downspout/Drains: , .\". .i\ ~. Valuation Description I Descrietion Tvoe of Construction Unit Amount Unit Tvee Unit Cost Value ...., "I.. ... . "-'j;, ',~::-~"~;:;;-~."~__~,-_ .'_~~~~~:~ .~ ;~;~/0F',-_~:~~"j,F7~TJ7?700I\~TI=EES~PATI1;~,~,-:~i3f,m~~;;:i\rJf "7~-"'7~:~!'i':q~;::~t~' : ~~'1 ~.r ~f , '-~.:J DescriDtion ~ackflow preventer Balance of Minimum Plumbing Permit Fees State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit :otal) Total Amount Paid , "'1 -,- ,Amount Paid $19.00 $39.00 $6.96 $2.90 $67.86 Date Paid 08/25/2010 08/25/2010 08/25/2010 08/25/2010 ReceiDt # 299317 299317 299317 ------- 299317 , '.,' ~;E~~:p, ;;,j~",;.. .~~~~r.:: ;,;~~.:"\;t" '_-i, u., .,-";:t,'l\pn~.,, :;t. .:d~" ~ .J;!,:;(;ti Springfield Building Permit 8/25/2010 3:02:33PM Page 2 of3 www.ci.springfietd.or.us CITY OF SPRINGFIELD Building I Resid~ntiaIJ)ermit PERMIT NO: 811-SPR~010-00145 IVR Num~e~:,811154329696 ."",'1,- ,', ., 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmilce nter@ci,springfield , or. us PROJECT STATUS: Issued 1\-,' :., ISSliED:' 8/25/10 APPLIED: 8/25/10 EXPIRES: 2/20/2011 VALUE: $0,00 SITE ADDRESS: 858 RIVER HILLS Springfield ASSESOR'S PARCEL NO: 1703341212100 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device "'-.. , '-", .~ -.~. I;. _~ E;;b\~~;~~;:::::r:~G;;'~'~~;::E~0}~~~~~~~yr~~:~0:'~~.f:i~~:~1r!:'f;~]F-.:~'.~~:~~ DeDartment Received Due Date ComDlete '. Rest"1t Reviewer . Permit Issuance 08/25/2010 08/25/2010 08/25/2010' Issued David Bowlsby ,,\pplication Acceptance 08/25/2010 08/25/2010 08/25/2010 Over the Counter David Bowlsby Initial Review 08/25/2010 08/25/2010 08/25/2010 Over the Counter David Bowlsby Planning Review 08/25/2010 08/25/2010 08/25/2010 Not Required David Bowlsby Public Works Review 08/25/2010 08/25/2010 08/2512010 Not Required David Bowlsby Structural Review 08/2512010 08125/2010 08/2512010 Not Required qavid Bowlsby INSPECTIONS REQUIRED ~ - ,.., ,-, ".' 'oJ :.._,~.t:__....,JLi ._" ___ ~..~. Comments Over the counter permit Over the counter permit Over the counter permit . Over the counter permit Inspections 3620 Backfiow Device <I ~ ,. "J'f' . ,', "~ ' .' By signature, I state and agree, that I have carefully ex~~~~~~;?~:the!Cb~pl:~ted 'application and do hereby certify that all information hereon is true and correct, and I further certifith~! any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permis;fon 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 front of the property, and the approved set of plans will remain on the site at all times during construction. '~,".r;. "':r:;l.?."rl !)f;...ti .1.-.. <,'[)'F':: i;A'i:~~: ., )'If:l;(\;l fCJ .-,' ..\, :!,!;.,:~r I... '.',: .\~ Ii, "Jr. Springfield Building Permit 8/25/2010 3:02:33PM Page 3 of 3 ;':,' .,..,"". ".,', ... .. :~~"S"-:-- ':~.::;:-:;\.;..;\'1~'~- .,}!:t"7~': ";r:I(;:i~1't"i i S::~~NG.~EL~ ~~ ~OREGON TRANSACTION RECEIPT 858 RIVER HILLS DR Springfield OR 97477-3641 CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 : www.ci.springfield.or.us pe rmitcenter@ci.springfield,or.us RECEIPT NO: 2010000134 RECORD NO: 811-SPR2010-00145 DATE: 08/25/2010 [DESCRIpTION,": i': ,-~'':!'I={ _,i~~ " ~,;'1t;tE;Ii1!;;5!;:;;Yi;;;~:C,c6UNT~C,O[)E.:L.,';"P-' AI'!IQLJNI:PJ.lE:' ." ':J Backflow preventer 224-00000-425603 $19.00 Balance of Minimum Plumbing Permit Fees 224-00000-425603 $39.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $6.96 Technology fee (5% of permit total) 100-00000-425605 $2,90 TOTAL DUE: $67,86 !';:'PAYMENTT,YPE" ,,;PAY3~Jf;;:::;lCAsHIER'DBi:JvwSBY4i,!;,-iC,QMnII~NIS ; ~"'..; ~-' ,;,4...., (t:, :'AMOUNTPAII:l', "t Cred it Card 079932 Alan Marchant A & K Landscaping $67.86 $67.86 '1;gl! ~i'l~:~()lU-i... :..; ~"-\r- " ');:P i :f'E.':.OH'.,,'