HomeMy WebLinkAboutPermit Plumbing 2011-7-19
Plumbing Permit Application
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225 Fifth Street. Springfield, OR 97477 . PH(541)726.3753 . FAX(541)726-3689
Pennit no.:
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.
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Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
. CATEGORY'OF CONSTRUCTION',' .,'
o Residential
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Job site address:
.
City:
., PROR;I;Rr(jYJ,]bwN-E_R'~:l~ff:i:';'X':l\;Jf;~~~~f,~?~~_~i~{~~ .
. Name:
Address:
City:
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.
71
Signature:
, "' CQNTRACT:OR,INSTALlATION... '.,,,J.,",l",;',,:, ..,"
.,
Business name:
~
"t!:"
City:
Phone.
E-mail:
CCB license no.:
Plumbing license no.:
Print name:
Signature:
ZIP:
7
BCD license no.:
440.2500.) (11/08/COM)
7
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New residential
I bathroomll kitchen (includes: first
100 feel of water/sewer fines, 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 I) $95.00 $
Residential fire sprinklers (includes plan 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 dwefling 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 ~d~\::.0-f.)W 1 $58.00 $~ .
Each fixture I $19.00 I $
Miscellaneous fees
100' stann, sewer, water line $76.00 $
Each fixture, appurtenance, and piping $19.00 $
Storm water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
systems exceedim! 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:,(1) $58.00 $ .
$M'~-.~i!~r$':;4_tik~'.'-;\'.~';~i'~Ji:,j1:r;h~s>~"~a~~f: Mi.nimum fee $
:i _ e l(:a :gas:plpll).g,~~~,:, .:'~?Si~k'jJ:_;;k.:." fJi
Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
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(A) Enter subtotal of above fees c;6'DO
(Minimum Permit Fee 558.00) $
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.] 2 x [MB]) $ &>~
(D) Technology Fee (5% of[A]) $ :z..~
TOTAL fees and surcharges (A through D): $ (.1 fIR
;-
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CITY OF SPRINGFIELD
Building I Commercial Permit
PERMIT NO: 811-SPR2011-01780
IVR Number: 811196211350
www.ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
07/19/2011
ISSUED:
APPLIED:
07/19/2011
07/19/2011
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@d,springfield,or.us
EXPIRES:
VALUE:
01/14/2012
$0.00
SITE ADDRESS: 1010 MAIN ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703354105200
SCOPE: Backftow Device
WORK INVOLVED: New
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Backflow device
Phone Number:
OWNER:
ADDRESS:
LANE REGIONAL AIR POLLUTION
1010 MAIN ST .
SPRINGFIELD OR 97477
Contractor Type
Contractor Name
CONTRACTOR INFORMA TION ~
Lie Type
Lie No
Lie Exp
Phone
# of Units:
BUILDING INFORMATION ~
# of Stories:
Height of Structure:
Type of Heat:
o
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage:
Hazmat: Sq Ft Carport:
Sq Ft Other: 0
Occupancy Load:
ATT"~ITln~r. Ore I
Electrical Specialty Code Edition: gon aw requires you to
Springfield Fire c~~~(ii~il~h~sCadtOPted by the Oregon Utility
: "...qWvQLlU11 en er. Those rules
Mechanical SpecjaltY,C.Q<!e=~!Jl!>l';001 0 throu h o~e set forth
Municipal I DeveRR>\\Q,~ifCb'dir:ay obtain COPi~S of the952'-00b1.
callml"-'hll 0 t ( ru es y
Plumbing Special~ Goge'Ellll~n er. N<2tE:1!he telephone
Residential specia:~~o~t~~wgK Oregon Utility Notification
Structural Specialty Code Editi;~: IS 1 '800-332-2344).
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Energy Path:
Site Information
~
Engineered Fill:
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall:
Soils Report Required:
NOTICE:
THIS PERMIT SHAll EXPIRE IF THE WO~J{
AUTHORIZED UNDER THIS PERMIT 15 NOr
COMMENCED OR IS ABANDONED Hm
ANY 180 DAY PERIOD.
Springfield Building Permit
7/19/2011 3:55:45PM
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Page 1 of 3
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.",-,"-'~ OREGON
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
www.ci.springfield.or.us
Building I Commercial Permit
PERMIT NO: 811-SPR2011-01780
IVR Number: 811196211350
permitcenter@ci.springfield.or.U5
PROJECT STATUS:
STATUS DATE:
Issued
07/19/2011
ISSUED:
APPLIED:
07/19/2011
07/19/2011
EXPIRES:
VALUE:
01/14/2012
$0.00
SITE ADDRESS: 1010 MAIN ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703354105200
SCOPE: Backflow Device
WORK INVOLVED: New
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Backflow device
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
DEVELOPMENT INFORMATION ~.
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
Tvoe of Construction
Unit Amount Unit Tvoe
Unit Cost
Value
FEES PAID
~
DescriDtion Amount Paid Date Paid
State of Or':!lon Surcharge (12% of applicable fees) ______!6.9~ 07/19/2011
Te"h."ol()~..!e-,,[?O&_ofE"':r11.i!total)___ _ __M____ _________ ~~~~_~...__~.:29/2011.
Backflow preventer ___.____._ !.1_~~~.____._.._Jl7/19/2011
B~nce of Minimum Plumb~lL!:ermit Fees $39.00 .._..~.__.~~011
Total Amount Paid $67.86
ReciDt #
2011002064
2011002064
". -----_.._~-_..-
2011002064
2011002064
Springfield Building Permit
7/19/2011 3:55:45PM
Page 2 of3
SPRIN.GFIE.L?ij
1!.!..-
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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 Commercial Permit
PERMIT NO: 811-SPR2011-01780
IVR Number: 811196211350
permilcenter@cLspringfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
07/19/2011
ISSUED:
APPLIED:
07/19/2011
07/19/2011
EXPIRES:
VALUE:
01/14/2012
$0.00
SITE ADDRESS: 1010 MAIN ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703354105200
SCOPE: Backftow Device
WORK INVOLVED: New
TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION:
Backflow device
Plan Review
I
Deoartment Received
Application Acceptance 07/19/2011
Comments: No Pla~ning I PW issues
Due Date
07/19/2011
Comoleted
07/19/2011
Result
Over the Counter
Reviewer
Chris Carpenter
Plumbing Review 07/19/2011 07/19/2011
Comments: Over the counter permit
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195?rn~e,n~::"f,~ver ,the,couQteLP7b!lJlt'!f>" ,,' i';~" .~^>,,:
07/19/2011
Not Required
Chris Carpenter
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INSPECTIONS REQUIRED ~
Inspections
3620 Backflow Device
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 1 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 shalt 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.
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Owner Contractor Signature
Date
Springfield Building Permit
7/19/2011 3:55:45PM
Page 3 of 3
SP~~~G~~~
~
~OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfleld,OR 97477
541-726~3753
www.ci.springfield.or.us
811-SPR2011-01780
1010 MAIN ST
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011002064 RECORD NO: 811-SPR2011-01780 DATE: 07/19/2011
[OESCRII'J"iONs,,>.' r,,~, s, _~;::::!!..':'i ,.,';:1" s ~;'f'jt~~'"..,: ,.-ACCQUNt~CODE~.:.::!t#ft..&AlVlb.UNtlJ.UE;';" --f - ;'i'T- 'j
~~!Iow preventer 224-00000-425603 19.00
,___~ala~e of Minimum Plumbin9 Permit Fees 224-00000-425603 39.00
State of Ore~~_~~~h_~ge (12% of applicable fees) 821-0000?~~15004 ._ 6.96
_ !.,,-~hrlD!~'!.~e~J50~ o!permit total) _______ __,___~00-00000-425605 2.90
TOTAL DUE: 67.86
_.PAXI'IIEt:!I:1XE~_-,,,;PA YO~:.~.C:~IER'CCAR~~"!i~.:~:c::_()_r~;:M.I~:r:{[St;!Fl'li'it4 "i,-KMQl,l~J!;PArQ' T,_ ;::'1
Credit Card John Oster Rod's Landscape and $67.86
019269 Irrigation
TOTAL PAID:
$67.86