HomeMy WebLinkAboutPermit Plumbing 2011-2-1
Plumbing Permit Application
225 Fifth Sl"et. Springfield, OR 97477 . PH(54])726-3753 . FAX(541)726-3689
SPRINGFIELD
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Date:
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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.
'5'Y;~i!1'!i{;\'~:~I!!OCAL;,GOVERNIVIEr-JTi"ARRROVAI!:(i>r~"'N\w;~'~'1'1:(
Zoning approval verified? DYes D No
Sanitation approval verified? DYes D No
CATEGORY OF. CONSTRUCTION' ',,'.
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 ,INSTALLA liON "
Business name: b
V
-(O~
Print name:
Signature:
440-2500-J (] ]!08/COM)
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New residential
] bathroom! 1 kitchen (includes: first
100 feet of water/sewer lines, hose
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms/! kitchen $374.00
3 bathrooms/! kitchen $439.00
Each additional bathroom (over 3) $95.00
Each additional kitchen (over I) $95.00
Residential fire sorinklers (includes Dlan review)
o to 2,000 square feet $58.00
2,001 to 3,600 square feet $116.00
3,60! to 7,200 square feet $174.00
7.20] square feet and greater $232.00
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and
water supply
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee
$238.00
$
$
$
$
$
$
$
$
$
$58.00
$
Each fixture
$58.00 I $
$19.00 $
Miscellaneous fees
] 00' storm, sewer, water line $76.00 $
Each fixture, appurtenance, and piping $19,00 $
Storm wat,e(r~t~~tipn/detention facility $19.00 $
IrrigationlSY.~t~mJc~l\IIIT "II ^' ....." ...J_' _ _$19.00 $
Piping or,private_stOfm'diain'agE'LL Ll\i Ir.c Ir I Mr: v~ U!:.iK
systems exc'eedlh,nheffiFstl100-feet~ TI-l c: Df o~~~P'98 \1,$IT
Special!f,fixtu!I'i:NCFn nJ:, I~ ~R~ ~]nn \]~'.$,1~.,iJ~) '$'
ReinspeCtiOi{(i)<8 9f.IJ\s.~x~iP'er,I)\,) $58.'60' $
Special requested inspections (no. of
hrs, x fee per hr.)
,
$58.00
$
Each additional inspection: (I)
, ~ ~ Mjnimum fee
Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
~~~~i~~flR~'iciAN-j;~ilstl~~jlfnti.~
(A) Enter sublJllal'lih:Dove f;es /;> rD
(Minimur1l%mit Fee $58.0~ $ S;S:
(B) Investigauve-ree (equa] to [A]) $ C _7u
(C) Enter ]2% surcharge (,]2 x [A+B]) $ M< tii:.
(D) Technology Fee (5% of[A]) $ / r /
TOTAL fees and surcharges (A through Dj: sf ))/:'7 <0
$58.00 $
$
..
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. . ..,,',,' OREGON
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2011-00150
IVR Number: 811138844873
www.ci.springfield.or.us
225 Fifth Sl
Springfield,OR 97477
Phone: 541-726-3753
Inspeclion Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
ISSUED:
APPLIED:
02/01/2011
02/01/2011
Issued
02/01/2011
EXPIRES:
VALUE:
07/31/2011
$0,00
SITE ADDRESS: 2108 BONNIE IN, Springfield, OR 97477-6510
ASSESOR'S PARCEL NO: 1703251209100
SCOPE: Plumbing Only
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Backflow Device
Phone Number:
OWNER:
ADDRESS:
SPINK ROGER
21 08 BON~IE IN
SPRINGFIELD OR 97477
Contractor Type
Contractor Name
BUILT BY DESIGN LLC
CONTRACTOR INFORMATION I
Lie Type
CCB
BUilDING INFORMATION I
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Hazmat:
# of Units:
o
Lie No
184126
Lie Exp
10/01/2012
Phone
541-942-6834
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other: 0
Occupancy Load:
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:
Site Information ~ 'reS 'IoU 10
on ~a'l'i reC\uI on UliliW
'\I:.\'l"iION: ore~ec\ '0'1 1M ore~e sel WIn
P>-' ruleS ac\oP ,\1ose rules a R 952.-00~.
~~I~~~alion ce~:~~~ 0 l\1roUg\1 ~~\1e rules '0'1
,,0 R 952.-00 , 'copies I p\1one
in oP>-o 'Iou ([\a'! o'oI~ln\Nole', t\1e ~o~i\icalion
009, l\1e cenle ' U\lIIW
calling \ 1M oregon 332.-2.344),
nu{[\per or ler is ~ _1300-
Cen ,
# of Bedrooms:
Sprinkled Building:
Fire Alanns:
, Energy Path:
Engineered Fill:
Fill Volume;'
Flood Hazard Area:
land Hazard Area:
Retaining Wall:
Soils ReportjRequired:
,~U 11..01:.
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
r,:)MMENCED OR IS ABANDONED FOR
, "',1 en DAY PERIOD,
Springfield Building Permit
2/1/2011 9:04:15AM
Page 1 of 3
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2011-00150
IVR Number: 811138844873
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permilcenter@ci,springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
02/01/2011
ISSUED:
APPLIED:
02/01/2011
02/01/2011
EXPIRES:
VALUE:
07/31/2011
$0.00
SITE ADDRESS: 2108 BONNIE IN, Springfield, OR 97477-6510
ASSESOR'S PARCEL NO: 1703251209100
SCOPE: Plumbing Only
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Backflow Device
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
DEVELOPMENT INFORMATION ~
Overlay Dist:
# Street Trees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure
to north property line:
REQUIRED PARKING
Total:
Handicapped:
Compact:
PUBLIC IMPROVEMENTS
~
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
Downspout/Drains:
Valuation Description
~
Description
Tvpe of Construction
Unit Amount Unit Tvpe
Unit Cost
Value
FEES PAID
~
Descriotion
State of Ore~on Surcharge (12% of applicable fees)
Technology f~.. (5% of perrT1itto~,._..,
~ackflow preventer
~~~~~Mini~~.~1~mb!!2.~_~ermit Fees
Total Amount Paid
Amount Paid
$6.96
$2.90
---------.
$19.00
$39.00
$67.86
Date Paid
02/01/2011
02/01/2011
02/01/2011
02/01/2011
Reciot#
2011000196
2011000196
2011000196
2011000196
Springfield Building Permit
2/1/2011 9:04:15AM
Page 2 of 3
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2011-00150
IVR Number: 811138844873
www.ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
02/01/2011
ISSUED:
APPLIED:
02/01/2011
02/01/2011
225 Fifth St
, Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@ci.springfield.or.us
I
EXPIRES:
VALUE:
07/31/2011
$0.00
SITE ADDRESS: 2108 BONNIE IN, Springfield, OR 97477-6510
ASSESOR'S PARCEL NO: 1703251209100
SCOPE: Plumbing Only
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Backflow Device
Plan Review
I
Department
Application Acceptance
Received Due Date Completed Result
02/01/2011 02/01/2011 02/01/2011 Over the Counter
Plumbing Review 02/01/2011
Comments: Over the counter permit
Initial: Re'Vie0',>,':<;;,"';::J0t,~' ,--"~02/01/20'11~'
_, ,"c'_ . '^">>- 'i:''':/i;;;,;;:wc:t,,,s;;c'+';'0f:~W-;''
;,. Comm~rits:-" ::'c.Qy~,'r~tt;;Lf,qul1t~rJ?~IDtt:.A~4f\
02/01/2011 02/01/2011
Not Required'
;02/01/201J,"::02/01/2011' ~ 'Over the Counter: .
;,.,~'~;;;-~~~:~b!,Q~:~,;~~:,t:ii:t:S~,~\~,~~:~:~':~ . < _
INSPECTIONS REQUIRED I
Inspections
3620 Backflow Device
Reviewer
Nancy Machado
Nancy Machado
" '; Na-ncy'Machaao'>'u
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Backflow Device: Prior to covering and provide a copy of the test report on site at the
time of inspection.
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 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 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 property, and the approved set of plans will remain on the site at all times during
construction.
~ jJ o. '0--
d.-/' 18-0
. I
Date
Owner or Contractor Signature
Springfield Building Permit
2/1/2011 9:04:15AM
Page3'of3
SPRIN.GFIEL~. "
a'
. ~K ~
. ,..",. 'OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726.3753
www.ci.springfield.or.us
811-SPR2011-00150
2108 BONNIE LN
permitcenter@ci.springfield.or.us
RECORD NO: 811.SPR2011.00150 DATE: 02/01/2011
~;V4_.,~,.: '.: L2;~V'.::;..~ J\CC()UN:f~C6[j'E7Ji ';;>',:,:::"":AM()UNtbUE.'"
224-00000-425603 19,00
224-00000-425603 39,00
----
821-00000-215004 6,96
100-00000-425605 2,90
TOTAL DUE: 67,86
!-"",P'A,y','M.,E,,'N-. J~,'TY,_'-_'P','E'~i' ,.e,' 'PA'.'Y.'.'O,','R '.f' 'C'A.S.H"E'.R.:,-N'M'A"CH.AD'O" ",-''':!, '~,,' ... .., , .,' . 'AMOUN AI
.. _, ... CO.MME;~I.~p,",Y/:\" - ~":",,-.,':,.' ~ n', D.".i-
Credit Card BUILT BY DESIGN LLC 67,86
RECEIPT NO: 2011000196
'DES',C'RIf>T'IO"N' "......,...? .d."'P,
L ,...;;(' ~,,'0'",,''V''k~"
Backflow preventer
Balance of Minimum Plumbing Permit Fees
~te of Ore90n Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
I
" "','.J
501645
TOTAL PAID:
67.86
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