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Home My WebLink AboutPermit Plumbing 2011-6-3 Plumbing Permit Application 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 SPRINGFIELD C,,- <lJO; "';.',.~-",'c;.;..,..., '~.'_ . ~l','i..'.:" ;.".,....\.~.;';.~.-,.::..;-;:;U,.'i . ''"''DEPA'RTMENtUSE ONL Y";;,Yf . . . .." '.~ Pennit 'Sf I ~O , z 9-0 no.: Date: b - "3 -1/ 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!:'~:;,; i/lfocAL;GOVERNMENT.. :A:PPROllA'1Y~;;;i~W!W Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CATEGORY OF CONSTRUCTION Residential 0 Government 0 Commercial ....;,"!(:@OB,SITE 'INFORMA'110Nj(AND:(;OCATION~,:.ij"';:iC;.: Job site address: i; S.; 0 . b \ City:S o-\=--l ./ State: Reference: J 802-0 .s;-r Taxlol.: () :;:l:.::~;t~)?. ;;~ :'!ir~:~:. ,.DESCRIPTIQN::\,Of}W.OR-K', ~~;f~t!~;~;;::l.i~'!f~f~f:n;; J1-c. /C.rLOl..J ';':;. (ce . Name:_)::>h, Address: y S City: S -.(:. Phone?,,,,,-! S \0 0 E-mail: IY'\ 0.....(\ J........ nCLC This inst. ation is being made on restae ial or' property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature:'\'<\' Q5"\ . CONTRACT INSTALL' Business name: ~ Address: City: Phone: E-mail: CCB license no.: Plumbing license no.: Print name: ZIP: Fax: BCD license no.: Signature: 440-2500-J (11/08/COM) ;~r':;'. ,;~,~:.:.~t.=.?~~t~~~'~~{~;EEEt~_S.CR EDU l::Ei;(h:~,:';: $.Jr~!.\f./{}'~~~_~\1?5~~~;;' ;;ifi~~:{~'lp.iX~h}~~~~~~'~~~~'~':i{~~:';~}ii'i~:~f~~ g~~' i~~~i~~~l~~~:. ~!~~;~~~~lJ,~'~ New residential I bathroom! I kitchen (includes: first 100 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, under floor low.point drains and rain-drain packages) 2 bathroomsJl kitchen $374.00 $ 3 bathroomsll 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 $118.00 $ 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 $58.00 $ Each fixture $19.00 $ Miscellaneous fees 100' storm, sewer, water line $76.00 $ Each fixt.ure, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19.00 $ Irrigation systems $19.00 $ Piping or private storm drainage $19.00 $ systems exceeding: the first 100 feet Specialty fixtures $19.00 $ Reinspection (no. of hrs. x fee per hr.) .. $58.00 $ Special requested inspections (no. oflAl1 Lfl~ $58.00 $ hrs. x fee per hr.) Each ad~itional inspection: (1) ~ :v1(C $58.00 $ 5'g t.M~Wi~~i!~~fpfpi~g~r~~~4~~~+;~~~2~~~:&; Mi.nimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. I $ ,....,.~~~r~.......,_......"'"...._~..,~.'" ~\~~" 'jj .' '~RP.C1IC~NJ""U.SE -." ,. ...~, . 'i'~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ S-8 (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ bYi' (0) Technology Fee (5% of [A]) $ t-r7J TOTAL fees and surcharges (A through Dj: $ b7 . .' 5P.~,~~~ [';,\ ~ ":"~'\':;:: OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01290 IVR Number: 811196258774 www.cLspringfield.or.us 225 Fifth SI 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 06/03/2011 ISSUED: APPLIED: , 06/03/2011 06/03/2011 EXPIRES: VALUE: 11/29/2011 $0.00 SITE ADDRESS: 4550 HOllY ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802051207000 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device Phone Number: OWNER: ADDRESS: NAGY JOHN S & MARilYN R 4550 HOllY ST SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor CONTRACTOR INFORMATION ~ Lic Type OWNER BUilDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Contractor Name OWNER # of Units: o # 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: Lic No 0000000 Lie Exp 08/12/2025 Phone 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: Site Infonnation ~ Engineered Fill: Fill Volume: Flood Hazard Area: '(tt8C:-C:88-009- ~ S! JalUao land Hazard~Arllbll!lON lil!l!ln uo6aJO aliI JOj Jaqwnu Retammg Waf :lio dial aliI :aloN) 'JalUaO aliI 6u!lreo Soils Rep01 ~%~Wf~\jljO sa!doo u!elqo liew nOA '0600 '~00-C:96l:lVO 116noJlll OWO-~00-C:96I:fv'O U! 4lJOjlaS afe SalnJ asolll 'JalUao UO!leO!l!loN Allllln uo6aJO alllliq paldope SalOJ MOIlOj O'l'noli SSJ!nbsJ Mel uo6aJO :NOIIN3111:f NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY i 80 DAY PERIOD, Springfield Building Permit 6/3/2011 2:01:00PM Page 1 of 3 I. 5PRIING~.IE~ ~].. .": ,~ ~.~~~ OREGON www.ci.springfietd.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01290 IVR Number: 811196258774 225 Fifth 51 Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 06/03/201.1 ISSUED: APPLIED: 06103/2011 06/03/2011 EXPIRES: VALUE: 11/29/2011 $0.00 SITE ADDRESS: 4550 HOllY ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802051207000 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: BackfJow device Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 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 ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Descriotion Tvpe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ DescriDtion ~t~of Oregon Surcharge (12% of applicable fees) "!:ec~".':~ogy fee (5% of permil lolal) Backflow preventer Balance of Minimum Plumbing Permit Fees Total Amount Paid Amount Paid $6.96 $2.90 $19.00 $39.00 $67.86 Date Paid 06/03/2011 06/03/2011 06/03/2011 06/03/2011 ReciDt # 2011001432 2011001432 2011001432 2011001432 Springfield Building Permit 6/3/2011 2:01 :OOPM Page 2 of3 .. SP1\N.;=L~ ~,~ ~OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01290 IVR Number: 811196258774 www.cLspringfield.or.U5 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 06/03/2011 ISSUED: APPLIED: 06/03/2011 06/03/2011 EXPIRES: VALUE: 11/29/2011 $0.00 SITE ADDRESS: 4550 HOLLY ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802051207000 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device Plan Review ~ DeDartment Permillssuance Received Due Date Comoleted Result 06/03/2011 06/03/2011 06/03/2011 Issued Plumbin9'Review~c 7,' 'h'06/03/2011-~1\06!03/201 h;06/03/2011:c. .~~Nil{Reciuir"d. ..,C'd~iTH~-;;~~: 'H_;Q~er:th~~cd~nJe;-perl1li.t::",,.~~"~~.:"~{,':":t?<~>_<~= >.~.' ~ ~:.\ ~.i~". .."~.,-~ . Initial Review 06/03/2011 06/03/2011 06/03/2011 Over the Counter Reviewer David Bowlsby David Bowlsby 00'_,:,,_ Y~~\li~~?WI~~(~, J~'_; '''''i''l;,':';-''''''':,~' ,.~: "~' -~~'__' " .' Comments: Over the counter permit Application Acceptance t. '. ' I _ 06/03/2011 . '06/03/2011 ,.' ~'., ".r .'[: _.~ ,"' 06/93/2011 Over.lhe""CoLinter - .. "". ';'1 _.-.1 . ,", Inspections 3620 Backflow Device INSPECTIONS REQUtRED ~ .pavid,Bowlsby . ,-;,;' 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, M~ !-I\_c.-0)/ Owner or Contractor Signature (j ~1~1 Date Springfield Building Permil 6/3/2011 2:01 :OOPM Page 3 of 3 .. SP1~~.G...._FIEl~ ~"'"..... ., = ":;~f\.. OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811.SPR2011.01290 4550 HOllY ST CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2011001432 lDESCRIP.JION Backflow preventer Balance of Minimum Plumbing Permit Fees State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) RECORD NO: 811-SPR2011-01290 DATE: 06/03/2011 '. ':'7<,,1',,:',:':;';,'; ... .'.:.'."" ACC'OUNT1CODE '.~ ,. ::; 'AMOUNT.D.UE 224-00000-425603 19,00 224-00000-425603 39.00 821-00000-215004 6,96 100-00000-425605 2.90 TOTAL DUE: 67.86 . AMOUNT PAID ". 67.86 l~RAXMENLIY:P'E' - "::P.AXo.~" c:A~~!ER::OBOwLm"_"'; - -. . '-.<'<OM.MENIS' Credit Card NAGY JOHN S & MARILYN R iih 040042 TOTAL PAID: 67.86