HomeMy WebLinkAboutPermit Plumbing 2011-8-18
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Plumbing permit Application
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225 Fifth Street + Spcingfield, OR 97477 + PH(541)726-3753 + FAX(541)726-3689
SPRINGPIELD
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L;i:~~tDEP.ARTMENT.&iE"'6N[y."~j
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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
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D Residential
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77
City:
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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.
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Business name:
City:
ZIP: Q?C{77
- (;r5'
Phone:
E-mail:
Print name:
Signature:
440-2500-) (11/08/COM)
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~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-
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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
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.Issu"ed' ~ ,.>,~'"
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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,__~.
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.'
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
. '
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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