The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 2011-7-1 i Plumbing Permit Application CITY OF SPRINGFIELD, OREGON 225 Fifth Street _ Springfield, OR 97477 . PH(541)726-3753 . FAX(54l)726-3689 DEPARTMENT USE ONLY ~jij II 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. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION Phone: E-mail: 'ftL This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from Ii nsin r uirem nts under OAR 918-695-0020. Signature: Business name: d::. Address: City: ZIP: Phone: E-mail: CCB license no.: ~lumbing license no.: Print name: Signature: BCD license no.: 440.2500-) (II/OS/COM) FEE SCHEDULE Description Qty. Cost Total ea. cost New residential I 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 bathroomsll kitchen $374.00 $ 3 bathrooms/ I kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over 1) $95.00 $ Residential fire sprinklers (includes plan review) o to 2,000 square Ceet $58.00 $ 2,001 to 3,600 square Ceet $116.00 $ 3,601 to 7,200 square Ceet $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 otber tban one- or two-family Minimum fee I $58.00 I $ Each fixture I $19.00 I $ Miscellaneous fees , 100' stonn, sewer, water line $76.00 $ Each tixture, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19.00 $ Irrigation systems I $19.00 $/"f Piping or private stonn drainage $19.00 $ systems exceedinp 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 $ Medical gas piping Minimwn fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ APPLICANT USE (A) EntersubtotaltO~~~es) $51 (Minimum Permit e $58.00) (B) Investigative fee 'L"]) $ ./ (C) Enter 12% surcharge (.12 x [A+B]) $ I-JQ (D) Technology Fee (5% oC[A]) $ "Zr<- TOTAL rees and surcharges (A through D): $( 7& ~ 1./ CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01654 IVR Number: 811120418830 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: Issued 07/01/2011 07/01/2011 07/01/2011 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@ci.springfield,or.us EXPIRES: VALUE: 12/27/2011 $0.00 SITE ADDRESS: 88 T ST, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703262203873 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install backflow device Phone Number: OWNER: ADDRESS: HOLT RANDAll l & CINDY S 88 T ST SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor Contractor Name OWNER CONTRACTOR INFORMATION I Lic Type OWNER BUilDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: . Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Lie No 0000000 Lie Exp 08J12J2025 Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Site Information ~ Engineered Fill: Fill Volume: Flood Haza~l'mON: Oregon law requires youto land Hazaret.IIW'\'ules adopted by the Oregon Utility Retaining~lIiication Center. Those rules are set forth Soils RePWi'I5ll.'1\'$M!-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). NOTICE: THE WORK THIS PERMIT SHALL EXP1REE'~MIT IS NOT AUTHORIZED UNDER THIS P ., COMMENCED OR IS ABANDONED FOR "~;' ANY 180 DAY PERIOD. ." . SprIngfield Building Permit 7f1J2011 9:01:32AM Page 1 of 3 SP~~;G.~..FIE.L~ ~(~ ~OREGON WWoN. ci. springfield. or. u s CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01654 IVR Number: 811120418830 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 ISSUED: APPLIED: 01/01/2011 07/01/2011 EXPIRES: VALUE: 12/27/2011 $0.00 07/01/2011 SITE ADDRESS: 88 T ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262203873 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Install backflow device 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 ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Description Tvoe of Construction Unit Amount Unit TVDe Unit Cost Value FEES PAID ~ Descriotion Balance of Minimum Plumbing Permit Fees ~echnolo~~ fee (5% of permit total) Backflow preventer ~tate of Oregon Sur!3"harge (12% of applicable fees) Total Amount Paid Amount Paid $39.00 $2.90 $19.00 $6.96 $67.86 Date Paid 07/01/2011 07/01/2011 07/01/2011 07/01/2011 Reciot # 2011001853 2011001853 2011001853 2011001853 Springfield Building Permit 7'1/2011 9:01:32AM Page 2 of 3 SPi~HG__..F.I. eL~.D. .-- 1&:..1.... - . -,~ ^m.ilf;;t 'OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01654 IVR Number: 811120418830 www.ci.springfield.or.us 225 Fifth St 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 07/01/2011 07/01/2011 07/01/2011 ISSUED: APPLIED: EXPIRES: VALUE: 12/27/2011 $0.00 SITE ADDRESS: 88 T ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262203873 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install backflow device Plan Review ~ Deoartment Application Acceptance Received Due Date ComDleted Result 07/01/2011 07/01/2011 07/01/2011 Over the Counter Plumbing Review 07/01/2011 07/01/2011 07/01/2011 Comments: Over the counter permit Iniliameview'-.. " ., 07/01/20i:t' ~07/01/2011~-'loi/01/2011' ,-' , "'_"~ /,_1<<0J0'<.o,~-v,,'" om"~ " ' _~'. ,. "~.C()m}iie'nt-s::' :O'(e~r!~e co~~ier:p~ffnif< "L, "~"?{'t;'4f;~-~~ ','t_m:' .;".:'~- ,.. '.'0' ." - . . om ~. om -"..... - ~ _ "f' Not Required Reviewer David Bowlsby David Bowlsby Over the Counter.: - .~, '.David.BowlsbY. " .'. '?t~~~;~r.~"f-~;"'~ ~'r~<';. '". -'~,,-- INSPECTIONS REQUIRED ~ Inspections 3620 Backflow Device '."< . . 'I -J ..' J I -',,- -n'" 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' have carefully examined the completed apptication 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 readabre 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 const~fiI) I~ /_ ( I \.. Owner or Contractor Signature Date Springfield Building Permit 7/1/2011 9:01:32AM Page 3 of 3 i;c~~ OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 FifthSt Springfield,OR 97477 541-726-3753 www.cLspringfield.or.us 811-5PR2011-01654 88 T 5T permitcenter@cLspringfield.or.us RECEIPT NO: 2011001853 RECORD NO: 811-SPR2011-01654 DATE: 07/01/2011 [DESC-RIFtTloN: .:.c-J<,'; '. /''''4iit.~,,-:",~:::.:i'., 0:-"",-.:; -, - c<ACc;OUNTt.COOE'+iLi. __~. Tii:~.AMOUNJLD_lIE;' - .~ Backflow preventer 224-00000-425603 19.00 Balance of Minimum Plumbing Permit Fees 224-00000-425603 39.00 State of Oregon Surcharge (12% of applicable lees) 821-00000-215004 6.96 Technology fee (5% of permit total) 100-00000-425605 2.90 TOTAL DUE: 67_86 t I'AYMENT.TYPF.;:.;'PAYOR.;":: :.cASHiE~'D~OI'lLSB'(:' - .COMMENTS "''''' .ii. ~.-~ .. - AMOUNTPAID.. .- Check r holt $67.86 3677 TOTAL PAID: $67.86