HomeMy WebLinkAboutPermit Plumbing 2010-8-26
Plumbing Permit Application
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
"~;,~t'6~PARTMENTusfoNi-Y;~l~\'
fl
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'i,;';l1i:\;;!IJ!()0A[;;GQVER.NMENT:API".ROVAJ!i~,~(t}!~~"';i;rf',;
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? ,0 Yes 0 No
CATEG,ORY 'OF. CONSTRUCTION
. "'.
o Residential 0 Government 0 Commercial
:","f~;)\JOB;:SI:rE' 'INF()RMMION~:JXIIIP,;IfO,c:;AJlON1;~tt/,;'it
Job site address: 2- 7),1-/
City: 31'pL- State: O-/Z- ZIP: 17'1?f
Reference: Taxlot.:
'/.".' ';<5!t'i's,'DEScRlpTI0N'OF.,mW.ORK ;;;;fift;i,\;':~".;i~~'}':
-=
e.
"
'Name:
Address:
City: c:1A. ' f:=."NE
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,
ZIP: '77 '-JO I
Signature:
, CONTRACTORJNSTALLATION_
Business name: CtAC1. S,; l...- fl...V,,IM,IC!>!'<.l :)
Address: ' s:- 2- '6 ~ w I L-L M-"'"'-
City:t:.U C, State: ZIP:
Phone:
. '----""""
<'BCD license no,:
Print name: S. 1;:::Vl"".--' tl^ 1'\-, ()-,.,.C'/
Signature:
~ \~D'\\\\I1)\\o/
~
440-2500-J (I 1/08/COM)
;~~~h;:~:;.:3';:.~\i~1;';J,~::~~{~q:~~?EEE~~~S:CH i;_D HEEi,J:;f'/,i+:.,::t!;!,?i';J~(~1{,*I~~?~!.:~N
",:,,,,,~;,'fi';i': .',:".,\;...."..i"O',.:. ,'""t ",i. " <'" ,'t., F,""T lit'"~
"DeSCription'''"""""",,,,,;,, '''.'f'''"' '..0 Qty. ".os 'i"" 0...
il, ,A ,;,:",,;.,-::.,t\};i,1{e<,:/s*~~~f;~:t.S{S:\X t::t:-(; - f'~:'ii;.i;l~,;~;t: t~._,_ .~,<r: ~:;:: f'. ~~~,:;-iV;}~~;:~',~lJ_~t:;~~. :
New residential
I bathroom/I kitchen (includes: first
100 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 bathrooms! 1 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 feer $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 $
Each fixture, appurtenance, and piping $19,00 $
Storm water retention/detention facility $19,00 $
Irrigation systems $19,00 $
Piping or private storm drainage $19,00 $
s"stems exceeding: the first I 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 $
t>ij'eijit~i:;'g~~s'_!p'fpritg~lt~~N~It;;t~:j(xi~;t~~~:) M\nimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
~-"'-''''',I'~;';;i:::t;;-~~'-'''''-~'',",;''C"'L'~''~:''-''lfr''~'"''~~"~'~~'^"-
~Vil~fA~r:~;~,::"- ,'. :~~~HL~lC~N~~l:J,,~,~~~~~~\',. :.:~~' ,':{~@
(A) Enter subtotal of above fees $",<1,)''1'
(Minimum Permit Fee $58.00) D
(B) Investigative fee (equal to [A]) $
(e) Enter 12% surcharge,(.12 x [A+B]) $II~
(D) Technology Fee (5% of [A]) $ 'i ?S../
TOTAL fees and surcharges (A through D): $/(/./''(
. '
S~.R....INGF.IEL ~
~~'l_
j'-~~"- ~
. . \tiU
'~ OREGON
www.ci.springfield.or.us
,
CITY OFSPR'INGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00147
IVR Number: 811167286994
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or.us
PROJECT STATUS: Application su
ISSUED: 8/25/10
APPLIED: 8/25/10
EXPIRES: 2/20/2011
VALUE: $0.00
SITE ADDRESS: 126235TH
ASSESOR'S PARCEL NO:
Springfield
1702303409600
SCOPE:
. WORK INVOLVED:
lYPE OF STRUCTURE:
PROJECT DESCRIPTION:
Change service and add/alter 10 circuits
OWNER:
ADDRESS:
HECHT INVESTMENTS llC
329 E 8TH AVE
EUGENE OR 97401
Phone Number:
Contractor Type
Contractor Name
CONTRACTOR INFORMATION ~
0'_",_ ....__.. __. .. . Lie Type
lie No
Lie Exp
Phone
--:>>"
BufLOfNG'U'lFORMA TION ~
~ ~"
,
# of Units:
o
# of Stories:
I Height of Structure:
Type of Heat:
Water Type:
Lot Size:
Sq Ft 15t Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
ATTENTION: OrerSqFI'G'Ma"g.':lires you to
follow rules adopts(1 ?tYcthA wegon Utility
Notification Center. ~'loseafBYes are set forth
- .'in OAR 952-001-00.!tqlfiH?.!.h,;,r,:OAR 952-001-
.Oq90. You may obtci6cilP!i~c9 c6alle rules by
Electrical SpeCia!ty"Code €dlUb'h'i the center, (Note:. the telephone
Springfield Fire Code Edillbh'1lber for the Oregon Utlirty Notification
Mechanical Specialty Code Editio,Qenter IS 1.800.332-2344).
Municipal I Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Code Edition:
Range Type:
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Hazmat: r
Energy Path:
I:~'~ Site Infonn~tion
~
Engineered Fill:
Fill Volume:
Flood Hazard Area:
land Hazard Area:
Retaining Wall:
Soils Report Required:
-.-.~. .. ...._-~_.
._.___ _,.'_~'.h.. _. _ ._
,.... .
.......:....l ., .~,,,j 't"
Utti:r;:i ; '/JliiJ..:: .
""'":'-' . NOIICE:
, , . THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
P(jUW'v31 {V ~
I '
o-rv L '(
Springfield Building Permit
::r_"l'~,iG;' ,'l~' ('
". ,8{26/2010 '11:36:44AM
:"";'k
Page 1 of 3
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I};~~~.id.~ntial Permit
PERMIT NO: 81:tcSP~2010-00147
,.,;;'1 r',~;';" i ,;.~ili'{i; :'1'
IVR Number:,8'11'1117286994
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: Application su
ISSUED: 8/25/10
APPLIED: 8/25/10
EXPIRES: 2/20/2011
VALUE: $0.00
SITE ADDRESS: 1262 35TH
ASSESOR'S PARCEL NO:
Springfield
1702303409600
SCOPE:
WORK INVOLVED:
TYPE OF STRUCTURE:
PROJECT DESCRIPTION:
Change service and add/alter 10 circuits .
DEVELOPMENT INFORMATION ~
.,
,"
Frontyard Setback:
Interior Setback:
Sjdey~rd Setback:
Rearyard Setback:
Solar Setback:
"","
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure to
north property line:
REQUIRED PARKING
Total:
Handicapped:
Compact:
PUB[~IMPRbvEMENTS ~
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
SUbdivision Accepted:
Notes:
~.;~-:~}~}~ /;::t::!\~.~~;~~ .
';;'~nh"~ 1"-:: ,\ I
Sidewalk Type:
Downspout/Drains:
. "~ Valuation:.o~scription ~
f.!f,;>;:~;';
':, ,.,'.......;:.-..;" "
Descrietion
Tvee of Construction
.'
'Unit Amount Unit Tvee
Unit Cost
Value
r';;!T::jV"',.~.. ,'" '".,'''''''.,....._'**'',.'-''*''0f,~~__. "'J"7""~~~~""'0S'~?ii<,~~.,..--",~v;~'",---,;"::.lt~,~'C"~~,~"f"C;'~"'i)U:T~0 >1j'Zif,,-,~.~" .,,.. ,'~'"-~n~~::J~-;"-
~
'1, ~".,~~."~,~-'t\S,.+", '.".. 'f. '. - ..'",\ ~"''''If.J'tr,,~1r'1;cl' .1;;..2/ ~., , ,....... .<t2'k"R"'" 'h"'FEES,PAID. 'l"~"'i+:""'ftf~"b:Jtlj"......,..(;o,.",-",...~li::~'-'t.
."'f";..';....:..., .., ," ..~' ."..t{."...-,."... ..N'. "',;,.-'C. ,"
-.~. ,,,"." --". ......,...... .. i', ,...-.... '.-..:-'~..= ,..~" ~" ..-....~. ' ..~.~........___... ." . M'~'" ...,-,,: "~",' .~ ...,,-. ..'~ ...... . '. ". ,~ ."...;......,.. ~..~
. ';1
Descriotion
Fixtu re
Technology fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
Total Amount Paid
Amount Paid
$95.00
$4.75.
~'!- .'
JUC ,"," ,,$.1J:.40 .'.
..,.~~~.-.~:~$rfff5'} .:,~,. 'I
Date Pa id
08/26/2010
08/26/2010
08/26/2010
Receiot #
299330
299330
299330
~7~:;i?;:"~;~:i~,t::V\- i,,;U,~:~IW:;'S.~~~~',~~~~~#,ffiffiR~~i@Jis,:~G:~::~~~:fih~~:t:;; --:~~:-~:~. -.,~-;'2::2;,;-JLj
Deoartment Received Due Date ComDi~t~;;~ R~~ult Reviewer Comments
Springfield Building Permit
8/26f2010 11:36:44AM
Page 2 of 3
l~~t .1 f" . 1--'
~!~~'~';i- ~ '-i. . ~ ;..n, ,:i~:'~:t""l
5.~:.~\N~~E~
liittth
';:;''OCOREGOH
www.ci.springfield.or.us
~ ' ."
CITY OFSP.RIN'G'FIELD
~.;",.~ i" ; ,! ;;,1 f~' ;"1,'Y" . . .
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
BuildingY'R.esideritial Permit
PERMIT NO: 811-SPR2010-00147
IVR Number: 811167286994
pennitcenter@ci.springfield,or.us
PROJECT STATUS: Application su
ISSUED: 8/25/10
APPLIED: 8/25/10
EXPIRES: 2/20/2011
VALUE: $0,00
!'.'.'
SITE ADDRESS: 126235TH
ASSES OR'S PARCEL NO:
PROJECT DESCRIPTION:
'~::,*~:\~~ : ~~.~, c~;'~~~t;;c;::':; SCOPE:
;::,,;+ ::::.,:'{'.,!'. . WORK INVOLVED:
."t):!., ,:,~lffp~ OF STRUCTURE:
Change service and add/alter 10 circuits
Springfield
1702303409600
INSPECTIONS REQUIRED ~
By signature, I state and agree, that I have carefully examined the comp1etl?d application and do hereby certify that all
information hereon is true and correct, and I further certify that anY and ,~n'iwo'r~' p=~rformed shall be done in accordance with the
Ordinances of Ihe City of Springfield and the Laws of the St?te.:oiOregon;p~rtaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without p.,e.rr.)S.~ipP of,theo;~iqmm'unity 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.
~
own~or...c.ontractGr'Signature
Inspections
3500 Rough Plumbing
3999 Final Plumbing
Springfield Building Permit
~( 2- (, ( l '"
" "
. I Date"
.~U' ~,(,_ " .
.~_~~:t~~:;~'~; 'f ~
":: 14\:'~, ~'_
- ,,-~,,':..':'";,'.
"'::'_-;~'.'"
. 0,
1!1
, ~',:' I :,
(:i"~~:i:~r.f;
':t", ,f'
~jL~
,.. .jj.~~.;;' .';::.L:~'~,-:_,..~-
.:~'~~:~~;Z '.::~~}',~t~ .>';.
"~("'t ,'8/26/20'10"E}I~ :36:44AM
Page 3 of 3
. ,~\'b'; ,,<;.:[11.'
S!:~ING. FI.E~~.
~'
.~..
. h:. OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00147
1262 35TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541.726~3753
permitcenler@ci.springfield.or.us
RECEIPT NO: 2010000145
RECORD NO: 811-SPR2010-00147.
DATE; 0812612010
!Q:~'pRIPTj0rt..L.:::; ;';;;1&yJt!"~;C;-:"2::1f;;I,i'j:'ll"~;Ei?',;'~':~l,,".6.c'C:QiJNfLCQI)E~;;;)~';;'-l\M.QQNJj)_U_E~;" .:: .:..J
Fixture ". . 224-00000-425603 $95.00
....~-_..-
Technology fee (5% of permit total) 100-00000-4.,2':;605 $4.75
Slate of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $11.40
TOTAL DUE: $111.15
[~;"F)AYMEN].fYPE,"'+mPAYOB~';:~CI\S~IERJcce-BiiENtEkli'l;C_QiiiMl:rii:S"-~~'.. .,f..~: '.; lff.:lt;1;:.;lr-ij,; :i\MOUNrI"AID-,':;l . '; " ~'I
Check
1043
sean mahoney
$111.15
"r' ./.
u
'"
;'C::~'_'" ,.,...*,
$111.15
:,'L.,
..:;::~~r: '.'
,i' , .~
.! /'
;.-11..;.:...."
. .J\"
v~