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Home My WebLink AboutPermit Plumbing 2011-4-1 Plumting Permit Application :': .,-.\- ", ""'~; ",h~:j~. ~ ";-= J:<i:''!..~:'~'':': ~"l'.',;"l' 'F!i',J;..., .:'tJ-;.;i...},., . _.~:tIT:Y Oi1\SPRiNGFiEtD.J;'ORifGON';-' . , ,['r".'" ;f'i!;-,~;:''' '-""'-f"'}t-':'--". ~~.b-,,~ ~..fl':;'","" ::it..~''':>$ >...g;.;:: .-...,....0::.. "."" '- "" .' '!.~'" .".~, $"";";; .,f"l ~~;~ -. ,A.$ t',""iF'';' r~ '=' .",,-, ta.,,~. ~,_""" 'If .... "'" "'J. _.,.~ ~= ,..........""'" ,-.-- 225 Fifth Street + Springfield. OR 97477 + PH(541)726.3753 + FAX(541)726.3689 ,,", ~~..,'-""'''''" .,.-..'..,:>7-':_....... '- .,...", "'''~- .,. .".'.,....;'~\).),~~ .'YD~pARtMEN.r:USE ONlY'~i;~~ 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. , 71li0CAl;.GO\lERNMENt;APPRO\lAl!1((iW:;;;~~~~~1i1' Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY' OF CONSTRUCTION'. o Residential 0 Government 0 Commercial ':">'f.:f:'JOS,SITE .'INFORMATlON,!,AND~;IfOCATJQN!i;;M,,,pt Job site address: Ct I 0 5., 2J-l tJ City: -f' L.. \~ ZIP: '? Reference:/? {):3 Taxlot.m ;<:"0 ~i,:~:.i~~~';'~?': '~~~~~~l~~~~-,,':D ESe RI f?JldN:tOE:~'I\"O RK<,Il~~:~t!.t?~~~!li~t;f~]1t. 'd h. .PROPERTY~)OWNE~):f.l',Ji';:f'h<~J;;m~If4:.''4'.\! . Name: Address: City: Phone: E-mail: This installatim, 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.lNSTAllATIQN.: "0':" ',d.. \.Ll Address: City: Phone: E-mail: CCB license no.: Li'l~c;, Plumbing license no.: Print name: Signature: 440-2500-) (11I08/COM) :g~!,-~.,.;:~1t:Y~~~':~;~'3~~I7EEf[S~CHEDUliEj~ji:rt;:~!"G!~~~~'~1~M~' "~ """1'. '.' .'~~'''''I':;';' ...tl"!;.q~"..,~..'l!'~~'-~.~'i"" ".' ". "1":' "( '," '-'C" ..__'" , -~" T -"-", .-O'r 'Descrjpt'ioH"~~l;.:1,;~,,~"~i:':-;,'.~~~~"J.""~': Qif' ~.~- 'osti~I~. ~". otal,,;,-) ~;l ;~l' . ~'.~ ~~::l"'{H };Y{:<l~:l':~;.i/'r.~r~':;:j:.t\;~-,f~ :,.,_, ,.",; ~:('{.'ea~~~I~~ ~;,L~o~t~f:/ New residential I bathroomll kitchen (includes: first J 00 feet 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 bathrooms!1 kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over I) $95.00 $ Residential fire sDrinklers (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 I $58.00 $ Each fixture 'p {l.c.-tL hM I i $19.00 $ 17 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 $ systems exceedino the first 100 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 $ ''-'~''~ """""~",'i ..-....... .;."..._-~~,--.- "'" C " .,~,---"" i'M ,I' 'T~'" ."""~~;y;", _l'~''''''~ ','" ,...~~' Minimum fee $ ,; _ e lea :gas:plpmg..l~b;;'i;~"':J:1}...'.~'~$r~ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ ~!~~~~~~PPW:GANT,,!lOSE~ffi'0iF~,\'~~ (A) Enter subtotal of above fees $ 5'3$ (Minimum Permit Fee $58.00) (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ b~ (D) Technology Fee (5% of[A]) $ ::L"I~ TOTAL fees and surcharges (A through D): $u>?~- f.l]" SP.~ING fIE.~L D .~~ ''''- .K'~1i .,c."-"R ~ 04.,d_~_ OREGON CITY OF SPRINGFIELD 225 fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone, 541-726-3769 Fa" 541-726-3676 www.ci.springfield.or.us Building I Commercial Permit PERMIT NO: 811-SPR2011-00534 IVR Number: 811113978887 permitcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 04/01/2011 ISSUED: APPLIED: 04/01/2011 04/01/2011 EXPIRES: VALUE: 09/28/2011 $0.00 SITE ADDRESS: 610 S 2ND ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703353300500 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Industrial PROJECT DESCRIPTION: Replace backflow device OWNER: ADDRESS: MOMENTIVE SPECIALTY CHEMICALS INC 180 E BROAD ST COLUMBUS OH 43215 Phone Number: Contractor Type Plumbing Contractor Contractor Name SUSAN JANE ARNOLD CONTRACTOR INFORMATION ~ Lie Type CCB BUILDING INFORMA TION ~ # of Stories: Lot Size: Height of Structure: Sq Fl1 st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage: Hazmat: Sq Ft Carport: Sq Ft Other: 0 . .< :T":"NTfON. Occupancy Load: '}II",. ' OrogOn I Electrical Specially Code, Edition:; ado -t aw reqUir "}U!!"'-'''!;') , P ed by th es you to Springfield Fire COde,Edition: n Center Th e OregOn Ut'I' ;' JIiH fP?-nn 1 . ose rule I Ity Mechanical Specialt}i[!l.qd'Tot/itiOrl: -0010 throu h s are Set forth Municipal I Developmeliilc:o~,a~lay obtain COPi~s OOf'4thA 952-001. n"mh.~ , center (~!,. e rut Plumbing Specially Cod'eIEdftlo~he O' . ro!l3l: the tel h es by r..,~ regon Ut'I' ep one Rasidential Specially Code'e<liil6n~S l-aoO_ Ilty Notificali Structural Specially Code Edition: 332-2344). 011 Lic No 49561 Lic Exp 12/1612012 Phone 541-484-3787 # of Units: o # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE' THIS PERn11T ~UTHORIZED J~~# EXPIRE IF THE WORK A~~~~~%~ ~~:6t;~~:O~~~/~6~ NOT Springfield Building Permit 4/1/2011 10:35:31AM Page 1 of3 . SP~ING.. fIEL~ ~\.~ t4'~'~ '~"".10>., OREGON CITY OF SPRINGFIELD 225 Fifth SI Springfield,OR 97477 Phone: 541.726.3753 Inspection Phone: 541.726.3769 Fax: 541.726.3676 www.d.springfield.or.us Building I Commercial Permit PERMIT NO: 811-SPR2011-00534 IVR Number: 811113978887 permitcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 04/01/2011 ISSUED: APPLIED: 04/01/2011 04/01/2011 EXPIRES: VALUE: 09/28/2011 $0.00 SITE ADDRESS: 610 S 2ND ST, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703353300500 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Industrial PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Replace backflow device DEVELOPMENT INFORMA TION ~ 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 I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Descriotion Tvpe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID I DescrilJtion Sta~ ~f.g!e:g_~~_Su~charg!..( 12% of applicab~ !~~:.L__ Technolo9yfee (5% of permit ~o.tal) __ ___ _ n ~~:kflow pr.:v~~_~te!__~____._____ ___.___ Balance of ~ini~~n:_~Il!~~ing Permit Fees Total Amount Paid Amount Paid Date Paid $6.96 04/01/2011 -._--- $2.90 04/01/2011 - ---.----- $19.00 04/01/2011 ----- ~_..-......__..-- ----- .-- $39.00 04/01/2011 ----.--- - $67.86 RecilJt# 2011000597 -- --- ---- 2011000597 2011000597 ---. -- ._--~ 2011000597 Springfield Building Permit 4/1/2011 10:3S:31AM Page 2 of3 1..~ S":~INGFIE.L~ ...-- ,~ ~~ c;."~ OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-00534 IVR Number: 811113978887 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 04/01/2011 ISSUED: APPLIED: 04/01/2011 04/01/2011 EXPIRES: VALUE: 09/28/2011 $0,00 SITE ADDRESS: 610 S 2ND ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703353300500 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Industrial PROJECT DESCRIPTION: Replace backflow device Plan Review ~ DeDartment Application Acceptance Received Due Date 04/01/2011 04/01/2011 ComDleted 04/0112011 Result Over the Counter Reviewer Chris Carpenter Permit Issuance "'04/01/2011':.04/0112011" 04/011201,1;..' Issued"'. ' . :,_". t"~~_~:~~~~:~~", ~t,,-,:,,\,~~.t." -:.~~','";2;t<~;~~;~~.' -~~,~;;':>-t' .~~::~~}; ';'. ,':;;::_.~-~,",_."" '. Plumbing Review 04/01/2011 04/01/2011 04/01/2011 Comments: Over the counter permit Not Required InitiaJ~Review_ " '.' ,>,: " .,~ ~~mments: ' . . '~.,04/01l201 r- "04/01/201C' 04/0112011"" Ove(the Counter 'iJ'7:", ' - .~. -i';-;,'",~",.:'f-:'~":i>",-' ',[ \' I:, ~i',,:{>-_'~,Ul- ! '~",';'~ '. ::;,:, qye~the'ct?unt.erpermit, h ."' '.:__\," ., "W ;';'::';'~;" (, -', -,t - , -,,, INSPECTIONS REQUIRED ~ Inspections 3620 Backflow Device ~ Chris_'G_arpenter '.''''-?'-'')~' !-'1 t,:r-.-'" ..;' "':' ,,-: 'j , . .' ~ .~ -" ,"'- '~'_' .. ",.,.. , '<-<i ~ , ~ '--~'._-, Chris Carpenter ...Chris~~rpenter' '" .. ...... ','f"","""" " t'.. ,. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, 1 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. ~ ~-$'-c.,~ I.-/-{-(( Owner or Contractor Signature Date Springfield Building Permit 4{1/2011 10:35:31AM Page 3 of 3 . 1.-" TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 www.ci.sprjngfield.OLUS 811-SPR2011-00534 610 S 2ND ST permitcenter@ci.springfield.or.us RECEIPT NO: 2011000597 RECORD NO: 811-SPR2011.00534 DATE: 04/01/2011 tDE.SCRII~.TION7":fiFf'>fi",,4<,.?" Z'/""",itlhK'&\i";;'~-:;,i'!"':'~~;tr_-ACCOU-NT!CODE');""'"j,!~.c::::AMoUN:tbuE '."~,,..J BackIlow preventer 224-00000-425603 19.00 ~~".ce 01 Minimum Plumbing Permit Fees 224-000~-425603 39.00 ____ ~tate of 2regon Surcharge (12% of applicable fees) 821-00000-215004 6.96 _--!echnol~gy fee (5% of permit total) 100-00000-425605 2.90 TOTAL DUE: 67.86 [":I"b.Y.MENj".::tt:IlE ::;';,i:\f~p;i6R '. CASHIER:'CCARPENTERd~",-,~, 'c:QMME.Nfs1L"'-'t~J~'''';h; ""J'>;' 'AMQUNT P AfD.~-r:_E;.<:;~ Credit Card Kurtis Arnold / Right way Plmb 67.86 041200 TOTAL PAID: 67.86 SPRINGFI.El.~ .' "":iFF ~ ^ \~:I . . "h> . OREGON www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2010-00257 2800 GATEWAY ST CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 pe rmitce nter@cl.springfield.or.us RECORO NO: 811-SPR2010-00257 DATE: 04/01/2011 ~~l?Lf).;.ii;':~'~~iLl!i:!A:CCOUNt~COOE';, - ,:-.,;.,'",- ,:iAivlOl.JNt5uE-G'=-:,- 'f\ 224-00000-425602 22,00 - -.' _.._~-,,-'_. ._----~.,~-,-.-......--~.-- 224-00000-425602 232,00 ,---- 100-00000-425605 11.60 TOTAL DUE: 265.60 lG~~'(tVJE~~i3rY,~E';f, ~~~P~'(QR':.:,:cKsHI'ERrNMAcHAD'oJ~~ ~:~'~!i.~~~'?CQMNi]~ij'J:~~~~~:~ +::;~t;~$-~;< ,;L~- JAMOUNT P AH?l;~ :'~;'.~?; - ':~"", ,I Check hswc petty cash/debra or Joel 265.60 894 Freeman RECEIPT NO: 2011000596 I,-DE"S'C'R",I""ION ','- --~"-"..., ',,'" . " r"i1; ,;::~'" ~,.. _ ." . ", -...,' - ~."., ~. ___~::c~ -~~_~~~C:~~l?PL__ .__-Y1an_ ~~~.-:!. hour _lechnology fee (5% of permit total) TOTAL PAID: 265.60