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Home My WebLink AboutPermit Plumbing 2011-8-12 Plumbing Permit Application SPAINGFlELD ~" ~jif~ It; ,;'-. 'l~:'.'''''::_"~-/!.~ ........ ;~.". , ,~..:' .,..-- -' <! '... '.'<"~'-'-::'-"li':'V.' ""DEPARTMENT USE ONL y~,:S\' <J./ f ~ ~;z..9Jt - Per!T!il no.: 32-- 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 Date: (J-'-j 2--~J 1 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, ',>;~,~;ij1i~;:'.;<@ocAL; 'GOVERNMENT. AJ>J>ROVA8-4J'i?;;;,~ffi-';;,~)i ;~:;{:':t,'.::_;;,~~.':f5~:,;:f.~~r~;~~~~;ftEEns.QJ~ EI) UEEt~j;;:~;:.':: '-:_~;f~?(~{f:*!':~;f~~~l~;, Zoning approval verified? DYes DNo ;:1~.~~4d~f(~.~~{~:~t~1;:.~1~~~~};~~;~J:i~;~ 2~' i:~;~~;f~:~L' :~!\~~}~-~t~ Sanitation approval verified? DYes DNo New residential CATEGORY OF CONSTRUCTION 1 bathroom/I kitchen (includes: first I ~sidential I 0 Government I 0 Commercial 100 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, under floor low-point ,;S::'ij}JOB., $lrE .INFORMA'[IC)N,:! AND"LOCATION;~:.U:.~i':) drains and rain-drain packages) Job site address: 5e':J "?~/'tI ?,r 2 bathroomsll kitchen $374.00 $ City: 5',P' FlL I State: 6Jf11 ZIP: '? ttr 7R 3 bathrooms!) kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Reference: f 1.. - 31.-24-. . Taxlol.~ Each additional kitchen (over I) $95.00 $ ~{:::'~i{~ y;-;./ :'i~fi::' ,'D ES CRIf'JI(jN'!,OF/~.W.ORK. ::.'d'i~~;;~:\!;;.~\~'~rf) J~ Residential fire snrinklers (includes nlan review) d?~~c -e ;eO//! /..Lrc7 / 'ri o to 2,000 square feet $58.00 $ 2,001 to 3,600 square feet $116.00 $ , " . PROPER,TV.. OWNER:;"f,';,',.."i",.~,~~;~,\:,'~~:\ 3,601 to 7,200 square feet $174.00 $ 'Name: /?' /J//re /l.(>~ ;>/},t;t.f/f/) Ft/...../ <;""V1- 7,201 square feet and greater $232.00 $ 55- ., 'J'? /'A c:: / Manufactured dwelling or pre-fab (circle one) Address: Connections to building sewer and $58.00 $ City: 5/ /7~ I State: of? I ZIP: ~777e water supply Commercial, industrial, and dwellings other than one- or Phone: - - I Fax: - - two-family E-mail: , Minimum fee $58.00 $ This installation is being made on residential or farm property Each fixtUre I $19.00 I $ owned by me or a member efmy immediate family, and is Miscellaneous fees - exempt from licensing requirements under OAR 918-695-0020, 100' storm, sewer, water line $76.00 $ ...i/ Signature: Each fixt.ure, appurtenance, and piping $19.00 $ CONTRACT.QR ,INST ALLA TION .' ~i '. ;' ' .~i ; Sto.rm water retention/detention facility $19.00 $ Business name: /J fA ~;- H.e -e ;rzcY'- Irrigation systems $19.00 $ ,y V JY/./l /).c ~~/...,O c./L Piping or private storm drainage $19.00 $ Address: systems exceed in a the first 100 feet City: L?, .It. e I Stat~: ~IZIP: q7~ /' Specialty fixiures $19.00 $ Phone: _?/ - (y/Jjof1c?C! Fax: Reinspection (no. ofhrs. x fee per hr.) $58.00 $ - - Special requested inspections (no. of E-mail: hrs. x fee per hr.) $58.00 $ CCB license no.: / bof 70 I BCD license no.: Each additional inspection: (I) $58.00 $ Plumbing license no.: fM~(ii~~i)g~~;ip'fprrrg~TIP?;;TI~~1~~2P~fi~~.~i;1 Mjnimum fee $ Print name: /?t,orr-/yV?~ Enter value of installation and equipment $ Signature: R'/C/ Enter fee based on installation and equipment value. I $ ~:'f~~_~~i;f,p,tl'C~N;r,,~lj!;-E~~~~ //tP .V . (A) Enter subtotal of above fees $1.la~ (Minimum Permit Fee $58.00) (B) Investigative fee (equal to [A]) $ a fu{!lXC- wo~s-rcx<J CrJf\ (C) Enter 12% surcharge (.12 x [A+B]) $~\Il.. ~ (D) Technology Fee (5% of [A]) $ ~:rzf ) TOTAL fees and surcharges (A through 0): $~Cn 440-2500-) (II/OS/COM) .. : ., CITY OF SPRINGFIELD S~;~:,N~~E~~ ~~ ~'ORCGON Building I Commercial Permit PERMIT NO: 811-SPR2011-01932 IVR Number: 811147594879 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@cLsprlngfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 08/12/2011 08/12/2011 Issued 08/12/2011 EXPIRES: VALUE: 02/07/2012 $0.00 SITE ADDRESS: 583 33RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702312402400 SCOPE: Single Family Residence WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Storm Drain Phone Number: OWNER: ADDRESS: EVERSON ANDRENE C & DAVID G 583 33RD ST SPRINGFIELD OR 97478 Contractor Type CONTRACTOR INFORMATION I Lie Type Contractor Name Lie No Lie Exp Phone BUILDING INFORMATION ~ # of Stories: Lot Size: Height'of Structure: Sq Ft 1 st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage: Hazmat: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: 2011 Residential Specialty Code Edition: Structural Specialty Code Edition: Site Information ~ # of Units: o Occupancy Type Construction Type R-3 Type VB # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Reqliired'lCE' ."..... . THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 1 SO DAY PERIOD. Springfield Building Permit 8/1212011 1:11:29PM ~ ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Ulility Notification Center is 1-800-332-2344). Page 1 of 3 l;:. '~. www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01932 IVR Number: 811147594879 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 08/12/2011 ISSUED: APPLIED: 08/12/2011 08/12/2011 EXPIRES: VALUE: 02/07/2012 $0.00 SITE ADDRESS: 583 33RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702312402400 SCOPE: Single Family Residence WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Storm Drain Fronlyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: DEVELOPMENTlNFORMA TION I Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north properlY line: REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: 100 Sidewalk Type: Downspout/Drains: Valuation Description I Descriotion TVDe of Construction Unit Amount Unit Tvpe Unit Cost Value FEES PAID ~ DescriDtion Amount Paid Date Paid State of Oregon Surcharge (12% of applicable fees) $9.12 08/12/2011 Storm Sewer -------.---- .---- ---$76.00 --0s7-i2i2ii1i.--- -- Tecl,;;ology fee (5%ot;;e;';;;;ttotai)------.---- .--- --. - $380 --" 08/12/2011- --- -- Total Amount Paid $88.92 ReciDt # 2011002233 2011002233 2011002233 Springfield Building Permit 8/12/2011 1:11:29PM Page 2 of 3 -. SPRI N, G FI E"L?'i] D ~h- .; ,~ . . . ~~.' OREGON CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2011-01932 IVR Number: 811147594879 www.ci.springfield.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: 08/12/2011 08/12/2011 Issued 08/12/2011 EXPIRES: VALUE: 02/07/2012 $0.00 SITE ADDRESS: 583 33RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702312402400 SCOPE: Single family Residence WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Storm Drain Plan Review ~ Deoartment Application Acceptance Received Due Date 08/12/2011 08/12/2011 Result Over the Counter Completed 08/12/2011 Plumbing Review 08/12/2011 08/12/2011 Comments: Over the counter permit Initial.Reviev/; ~--;, "':...';';,", 08/12/201:1'+, '08/1212011 "\ ":~'i' <,"" ,"';., ,~, ,':' ';';',:w" - "i \' 5, 'i _ " _~/F$;: :', t ',' , fRomme~~s: .:.Over~t~~~~ounte:r:pefmit:_"t~"t ' ' ""'.... -, ".k."~ 08/1212011 Not Required Reviewer Kip Kaufman Kip Kaufman 08/121201.h .. Over tl'ie-Gounter'" ,T, ,-Kip Kaufman, - ~<::~~~:;;;' j,:r_~"::~"~i.'? :.',~_"~".'~~J_'~;~.'\;[..;:' ._~1!~:~L;',,\.., _~ "'" 'b .,. - -: {,-.~. "";.;.).:: - . . -. ~. INSPECTIONS REQUIRED ~ Inspections By signature, I state and agree, that I 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 7~.'"'"'-. .""~.._".,;~=;":;;'_.""""' 'Owner or Contractor SIgnature Date Springfield Building Permit 8{1212011 1:11:29PM Page 3 of 3 SC!~N~.~. IE~ ~~ .~ ,~ . *= . OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811.SPR2011.01932 583 33RD ST permitcenter@ci,springfield.or.us i ,PAYN[sNJ~TItPE' Check 1154 RECEIPT NO: 2011002233 RECORD NO: 811-SPR2011.01932 lDESCf{leTION . . n"., ,:0~::i!;'~'",'~'",,r"?3~C~Y'ACCOUNf;.c.ODE ,- ~., State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 Storm Sewer 224-00000-425603 Technology fee (5% of permit total) 100-00000-425605 TOTAL DUE: :",\.Po\ygR' ',.cAsHI~uFMMLc,,;"i~L:<;Ql\itIlliENf.s~~~~':-y'~ , ,~~AMOUNT PAID':.'''(';;':~;;'; i Rooter King ck #1154 88.92 DATE: 08/12/2011 ,--';>.: ~,;'AMOUNT.D.UE ..".. i 9.12 76.00 3.80 88.92 TOTAL PAID: 88.92