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Home My WebLink AboutPermit Plumbing 2010-10-12 Pluinbing Permit Application . <' ".' !,. . i~, . (try OF SPRINGFIELD, ORE:GON , . v.',~ .iT};-~"':_ ~:. t. .'''';;- i ,,-.J .'-. _-\"i'l-.,r.-:;".{~'~"'. 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 SPRINGFIELD "-.,.;'" "'~"'->"""-"':;''::---''''-'.' ,....,; ,," ...,-:, -',;~. ;...,'......, "", DEP~RTMENT USE ONLY,'r;' Date: Jj) ~ J '2- - J-g 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'iH\::'..?(iEOCAl2i,GOVERNMENT:;.APf'ROVAl!i8y;;:::'1'{1:7/> Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY' OF, CONSTRUCTION ~Residential D Government D Commercial 'iii'i;;;tJClB!SrrEINFORMATIQN\'AN[)':[OCAT:JON{ ",:,.. L\~ d . Name: PROPERTYi'OWNER";;~ ..'< "2) '.,-~.., ". <:'." ;'7;~'~>:,:". ',':~~\' City: ZIP: ~lL\ l1 Phone 5-\\- ~ E-mail: ~XI.S e; ':" n ' Qo,\ This installation is being made on .residential or farm property owned by me or a member of my immediate family, and is exempt fro licensing requirements under OAR 918-695-0020, Signature: "~ CONTRACTOR.INSTAllA TION.. Business name: Address: City: Phone: E-mail: CCB license no.: Plumbing license no.: Print name: ZIP: BCD license no.: Signature: 440-2500-J (lIIOB/COM) I,r> ,~,;,>.:<",-, :;st,")iffFEE(fSCH EDOI.:E;:;;t<'t\i~ni'1i!+\,'"~,t~!':~) ;- ";';'i; ,":,tiirJ;:c1B~, f~5~~~t :;\~~~!;) New residential . 1 bathroomll kitchen (includes: first J 00 leet of water/sewer Jines, hose $238.00 $ bibs, ice maker, under floor Jow-point drains and rain-drain packages) 2 bathrooms/I kitchen' $374.00 $ 3 bathrooms!l 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 ree V $58.00 $ Each fixture $19.00 $ Miscellaneous fees . 100' storm, sewer, water line $76.00 $ Each fixture, appurtenance, and piping $19.00 $ Stann water retention/detention facility $19.00 $ Irrigation systems $19.00 $ Piping or private stann drainage $19.00 $ svstems exceedinl! the first] DO 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 $ ~:ft4e(ifi~iig~;~!pi'p'i~g:HA,~kB:~'j},::,'~;.<F:~:) .. .. f/P}{,: Minimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ t~l;:-We;~;,~tA~:li~~:'&~~~h~;:~~~j\Fle~)C:A'N:fJJfis,~~!?itt3;~?t0~_i~~~~~1$:{~~~ (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (. 12 x [A+B]) $ (D) Technology Pee (5% of [A]) $ TOTAL fees and surcharges (A through D); $ www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00496 IVR Number: 811177309615 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: Issued STATUS DATE: 10/12/2010 ISSUED: 10/12/2010 1 APPLIED: 10/12/10 EXPIRES: 4/10/2011 VALUE: $600.00 SITE ADDRESS: 1429 M ST, Springfield, OR 97477.3213 ASSESOR'S PARCEL NO: 1703253303800 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install New Electric Water Heater OWNER: ADDRESS: SHELTON ALLEN R & JENNIFER E 1429 M ST SPRINGFIELD OR 97477 Phone Number: Contractor Type Contractor Name CONTRACTOR INFORMATION ~ Lie Type Lic No Lic Exp Phone BUILDING INFORMATION ~ # of Units: o # of Stories: I Height of Structure: Type of Heat: Water Type: Electric Range Type: Hazmat: Lot Size: Sq FIls! Floor: Sq Ft 2nd Floor: Sq FI Basement: Sq FI Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: # of Bedrooms: Sprinkled Building: Fire Alarms: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: " Energy Path: Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. ATTENTION: Oregon law requires you to fOll,ow rules adopted by the Oregon Utility ~otlflcatlon Center. Those rules are set forth In OAR 952-001-0010through 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). Springfield Building Permit 10/12/201 3:07:59PM Page 1 of 4 .. www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00496 IVR Number: 811177309615 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: Issued STATUS DATE: 10/12/2010 ISSUED: 10/12/2010 1 APPLIED: 10/12/10 EXPIRES: 4/10/2011 VALUE: $600.00 SITE ADDRESS: 1429 M ST, Springfield, OR 97477-3213 ASSESOR'S PARCEL NO: 1703253303800 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install New Electric Water Heater DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: Total: Handicapped: Compact: . PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Descriotion Tvoe of Construction Unit Amount Unit Tvoe 'Unit Cost Value ~~"'27I>~'i;?i:fJl,,,7ief". _ ~::; '~,;~~~:~k,~~-~-;:~:",\ ~_:t, ~'_~:~\-;-:~ ;'f{"'" /771 ",,,...., ,%,..' r'>-- /";:::~:.t2'~, '.,~. " ,7r::s;~'75:~iG'''"G~'';t~_<~~!tT~~.;';T:Y':'?"$'2'''W:_''' -E,~ES ,PAID ,;' .;~ Descriotion Amount Paid Water heater $19.00 Balancwe of Minimum ~Iumbing Permit Fees $39.00 State of Orego!2.Surcharge (12% of applicable fees) $6.96 Technology fee (5% of permit total) $2.90 Total Amount Paid $67.86 Date Paid 10/12/2010 10/12/2010 10/12/2010 10/12/2010 Receiot # 374575 374575 374575 374575 Springfield Building Permit 10/12/201 3:07:59PM Page 2 of4 CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us Building I Commercial Permit PERMIT NO: 811-SPR2010-00496 IVR Number: 811177309615 permitcenler@ci.springfield.or.us PROJECT STATUS: Issued STATUS DATE: 10/12/2010 ISSUED: 10/12/2010 1 APPLIED: 10/12/10 EXPIRES: 4/10/2011 VALUE: $600.00 SITE ADDRESS: 1429 M ST, Springfield, OR 97477-3213 ASSESOR'S PARCEL NO: 1703253303800 SCOPE: Plumbing Only WORK INVOLVED: Repair lYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install New Electric Water Heater t~;~:<M:'~""!";:' .'-." ~: ::)'."-';>:.~~ro*;tzr';~-{ >I'~~.S?jY~I~'~~~_~I~;:~~t'~\f::::>',,~, -~.' r~'.\. ~,.',r:.~ "-~:;;;r~'~' -l ",'.~ ..., % ,- ':(t,." . ~ 0 _ ,,~ Springfield Building Permit 10/12/201 3:07:59PM Page 3 of 4 www.ci.springfjeld.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00496 IVR Number: 811177309615 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 5P~...I\N.G-..F.IE.L..~D.. . . ~"".~ /.'''",,^ ~J' . i;:::,'.:"" : 'OfU"GON permitcenter@ci.springfield.or.us PROJECT STATUS: Issued STATUS DATE: 10/12/2010 ISSUED: 10/12/2010 1 APPLIED: 10/12/10 EXPIRES: 4/10/2011 VALUE: $600.00 SITE ADDRESS: 1429 M ST, Springfield, OR 97477-3213 ASSESOR'S PARCEL NO: 1703253303800 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install New Electric Water Heater 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 ac~ordance 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 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 atthe 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. . ~AM~CV' ~)n 10- \/_ -)-0\0 Owner or Contractor Signature Date Springfield Building Permit 10/12/201 3:07:59PM Page 4 of 4 S!i~N.G.._FIEl~. . ~c aiL ",'o;:iI1 -''''",OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00496 1429 M ST CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 permitcenler@cLspringfield.or.us RECEIPT NO: 2010000550 RECORD NO: 811-SPR2010-00496 tl:!!,!?CR!E.ll0Jt~';,,:};";:;-~,", "~A'; " Water heater Balance of Minimum Plumbing Permit Fees State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) ';e'e; ,;:";;',' 7' \;'3'A'C' C"OU'N'T:-"C"O 0' E' ,;, ," ...""...~_u_" '..-~^ ~ .. "'.' ..__~ _ ........._.~ . 224-00000-425603 224-00000-425603 821-00000-215004 100-00000-425605 TOTAL OUE: DATE: 10/12/2010 '1"'v.-c-f' - '~MOJjNI.QUE -' ',:- ~ $19.00 $39,00 $6,96 $2.90 $67.86 H ,;'.~'-':~AMOUNTPAiD'.f. _ -." ,I 1'-;:ip.AYMENT.TYRE~' "RAY:OR'~ :cASHIER: KKAU~MANT?ZIci'(';dJ~!VJ:EtjJS:";":- :. Cash Jenny Shelton Cash $70 $67.86 $67.86