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Home My WebLink AboutPermit 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 SP~:~L~ D'~'~ . ",:,.,,,';<,. 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~ ~l. _"'- "'" AL A;,L,~. ~1 ""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-'''' '.:_.'.~).;., ..J~..-:~. ':~.'.; It..\{~ &:.;~'.: "',; .,._ ..... '"' . ;~" , \_~:_~} f,",;2.H ~__......'i:._..;',~. " - ~:- f''''';h, ,r'"~.,,,,, 'J J ,. 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