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Home My WebLink AboutPermit Plumbing 2011-6-23 , Plumbing, Permit Application "';'TDEPARTMENTUsE"oN'Ly~y.f Permit no.: $// - 0 ) :)L/L/ Date: ~/?-.5// I 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 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 snspended for 180 days. "i;NH::\.;'}'frOCAL; '13()VERNMEN'r' 'Ap~R()VA@~01'!'&Y;i:,\' . Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION City: Reference: ZIP: '7 '71/7 Taxlo\.:O 7000 ,(JRK,':'~;!;1ll~;t':~;\1,:}.1~i5;~:~: -ec.V-'2./ :~l-~::;:;,,:C;;:J. , PROPERTY, OWNER""": . Name: Address: City: ZIP: Phone: 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: ~l CONTRACTOR INSTALLATION . .,,' Business name: ' .....1" L U Address: City: Phone: E-mail: CCB license no.: ',..':' Signature: . ..~'... BCD license no.: Plumbing license no.: Print name: 440.2500-J (II/OB/COM) ':i;>:: """"""'\""~""i""I'EE;<S0I'1EDCJl ,"""." -. ...'....'H.'.,.'.... . '""'-"i'''''''''''"''--~''~'';~''>--'' --, ,.- -" E"!:""" ,.;.,.-;.,..".:,."'........-"....,_<...., ..:~~i "'<n,:;':., ..,''':'".J:"~:.:'<,c;',,' ,'- _ n. _' ,... _ _ . '"..:~ :', ,_, .}:.'i:/:. "i';..~'.>." '::"i,-:."-',.,: .1RS~-~;~tei~~~g~:~;~~~t~;~f,~~\\J,~;~;:;,;~~~t~1'~i!~;: 2~~' ~:~~f:;!:;::{ :,~~,;}~j1:tt': New residential 1 bathroomll 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 bathrooms/l kitchen $374.00 $ 3 bathrooms/l kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over 1) $95,00 $ Residential fire sprinklers (includes piau 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 $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 $ svstems exceeding- 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 $ KM~~_i~~I!g~~~'!pfp'ftg~1r~gi:1~~ft~~i;;~t;~t*;~ Mjnimum fee $ Enter value of installation and equipment $ Enter fee based nn installation and equipment value. $ 9tJ~~t~~~~i':J~~~~Ae~'~ic)ANW~irfs;E~~~ .'f>~"""~.",'-"",,,^,, ,___~,,,,,,"'W "..,...,v_j_.."'..,__..o....,....;._..... """""_" _..~ . .,,,,,. '.' .,::;~~ (A) Enter subtotal of above fees $ 76 (Minimum Permit Fee $58,00) (3) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [MB]) $ 912 (D) Technology Fee (5% of [A]) $ '3 gc TOTAL fees and surcharges (A through D): $ 2'.8' "/.2 < SP~.\..~N. :"'.IE..~ ~~ ~OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01544 IVR Number: 811101114920 www.cLspringfield.or.us 225 Fifth St 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 06/23/2011 ISSUED: APPLIED: 06/23/2011 06/23/2011 EXPIRES: VALUE: 12/19/2011 $0,00 SITE ADDRESS: 1164 L ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703264407000 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sanitary sewer line approx 60lf Phone Number: OWNER: ADDRESS: BATES KIM DELPHINE 1164 L ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION ~ Contractor Type Plumbing Contractor Contractor Name GARYS ROOTER & PLUMBING SERVICE lLC Lie Type CCS Lie No 174640 lie Exp 02/28/2013 Phone 541-935-6350 # of Units: BUILDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: 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: Lot Size: Sq Ft 1st Floor: Sq F12nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land ,Hazard Area: Retaining Wall: Soils Report Required: ATTENTION: OrE'l!:l!l!1 IllW ~~fl\1ir'~~ ~~\j.\o follow rules adoPted ~y thE) 9r~~8R P!!l~ Notification Center. Tho'se rule~ ?rE) l1~t !Qr~ in OAR 952-001-0010 through OAR 952-0Qi ~ 0090. You may obtain copies of the r~les I:i.y calling the center. (Note: the telepnone . . ... number for the Oregon Utility Notificatio~ Sprlngfle" S"""g Permit Center is 1-890-332-2344). .612312011 ':55:11AM - ~ - . - J' _ _ '.: ..;,.i..i..~;'1.' '.~. :~~~:~\6 ~~~~~ ~~~~i~~~i,~~~~" COMMENCED OR IS ABANDONED FOR.>: . . AI~Y 180 DAY PERIOD. .. Page 1 of 3 SP~:...~~l~ ~~ ~OReGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01544 IVR Number: 811101114920 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permltcenler@ci.springfield.or.us PROJECT STATUS: ., STATUS DATE: Issued 06/23/2011 ISSUED: APPLIED: 06/23/2011 06/23/2011 EXPIRES: VALUE: 12/19/2011 $0.00 SITE ADDRESS: 1164 L ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703264407000 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Replace sanitary sewer line approx 601f DEVELOPMENT INFORMATION I 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 Accepte~: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Descriotion Type of Construction Unit Amount Unit Tvpe Unit Cost Value FEES PAID I DescriDtion State of Oregon Surcharge (12% of applicable fees) ?anitary sewer Technology fee (5% of permit ~'?,lal) Total Amount Paid Amount Paid $9.12 $76.00 $3.80 $88.92 Date Paid 06/23/2011 06/23/2011 06/23/2011 Reciot # 2011001731 2011001731 2011001731 Springfield Building Permit 6/23/2011 8:55:11AM Page 2 of 3 SPRI.NGFIEL:iiJ .~ .~ .. ,~',,- OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01544 IVR Number: 811101114920 www.ci.springfield.or.us 225 Fifth SI 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: 06/23/2011 06/23/2011 Issued 06/23/2011 ISSUED: APPLIED: EXPIRES: VALUE: 12/19/2011 $0.00 SITE ADDRESS: 1164 L ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703264407000 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sanitary sewer line approx 60lf Plan Review I Deoartment Permit Issuance Result Issued Received Due Date 06/23/2011 06/23/2011 Comoleted 06/23/2011 Reviewer David Bowlsby Structural Review 06/23/2011 06/23/2011 06/23/2011 Comments: Over the counter permit Not Required Public Works Review 06/23/2011 06/23/2011 06/23/2011 Comments: Over the counter permit IniliaLReview : "' f'.: - 06123/20f1 '06;23/2011 i0612}1?Q1 h ...c,~.:. ~' ,- , '" ~ "^~ ~""' .,^j ",:...'.z'._....'... '.",'" . Comments: OverJbe ~pu.fl.!.e! permIt 0 C$t~ : . '^~. -'< ;/.: ",:;"',~:'!" .,... ~~,_. ~. Not Required . Qvedh~Cotlriter;"~ ,'X' . ...:DavlcLBowlsby '-e. t . ~:,/t'.rf-~!:[~~3~:,..':~,...~.. ' ". ~ David Bowlsby David Bowlsby INSPECTIONS REQUIRED ~ Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is tr~e 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. .__;JeP~O t/'-~/I . Owner or Contractor Signature Date Springfield Building Permit 6/23/2011 8:55:11AM Page 30f3 SP~~N~~EL~ ~ EiOREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 FJfth 51 Springfield,OR 97477 541-726~3753 www.ci.springfield.or.us 811-5PR2011-01544 1164 L 5T permitcenter@cLspringfield.or.us RECEIPT NO: 201,1001731 RECORD NO: 811-5PR2011-01544 DATE: 06/23/2011 tDESCRIP..TION'c;'V1C < .~.:~c ;?'", 53+:', ..' G". " .. 'AccoUN':tCODE';. " - ;:'''AMOUNLDUE ,.,' ' I Sanitary sewer 224-00000-425603 76.00 State of Oregon Surchar~.e (12% of applicable fees) 821 -00000-215004 9.12 _,~nolo.2Y fee (5% ofJ'ermil lotal) 100-00000-425605 3,80 TOTAL DUE: 88.92 L'E~yJ'ilg,NjT TIP.E": F:PA'[OR"_ C~~>iiER?OB()WLSBY-=:'~, ;.{LG.OJIIIMEN~"-',;'" -,,'c;"';j~ '~.., :'AMOUNT.~~I[)_:" Credit Card aaron mustin 88.92 02305b TOTAL PAID: 88.92