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HomeMy WebLinkAboutPermit Plumbing 2011-8-18 . . . _\I. Plumbing permit Application '4:/'9;" :.~":.~ - t '1""'7_.'Cf"'1ft:'V<;"'. ,. :~",-"';:;'" ""i,(!;Iir:,,~:;r~ 'l,,~;L'IM~~,? ~Jt.1'fl'7'l; '" J I >. ~ertY':OF~SpRiN~FIEi'j)1'()RE'GON_ '. ~.; .~~; ;-~~!:.J-'-' ;.:~:~..:.;:-~ :(:': : "~}=i~ ~_,-r,,"~~;,_ .. ;~~~. 225 Fifth Street + Spcingfield, OR 97477 + PH(541)726-3753 + FAX(541)726-3689 SPRINGPIELD ~--" .".~ .......~.'"."""'" "'''''- ~-.- ~f~:'J'. ~I . L;i:~~tDEP.ARTMENT.&iE"'6N[y."~j ..- ....' "'.', .-...... '. '--,;,." "ff.!;:" Date: 6. 2- 5, Permit 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. . '\>"i,;;'?:?i;~' :~lEocAL;;:GOVERNMEN:r.;)l;PPROV A~'t?%i-'%!i:\' Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION D Government D Commercial INFORMA1]ONf_W;ID~COCAl1I0N:liJ!')\:t~, rJ..o..r-o r e.. ZIP: Reference: '70 Taxlot.:Df ~<D 0 i~~\~:,:~.:~~i~;;_;~(!~~r~:t,;D ESCRI RJ:10NJ~'O F.i_~V\I,dR'K:~~~~(~~:.:tt~"~\:~;:: D Residential : ',,';~i'jJ'J() B,"SIJE 77 City: k w V;v~c. L- ,l" /+u L i) t -,.J CVL ZIP: ,('N? Fax: 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. ""i_'.~;~'j( ,{r':~-+,''- ,_::,,: ~ " Business name: City: ZIP: Q?C{77 - (;r5' Phone: E-mail: Print name: Signature: 440-2500-) (11/08/COM) ,~;;t:1r~:1.;tr~(~~~"'%~i~~Fo;EE~IS:CJ~ E;DU L!E_~r.ft;; :!;f~.~f:M~~;z:;!il:~~~( <,\\.: ,'~ 'i';. ,.--\f.''Sf.'!' ;'l-i;:;;-M",,.,\;'l':"{~"r~-~ -~.~,:_~," ~- . ,'.', ':,~:~;;, '~:""Ct\~ 'f T .t 'I.;;H ~Des~criptionW;'Sf.~~t:;!!.t:r,:~;.~:\:t~r~~i(~k Qty: 1,-','.' O~,i~i.j i', 9 ~..:{ io~- ,,>:,>1' '>';\(>.- t'1:- :~~<!'>:%-':;.'.;;<~~PX~'~~tt \"~',i~-')w.t,~ ~~"'~'j";,:: (~;,l{ ea.;>:"'L ~,:,;~ ~9st~;:; New residential 1 bathroomll kitchen (includes: first ] 00 feer of waler/sewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) 2 bathroomslI kitchen $374.00 3 bathrooms!! 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 reet $174.00 7,201 square feet and greater $232.00 Manufactured dwelling or pre-fab (circle one) Connections to building sewer and water supply Commercial, industrial, ao.d dwellings other than one- or two-family . Minimum fee $238.00 $ $ $ $ $ $ $ $ $ $58.00 $ Each fixture Miscellaneous fees 100' storm, sewer, water line ( Each fixture, appunenance, and piping Stenn water retention/detention facility Irrigation systems Piping or private storm drainage svstems exceedinl~: the first 100 feet Specialty fixtures Reinspection (no. ofhrs. x fee per hr.) Special requested inspections (no. of hrs. x fee per hr.) Each additional inspection: (1) I $58.00 I $ $19.00 I $ $76.00 $ '7!-pc $19.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 $ $58.00 $ $58.00 $ $58.00 $ ~:~f~;~:k~I~~$;pip'ingt~~~~<t~~l.,.;:it~~}: Mi.nimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value, I $ t;i~iG"&.~Iip.~tiCANT;!;l'JSE~"TJ:;i\:Z:!';ii~~~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (8) Investigative fee (equal to IA]) (C) Enter 12% surcharge (.12 x [A+8]) (D) Technology Fee (5% of [A]) TOTAL fees and surcharges (A through 0): $ 1)4> $ $ 4"-'\.- $ 'J ~9 $?f~P- l SPRING..FIEL;t4 tiil~ ~ . t: r.~ ;'.c OREGON ciTY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01962 IVR Number: 811179746281 www.cLspringfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perm itcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 08/18/2011 08/18/2011 Issued 08/18/2011 EXPIRES: VALUE: 02/13/2012 $0.00 SITE ADDRESS: 2568 MANOR DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703233301500 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace water line Phone Number: OWNER: ADDRESS: LEWELLEN DONALD E & MARJORIE C 42037 HOLDEN CREEK LN SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor Contractor Name C & R PLUMBING LLC CONTRACTOR INFORMATION ~ lic Type CCB BUILDING INFORMATION ~ # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o Lie No 167015 Lie Exp 07/01/2012 Phone 541-736-9582 Lot Size: Sq Ft 1 st Floor: . Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Electrical Specialty Code Edition: Springfield Fire Code Edition: ATTENTION: Oregon law requires you to Mechanical Specialty Code Edition: follow rules adopted by the Oregon Utility Municipal I Development Code: Notification Center. Those rules are set forth Plumbing Specialty Code Edition: in OAR ib",~-001-001 0 through OAR 952-001- ... . . 0090. YOU may obtain copies of the rules by ReSidential Specialty Code EditIOn: calling the center. (Note: the telephone Structural Specialty Code Edition: number for the Oregon Utility Notification ~ Ct:lllt:1 i;) J-ovu-vv':::'-O::::v"t't). Site Information I # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield Building Permit 8/18/2011 11:30:57AM Page 1 of 3 .. SPRING...FIE~. ~l~ .~ '0' OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01962 IVR Number: 811179746281 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pennilcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 08/18/2011 08/18/2011 EXPIRES: VALUE: 02/13/2012 $0.00 08/18/2011 SITE ADDRESS: 2568 MANOR DR, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703233301500 SCOPE: Plumbing Only WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace water line 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 ~ Description T VDa of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ Description Amount Paid Stale of Oregon Surcharge (12% 01 applicable fees) $9.12 Water Line $76.00 Tech;;;;i;)"gy-fee is%(;[ pe;;;;itt;i~----- ----------.-.-. - ii80---'-- Total Amount Paid $88.92 Date Paid 08/18/2011 08/18/2011 ---_._.._- 08/18/2011 ReciDt # 2011002268 2011002268 2011002268 Springfield Building Permit 8/18/2011 11:30:57AM Page 2 of 3 . SPRING" FIEL~ .~ " ,~ .,~ OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01962 IVR Number: 811179746281 www.cLspringfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitce nter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 08/18/2011 ISSUED: APPLIED: 08/18/2011 , 08/18/2011 EXPIRES: VALUE: 02/13/2012 $0,00 SITE ADDRESS: 2568 MANOR DR, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1703233301500 SCOPE: Plumbing Only WORK INVOLVED: Repair' TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace water line Plan Review ~ DeDartment Application Acceptance Received Due Date ComDleted Result 08/18/2011 08/18/2011 08/18/2011 Over lhe Counter 08/18/201.1 . 08/18/2011 "~ .f'.- .Issu"ed' ~ ,.>,~'" ,',oct..w' -...,,' Plumbing Review 08/18/2011 08/18/2011 08/18/2011 Comments: Over the counter permit Not Required Initial'Review Comments: ~ Over the Counter f",r''',: 08/18/2011. Over the 'counter permit ':~~. , - 08/18/2011' 08/18/201,1 ",. INSPECTIONS REQUIRED ~ Inspections 3315 Waler Line Reviewer Chris Carpenter Chris' Carpehte~., ,.' Chris Carpenter Chris Carpe~ler,__~. ./ ",' .' 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 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. q /10 1\\ Date Springfield Building Permit 8/18/2011 11 ;30;57 AM Page 3 of 3 . ' -. S~:I,N,G~EL~ l.~~ ~ORfGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 www.cLspringfield.or.us 811-SPR2011-01962 2568 MANOR DR , permitcenler@ci.springfield.or.us , RECEIPT NO: 2011002268 RECORD NO: 811-SP,R2011-01962 ~DESC'RIF1];IQN;;r:,.o", o1?i~ ,,,:,' ;"'in" ~"- ,'~f::"", '!/1.C,CQ,UNT':CODE, ,<' " State of Oregon Surcharge (12% of applicable fees) 821tOOOOO-215004 Technology fee (5% of permit total) 100~00000-425605 Waler Line 224"00000-425603 TOTAL DUE: t'-'R"'YIVI!~tJ'YEiL~,:p.~':(o~il:!'.gB;;CCARPENi~R.:~;,~~,~Ql'iLM'E.:r{[~:," Credit Card C & R PLUMBING LLC 368159 ~ ,p /e,,^.-, DATE: 08/18/2011 ,',:';', ~''''AMOUNr.D,liEF '9,12 3,80 76,00 88.92 'AMOUNT< PAID , .-, ,'" J ... ~~,~,-4f-""" ....J, ':""":.0d 88,92 TOTAL PAID: 88.92