HomeMy WebLinkAboutPermit Plumbing 2011-5-23
Plumbing Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth Street. Springfield, OR 97477 . PH(541 )726~3753 . FAX(541)726-3689
~~
DEPARTMENT USE ONLY
sM eel( -0 10 f.( b
Penmt no.:
Date: S - z.. 3 . ( I
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or eontraetor doing the work. Permits
expire if work is not started within 180 days of is sua nee or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
Sanitation approval verified? DYes D No
CATEGORY OF CONSTRUCTION
o Residential D Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: \O~ 0 D ;
City: ,.:~.i;;e.l.l Ce. ZIP: 97478
Reference: 8oz..D SZ- Taxlo!.: Dc:::;~a
DESCRIPTION OF WORK
lh..\-h-h.> -1-0 W ~ \ 'c..;.... B" ~\.. tv lP
Con."oI,S~O" / N!.v\.'\.C:H~e.. \
PROPERTY OWNER
l?R~r
Address: fD?D
Sf~i)
.~, Name:
ZIP: '7 7C; 7~
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020.
Signature:
CONTRACTOR INSTALLATION
Business name: L U)<. t "2. +-L.. Q~ 0 l'<. 0"-
Address: 11530 SW A_ <-
City: "\ i ~ r- d ZIP: q 7 ~ Z
Phone:;o3-~'I'- o;!...+ Fax:S03 -4"e.. .. 705"
E-mail: ..tar......;l.Ic..~..<...~ be \.1.01'. e.....
CCB license no.: BCD license no.:,:r'P,:'74'.
Signature:
440.2500-J (11/08/COM)
FEE SCHEDULE
Description Qty. Cost Total
ea. cost
New residential
I bathroom/I kitchen (includes: first
IOO/eel afwater/sewer lines, hose 5238.00 $
bibs, ice maker. under floor low-point
drains and rain-drain packages)
2 bathroomsll kitchen 5374.00 $
3 bathrooms/1 kitchen $439.00 $
Each additional bathroom (over 3) 595.00 $
Each additional kitchen (over I) $95.00 $
Residential fire sprinklers (includes plan review)
o to 2,000 square feet $58.00 $
2,00 I to 3,600 square feel $116.00 $
3.60 I 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 onc- or
two-family
Minimum fee I $58.00 I $
Each fixture I I $19.00 I $
Miscellaneous fees
100' storm, sewer, water line $76.00 $
Each fixture, appurtenance, and piping .1 $19.00 ~Jli
Stonn water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private stonn drainage $19.00 $
svstems exceedinp' the first tOO 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: (1) $58.00 $
Medical gas piping Minimum fee $
Enter value of installation and equipment $
Enter fee based' on installation and equipment value. I $
APPLICANT USE
(A) Enter subtota! of above fees $ 58~
(Minimum Permit Fec $58.00)
(B) Invesligative ree (equal to [A]) $ N~
(C) Enter 12% surcharge (.12 x [A+B]) $ (. .9C.
(D) Technology Fee (5% oJ"[A]) $ 2.'UJ
TOTAL fees and surcharges (A through D): $ '7.8<'
t
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. ",:,.,,,';<,. OREGON
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 Residential Permit
PERMIT NO: 811-SPR2011-01046
IVR Number: 811167988138
permitce nter@ci.springfield , or. us
PROJECT STATUS:
STATUS DATE:
Issued
OS/23/2011
ISSUED:
APPLIED:
OS/23/2011
OS/23/2011
EXPIRES:
VALUE:
11/18/2011
$0.00
SITE ADDRESS: 1090 DIXIE DR, Springfield, OR 97478
ASSESOR'S PARCEL NO: 1802052400300
SCOPE: Plumbing Only
WORK INVOLVED: Remodel
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Bathtub to walk~in tub conversion
OWNER:
ADDRESS:
BAKER FRED JAMES & SANDRA KAY
1090 DIXIE DR
SPRINGFIELD OR 97478
Phone Number:
CONTRACTOR INFORMATION I
Contractor Type
Plumbing Contractor
Contractor Name
LEAFGUARD NORTHWESTlNC
Lie Type
GGB
Lic No
116960
Lie Exp
09/11/2012
Phone
503-646-0224
BUILDING INFORMATION I
# of Units:
o
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Hazmat:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other: 0
Occupancy Loa~:
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Energy Path:
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
I
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area: quireS you to
Retaining Wall: NTION: Oregon la~;e Oregon Utility
Soils Report Re~tI.e::rUleS adopted by eules are set lorth
ib'((b'W Those r 2. 001-
NI OotiIAi~~~~_g~~:~~1~thrOu~~ ~~~e9;ul~S by
n y obtain cop' \ hone
0090 You ma (Note' the te ep .
"\',ng the cenler, Ut'ililY Nolilicatlon
ca h Oregon
number lor I e, _800-332.-2.344),
Cenler IS 1
NOTICE: - ..".'.., K
THIS PERMIT SHALL EXPIRE IF THE WOR ..
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD,
Springfield Building Permit
S/23f2011 11:S2:02AM
Page 1 of 3
..
SPR..I.N. G..FIE~
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""y~ OREGON
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2011-01046
IVR Number: 811167988138
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
pennitce nter@ci,springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
OS/23/2011
ISSUED:
APPLIED:
OS/23/2011
OS/23/2011
EXPIRES:
VALUE:
11/18/2011
$0.00
SITE ADDRESS: 1090 DIXIE DR, Springfield, OR 97478
ASSESOR'S PARCEL NO: 1802052400300
SCOPE: Plumbing Only
WORK INVOLVED: Remodel
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Bathtub to walk-in tub conversion
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
~
Description
Tvpe of Construction
Unit Amount Unit Tvpe
Unit Cost
Value
FEES PAID
r
Description Amount Paid
:>t~~of Or~2".n.~~.r.0a.':,ge L!?~::f_~eel~~~f~e2L _______ _ !.~9~ _ __.
T~chnologt fee (5%_ ofpe!mit tot~) _.__. _ _. __._. _ .__. __ __ .$2,f!I!.
Bathtub $19.00
Balance of Minimum Plumbing Permit Fees $39.00
Total Amount Paid $67.86
Date Paid
Recipt #
2011001185
--_._~_.._..- -- ----
2011001185
2011001185
2011001185
OS/23/2011
OS/23/2011
. - ._-------. ._-_._--
OS/23/2011
OS/23/2011
Springfield Building Permit
5/23/2011 11:52:02AM
Page 2 of 3
Stl~N~~
.i:~
>r OREGON
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2011-01046
IVR Number: 811167988138
www.ci.springfield.or.us
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
Issued
permitcenter@ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
OS/23/2011
ISSUED:
APPLIED:
OS/23/2011
OS/23/2011
EXPIRES:
VALUE:
11/18/2011
$0.00
SITE ADDRESS: 1090 DIXIE DR, Sprin9field, OR 97478
ASSESOR'S PARCEL NO: 1802052400300
SCOPE: Plumbing Only
WORK INVOLVED: Remodel
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Bathtub to walk-in tub conversion
Plan Review
~
Deoartment
Application Acceptance
Received Due Date
OS/23/2011 OS/23/2011
ComDleted
OS/23/2011
Result
Over the Counter
Ilnilial Review:~~- ~vC "T;~.' ~ OS/23/201:1"f''05I23/201.1
~~ri~:mm~,~ts;~:~?i~}~h~~~~~itr'~~~hiU~4~~\'S~'1~,~-i~;''0 ('
Permit Issuance OS/23/2011 OS/23/2011
PublicWorks-":~evjew
1.-ocaininents:'
'~".r~' .. '"
~ ..'
h
. ~Not: 8eq-LJired";'}r:::(
,. - '... -~-.l''" ",
".". .-
Structural Review
OS/23/2011 OS/23/2011 OS/23/2011
Not Required
Comments: Over the counter permit
IPla,nnirig Review' . " ,,. '.: . .05/23/201 ,1.--:05/23/2011; "0512312011 "
1 co~ment$;:; Over t~e cou~ter~perm~t~.. ~"o.--j" of~'; ,~'(:. '~~~'"<~~fi1' ~~
t.....:-;...,._"" ';,':;"......___._ ;: ~. ~.; , ",' '1 ''10. ',if -'
Reviewer
David Bowlsby
David Bowlsby
David Bowlsby
~Not Required1f~:"t ", '~0 ~9~vid~BO~~bY-''''
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INSPECTIONS REQUIRED ~
Inspections
3500 Rough Plumbing
3999 Final Plumbing
Rough Plumbing: Prior to cover and including required testing,
Final Plumbing: When all plumbing work is complete.
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 Sa.fety. 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.
~ Q, 0- ~-Q
Owner or Contractor Signature
<; - L. "3 . 2.oq
~
"
Date
Springfield Building Permit
5/23/2011 11 :52:02AM
Page 3 of 3
S~J~~N;..~.E~?iJ
~,~
~OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01046
1090 DIXIE DR
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@cLspringfield.or.us
RECEIPT NO: 2011001185 RECORD NO: 811-SPR2011-01 046 DATE: OS/23/2011
[DESCRI~'J:IC)N,'" , ".~C;-- -7'1' C", ". .~f';~~~~.1''-F.'::''''''''l\ccelJN"Lc;6DE:' jr""'-.0'Ec~~~.t-AMOUN'r~buE-' -,- .-. ... i
Balance of Minimum Plumbing Permit Fees
Bathtub
State of Oregon Surcharge (12% of applicable fe."s)
Technology fee (5% of permit total)
224-00000-425603 39.00
224-00000-425603 19.00
821-00000-215004 6.96
100-00000-425605 2.90
TOTAL DUE: 67.86
i:;_QM.IIIIEfII::f.S."i.""~:, ", ._.. ,- . 'AMOUNT PAil)""," .
67,86
I
t:::~AYIVIEf~I,T:Y~:E:';' <' :'P.J!.Ys.\R:dficASHIERDBOWLSBYt:;~: :i
Check baths by beldon lie
422
TOTAL PAID:
67.86