HomeMy WebLinkAboutPermit Plumbing 2010-8-31
"
. ,
Plumbing Permit Application
<?i!!DEiSA'RTMENTl.isfONty~;ti
Permit no: S./O - IF J
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.
';i<!f,;t:<;\,;~IIOCAL:"G()VERNNlENt,';ApF,'ROVAI!J,0f~;;;}~J;"~,:
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEGORY, .oF C.oNSTRUCTION >,
o Residential ' I 0 Government I 0 Commercial
',i;:iii!t,'JOS; ,siTE , 'INF.oRMAfIONi;iANP,,'[OCA]lON!r;XL\ ';:'
Job site address: It.?? J r
City: S PFCi) I State:(9~ I ZIP:9'l1f1J1
Reference: (IU :J:'Jto~\ ' I Taxlot.:\lMW
,.;i,j":'):X"'"',~fK':'DEStR.II?TI(jN,,l.ol;,iWORK;:,1~;t;;f,;f;\"\i'ii;',;{';[;\
D ~ .. u L F,D~ b.- <\IIJI<:- 4-
,
I U=:-/V\ ~'C-'-
" . PRO/?ERTY,"OWNER.i;",!?';:'\',;..''!'C;;::i)i;,ft,',iiW:;
Name: ( 00-'-"', 0
Address: I C7 J F
City:
I State:
I Fax:
I ZIP:
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 GAR 918-695-0020.
Signature:
CONTRACTOR .,INSTALLATION "
Business name: ...,ic'\"t('J..:> p~ "l' tV
Address: Po \Sex ')1Lj-~ F
I State:
I Fax:
""":"';''',, '
City:
Phone:
I ZIP:
E-mail:
CCB license no.: I.) g- 2'/ ';> I BCD license no.:
Plumbing license no.:
Print name:
Signature:
CJ~{\It;I'1-I\-<.- ~'NT~'C>07---
Sly N,^~vzE P'I!lD,\-<=-/'-"
roc> ~ 2.. St:-"t "'-5 j2.{)
W"IT7"-<;;c c,.,z<Jv~
t3e-iS
~
, 'iO'1 n
440-2500-J (11/08/COM)
.',',,:., "~:~'/~.:J:"h~s~< J~:rf::~;~~'~~fr:~-FJ:-E~:~s:cH I;DdEE{~:~,~t-,:',3~f~~~:j:,:~:~2!if,J~~~~2?'
-,-;-'.' "";'''''' ',,', ''';':j' "';,:"':0-:,',,,,"";'; -''''f',:' '-.;.1:- .,",ii . '''C'' ("'." "T (' V:"
'..Desciiptiori';j"""""""7,;, ,,,.,,,"1' "";;IPty"'" os ,-" ." 0 a;,
;:;/ r;;16?;,.,:;';n:,'~;f,~'c_,~';:0:t,\~tl~~?:!..'J t"~;;;:;:; :,;~::i;~"~':'\~> t '<'. :,..,;i;,.~; '",!:.e,~;:~z\K; fi;~,;:'~o_$ljl{;
New residential
I bathroomll kitchen (includes: first
IOOfee' of water/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathroomsll 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 Dlan review)
o to 2,000 square feet $58.00 $
2,001 to 3,600 square feet $116.00 $
'3,601 to 7,200 square reet $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 ree $58.00 $
Each fixture "2- $19.00 $) ~
Miscellaneous fees
100' storm, sewer, water line $76.00 $
Each fixture, appurtenance, and piping $19.00 $
Stonn water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
systems exceedine. the first 100 feet
Specialty fixtures $19.00 $
Reinspection (no. of hr" x ree per hr.) $58.00 $
Special requested inspections (no. of $58.00 $
hrs. x fee per hr,)
Each additional in~pect;on: (I) $58.00 $
HM_~~i~~:i'(g~rprprgg:tr:~;.$11~:}~[~~){~i~~4~~~~' Minimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
,.......-"'~\lf1l1i'D.',..........,_....-....~"i'~"~
g::4?;~~iA;~.,R,,~'""'_,,~ ,,"~&g~'~~Nr~~.SJ;f,:? m<~ ,,-~~~.: ~ .,,:
(A) Enter subtotal of above fees $ ~fC_;::
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [All $
(e) Enter 12% surcharge.C.12 x [MBll $ c,~-
(D) Technology Fee (5% of [All $ 2- ..~
TOTAL fees and surcharges (A through D): $ &7 ~-
.;; . ~:?...
;''''
CITY OF!{S!,?,R,INGFIELD
")",:J, ;..)'1' .;.li ','
Building I,Residential Permit
~~' ',' p '"
www.ci.springfield.or.us
PERMIT NO: 811-SPR2010-00188
IVR Number: 811165603733
PROJECT STATUS: Issued
ISSUED: 8/31/10
APPLIED: 8/31/10
EXPIRES: 2/26/2011
VALUE: $0.00
225 Fifth St
Springfield,OR 97477
Phone: 541.726.3753
Inspection Phone: 541.726.3769
Fax: 541.726.3676
permitcenter@ci.springfield.or.us
SITE ADDRESS: 1673 F
ASSESOR'S PARCEL NO:
: , SCOPE:
", " W9RK INVOLVED:
:rY~E OF STRUCTURE:
Springfield
1703362116900
.,M'
PROJECT DESCRIPTION:
1-_,""',):, ,
Move kitchen sink fixt~~e1,.:ad.d icemaker
Phone Number:
OWNER:
ADDRESS:
lOOM IS RAYMOND l & LINDA F
1673 F ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION ~
Contractor Type
Contractor Name
SIGNATURE KITCHEN & OESIGN'INC
JOHN'S PRECISION PLUMBI,~~."t~q' l~~.!i':q.T( ~
Lie Type
GGB
I, ~. PLUMBING
lie No
180485
2D-42~PB
Lie. Exp
02/11/2D12
07/0112011
Phone
541.686-3356
541-736-8690
# of Units:
B~!:9ING,INf,9~MATION ~
# of Sto'ries:
I Height of Structure:
Type of Heat:
Water Type:
Range Type:
o
# of Bedrooms:
Hazmat:
Sprinkled Building:
, '
Fire Alarms:
. ,-. . ,,~::?: i, :.. "
Electrical Specially Coile Edition:
.' " .
Sp~rigfie'ld Fire Code Edition:
Mechanic'al Specially Code Edition:
Municipal! Development Code:
Plumbing Specially Code Edition:
ResidentjaJ Specialty Code Edition:
Structural Specially Code Edition:
Energy Path:
Site Information
Engineered Fill:
Fill Volume:
Flood Hazard Area:
land Hazard Area:
Retaining Wall:
Soils Report Required:
..\.ft;t4; ifK!~W;;~N~,'
.;;.;,.:;:~"';':;: '+S:o:::.~;;;.,,:'::.,
". ,J.'
, ; ':-
.}4~~~~ ~.; ;~,lQkS' ~.l'
Springfield Building Permit
i,"
, 8/31/2010 1:23:24PM',
:';0;:" 1,,','11; :>:;:. '
, "
i:;'~';}~':'f?~~l/ ,\,,~'
< :tl
lot Size:
Sq Ft1st Floor:
Sq Ft2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other:
Occupancy Load:
. (....8'1:-'1:88.008- ~ Sl Ja\Ua8
v v 6 0 aLl\ JOI Jaqwnu
UO!\BO!I!\ON A\!I!\n UO) a'~a uaO aLl\ 6U!ljBO
aUOLldaja\ aLl\ ,a\ON \ ABW no" '0600
Aq SajnJ aLl\ 10 S8\d~JQ UIB\~~. ~OO''1:S61:1'iO U!
-IOO''1:S61:1'iO Ll6Jnas~~~ \alua8 uO!\BQ!I!\ON
4\JOI \as aJ6B sa1naLl\ Aq pa\dOPB salnJ MOllol
'~I\n uo aJO 1'':<;/
'noA saJ!nbaJ MB\ uo6aJO :NOIIN3 .1.
z...:: },'ii~~?i'-:."!<'
NOTICE: EXPIRE Ir1HE 'NOR" ::
THIS PERMI1 SHl\.lllHIS PERMIT IS NOT "
P,U1HORIZED UND~: I\.BI\.NDONED fOR ...",
COMMENCED OR ,,'
I\.N'Y i BO DI\.'Y PERIOD.
Page 1 of3
. , .
,- {:;:: ".
www,cLspringfield.OLUS
;':( ~'~1,,:j;h,;;,'; ~, 1,\
CITY OF:SPRINGFIELD
. Building I Residential Permit
PERMIT NO: 811-SPR2010-00188
IVR Number: 811165603733
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
sr~:~..~~~
l~~
~OREGOH
permilce nter@ci.springfield.or.us
PROJECT STATUS: Issued
".-" j,,, '.' '.
ISSUEOFs/31110":: I
,::;';r:;.c,;'_. ",';-',":. ":;:.~:
APPLIED: S/3,1I10 .
. "t!'(,)",;:;.'.. ,.. f~:.l,~~ " {
'L' .
EXPIRES: 2/26/2011
VALUE: $0.00
SITE ADDRESS: 1673 F
ASSESOR'S PARCEL NO:
Springfield
1703362116900
SCOPE:
WORK INVOLVED:
TYPE OF STRUCTURE:
PROJECT DESCRIPTION:
Move kitchen sink fixture, add icemaker
DEVELOPMENT INFORMATION ~
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd: ',:
%, _o!!,.,1::0~ -Coverage:
Highest point"ofi!s.t,ructure to'
north property line:
REQUIRED PARKING
Total:
Handicapped:
Compact:
PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
,!~~~t~ :':,':\"';"/"'.,..0,.: ',!, ::,'
'';,',~':.'.;,'':.:::: '.. '
Downspout/Drains:
Valuation Description ~
Descriotion
Tvoe of Construction
Unit ~mount Unit Tvoe
Unit Cost
Value
1. ;,
.._ '1:"
r;:, ,,::,]! J}~':; ,?:-~"';:~~_~0, -~~;0~':2~{'~J:"
".",o;c,f ',~fi_ 'J.:w::~~:::T~E"" TE~S' -;>P-"'''"''''''''D;;'!i''?t;-';h.5:'~J?:;r<.';":' :::;:;if:Ft: ,,:. '''t-''{,':f.];;rU "1":;':~r.J" ;!'-"".-,;.,-';:'-S;: F;;; - :::-;-~~{
''';' .'t>'U-- l't~".tfD2q,____ ,,- .AI .i(fP.Jf.i!J, ~ ''i'w,.,:;''1:Iw w"j~'1:<d'",;",..'i:--,'!iJL" %)0},;rr,~", "'--, . --. -,I',~"~ ,."'"~"" ~
;;',", ':,.~",,: .Amount Paid Date Paid ReceiDt #
$19.00 08/31/2010 299377
$19.00 08/31/2010 299377
$20,00 08/31/2010 299377
$6.96 08/31/2010 299377
$2,90 08/31/2010 299377
$67.86
DescriDtion
Sink/basin/lavatory
Fixture
Balance of Minimum Plumbing Permit Fees
State of Oregon Surcharge (12% of applicable fees)
n;chnology fee (5% of permit total)
Total Amount Paid
:~)b'/~' "~:(li.-';'iiY:""
:,-.':,~'':.;.: ,.::.'T; ~:'.~..
.,'.'.','-,..:..,..'.'....,-,.,,:,., "'. '
',' ;,'~,j,.~..:;':.;'".'!,",
.......'.,.,.... "
Springfield BUilding Permit
8/31/2010 1:23:24PM
Page 2 of 3
..
SPj\H:'~IE~
~-~
",~
. ,';- OREGON
CITY OF SPRINGFIELD
Building I Residential Permit
. ...
PERMIT NO: 811-SPR2010-00188
~ , .'
225 Fifth Sl
Springfield,OR 97477
Phone: 541-726-3753
Inspeclion Phone: 541-726-3769 '
Fax: 541-726-3676
www.ci.springfield.or.us
permitcenter@cLspringfield,or.us
IVR NUI1)IJ,llr: 811,J65!!03733
PROJECT STATUS: Issued
.,\,_..il,I,f'J
ISSUED::8/31/10
APPLIED: 8/31/10
EXPIRES: 2/26/2011
VALUE: $0.00
SITE ADDRESS: 1673 F
ASSESOR'S PARCEL NO:
Springfield
1703362116900
PROJECT DESCRIPTION:
SCOPE:
WORK INVOLVED:
TYPE OF STRUCTURE:
Move kitchen sink fixture, add icemaker
",~",,:~r;,'tt--'-:r"?'~'*7>._,~;jj$~iA:~.~~"~::'::\:::::;j:'.\~"'::?~rif.' 17~~~r.$:i~ ,~'~,~'''i;FS\\'<Gi''':A'fiJT'-=::-~''''''''~''::'\7~t'7'~'+;;;;:Y>1-;<::'l!~ ~";-;.T" .:'~.;:-
:<.<.: i2Q
,c-..:"t~'c~'".T~:J,~''' \'1;", _0 ~ J"'''''''''''''''':~.'t::..- .'< J; ,w'y:}lim;rr%;,,,,,. _+....{I,",..:'" .Plan,Revlew ~',-, ,~~ ~5::"j%'L,;:,t'i,&"Tk'~~';'t:,;,!.p",",,;;. 'd"A:j~'
".,,-_%,1. '~1i~ " ",_~,v~,^
.... .....~ ....,R..._ ,....~ ._......c.. ..ic"" ..._...............~,,_ ~.._...._ ".,_u~.._."...,'" ....,...., __~~..,_~,...~.,.........,......'......,....~,. ........
Department
Application Acceptance
Initial Review
Planning Review
Public Works Review
Structural Review
Permit Issuance
Received
08/31/2010
08/31/2010
08/31/2010
08/31/2010
08/31/2010
08/31/2010
Due Date
08/31/2010
08/31/2010
08/31/2010
08/31/2010
08/31/2010
08/31/2010
ComDlete:v
08/31/2010:'"
08/31/2010
08/31/2010
08/31/2010
08/31/2010
08/31/2010
Result
Oveithe Counter
Over the Counter
Not Required
Not Required
Not Required
Issued
Reviewer
Chris Carpenter
Chris Carpenter
Chris Carpenter
Chris Carpenter
Chris Carpenter
Chris Carpenter
Comments
Over the counter permit
Over the counter permit
Over the counter permit
Over the counter permit
Inspections
INSPECTIONS REQUIRED ~
By signature, I state and agree, that I have carefully examin.e,d)heJct;>rDRIf?te..o.'applicatlon and do hereby certify that all
information hereon is true and correct, and I further certify..,.thc;lt any and all'work performed shall be done in accordance with the
Ordinances of the City of Springfield and the Laws of 't~e'.$_iate or 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
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 ro erty, and the approYe~ set of plans will remain on the site at all times during
construction.
Owner or Contractor Signature
Springfield Building Permit
;H (
~';~ei3~If ':'{~YP~'fB'at~~ .r
.,:~i:"GF';. "
-- . ;,.'~,'.'.~~-,"",.'-,:_:,,' ",~,
i20~G:- ..
:r.11Y
';:-.'.
,:i), .'.i \! !' .. ~1.:'I~'
"
8/31/2010 1:23:24PM
Page 3 of3
~. "
. ~.~t~~ '<:~~, ;~'~~ft;~ ,"
. , .
SPRIN,G',~L~
~JI;\".
':c. rt1i
".\ OREGON
TRANSAC,TION RECEIPT
811-S~R26;1'O~dO 188
16i~ FST
www.ci.springfield.or.us
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
pennitcenter@ci.springfield.or.us
.'f'
RECEIPT NO: 2010000188
.....,.'^~~".
'L ~fi:~;' :"
RECORD NO: 811.SPR2010.00188
.'.
I DESCRIPTION
Sinkfbasinllavatory
Fixture
Balance of Minimum Plumbing Permit Fees
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
~:-_..
""')~.',., '.j:,,:' {:
. '~,[t.O.i.fN:CCJ:~QE'." " . ,,,,,' ,
224.00000.425603
224.00000.425603
224.00000.425603
821.00000.215004
1 00.00000.425605
TOTAL DUE:
I . PAYMENT ,TYPE; . PAYOR: ,.;cAsHIER:ccARPENTE'R'>:'COMMENlS',
Check
2470
SIGNATURE KITCHEN &
DESIGN INC
,{.?p
:..~! ~-'
. ,_ 'rjU
"d,)
DATE: 08/31/2010
"<"1
4~~6J.!~Jj:tU.IO""
$19,00
$1900
$20.00
$6.96
$2.90
$67,86
. AMOUNT PAID.:; ,.
.."',
...t"
. -I t.
. -r:.::1.. r .
h';i '(')"'(' ~"
!'J I.:"..',' I
.' ,
.;::::.;::~ r
i)
: \ t-/l1 "'. ~.. '~/,P~':: r
~ ",,;<~
:..:''''. :- '.~":.. ~.
'i;f~.. 't) :iIY.( ~-I
:.1 .-.
, .;.'; 'J.~ ".~'
) { -,j
. ,";' ~'.
i\,~,' ~_, :
"r:': i
$67.86
$67.86