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Home My WebLink AboutPermit Plumbing 2011-8-15 -. Plumbing Permit Application ",,?"6~PARTMENTus{ONLy::)i;'3f; Permit no.: c;, / / -' /9'( Cl Tbis permit is issued under OAR 918-780-0060. Permits are issued only to tbe person or contractor doing tbe work. Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. '<;?.',::..:;'(jifpCAU 'GO'ilERNMENT~ 'AP.PRO'ilA~41q;;rj~@f';;i:,?\i Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION g! Residential 0 Government 0 Commercial \"fi:S.4oB..$ITEINFORMATIONi? ANP'(,L:OGA"lHON',:J +',';i';. Job site address: 3'tst:> OOrYU_I1S 0/2, City: 5f/2Jt1J6FlcLJ) Reference: Taxlot: 'i,;,;!(:" ';>i'!;:, .PESCRIp.TION'OF.'VVORK. ::"I~~t6::\ '., .!/~{:" MOI/v(, l3k:kri~ Cf5J/(t 73 Sf/2II.;ei!;t S't'S76M -PROPERTY, ;OWI'lER/j~i . NameCJII0'.5" [,..JAr;tSo/\J6,f 'f3u oovC-dl-S 1M. City: 'fl2lt'JG!J{iJ) State: 012. ZIP: 97i7fS Pbone:SYI -2lii- '10/7 Fax: E-mail: {iZI5.or.v!3@}{OI/l.1/1/i.CC;l..1 Tbis installation is' being made on residential or farm property owned by me or a'member of my immediate family, and is exempt fro'~l's~~:equirements under OAR 918-695-0020. Signature: ~P'~ . CONTRACTOINSTALLATION 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 Business name: Address: City: Phone: E-mail: CCB license no.: Plumbing license no.: Print name: ZIP: Fax: BCD license no.: Signature: 440-2500-J (l1/08/COM) Date: ;~,~\'-f;.' _ .,;;;,.,'.( ,.'.'.,;;;:,.,."".,;;;:;,:.,:",-- -... -E":"SC ' .. .... d,:,' --' ",""..", ,.". ,,,,:~.,, _"."c.:,.'.',..;>o.""",')',,-~"- .',. -- """"'0 "C"FE " .HEDUl::E"'," '-." ,x!". """"';i> ,,,, '. ".;;:~": .,,:-,,<~,'~.;y:'tt7' (l,._. ....' .",~: ,: '-, ',.i!."i::<~;1':_~"!',-",':-.-'h,",;.", ~-:;,- Iy,H~~!~i;tii)i,';':'~ ",; ..CosC:: :.TotaF' c./G :2~! ~'~C;i.,e~;~,~.L :rL~.Q_~!'jr New residential I bathroomll kitchen (includes: first 100 feet of water/sewer lines, hose $236.00 $ bibs, ice maker, under floor low~point drains and rain-drain packages) 2 bathrooms/1 kitchen $374,00 $ 3 bathroomsll 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 $56.00 $ 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 dwelling or pre-fab (circle one) Connections to building sewer and $56.00 $ water supply Commercial, industrial, and dwellings other than one- or two~family Minimum fee I $56.00 I $ Each fixture $19.00 $ Miscellaneous fees 100' storm, sewer, water line $76.00 $ Each fixt.ure, appurtenance, and piping $19.00 $ S~orm water retention/detention facility $19.00 $ Irrigation systems }' $19.00 $ If Piping or private storm drainage $19.00 $ svstems exceedine: the first 100 feet . Specialty fixtures $19.00 $ Reinspection (no. ofhrs. x fee per hr.) $56.00 $ Special requested inspections (no. of $56.00 $ hrs. x fee per hr.) Each additional inspection: (1) $56.00 $ ~M~'~Wilj~~~il(W&'i~~gtE~Mf;:~~~~;,l;1.b~~~~~ M~nimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. I $ '.'~"""H"""~-"'-"0-'"-''''-'~~''' i'i~w,if\'l',>' ;~~~ ,;lI;e,p.,LHC~I'l;r.;;\9.SE~ ,'. ': . . ~ (A) Enter subtotal of above fees )!~ ~ (Minimum Permit Fee $58.00) $ (B) Investigative fee (equal to [A]) $ (el Enter 12% surcharge (. 12 x [A+B]) $ &>?!L. (D) Technology Fee (5% of[A]) $ 2'~ TOTAL fees and surcharges (A through Dj: $/.'7~~ . SrhNG:~ ~,~ ~OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01940 IVR Number: 811182445115 www.ci.springfie!d.or.us 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@cLspringfield.Of.US PROJECT STATUS: STATUS DATE: Issued 0811512011 ISSUED: APPLIED: 08/15/2011 08115/2011 EXPIRES: VALUE: 02/10/2012 $0.00 SITE ADDRESS: 3430 DOUGLAS DR, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802062102800 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device for irrigation system Phone Number: OWNER: ADDRESS: WAGGONER CHRISTOHER D 3430 DOUGLAS DR SPRINGFIELD OR 97478 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: ATTENTION' 0 Sq Ft Other: 0 f If ' re!=lon law r.c", ';'e o ow rules ado Occupancy toad: S you to ~Inl'f' f-'1"U uy tile Oregon urn Electrical Specialty Code Edilio\,':catlon Center. Those 'rules ar t ," Y In UAR 952-001 00 e se orth Springfield Fire Code Edition;90 y - 10 through OAR 952 001 vv . ou may obtain' -. Mec~anical Specialty Code Ed[tiRP.g the center (~OPI.eS of the rules by . . ""l1b,' ote. the telephone MUnicipal I Development Code: er Or the Oregon Ut'I't . . C. II Y Notification Plumbing Specialty Code Edition; 8nter2011-800-332_2344). Resident.ial Specialty Code Edition: Structural Specialty Code Edition: Contractor Type Plumbing Contractor Contractor Name OWNER CONTRACTOR INFORMATION ~ Lic Type OWNER BUILDING INFORMATION ~ # of Units: o # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Lie No 0000000 Phone Lie Exp 08/12/2025 Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE: , THIS PERMIT SHALL EXPIRE IF THE ~ORK ~UTHOR'ZEO UNDER THIS PERMIT IS NOT ~MMENCEO OR /S ABANDONED FOR ANY j 80 DAY PER/OD. Springfield Building Permit 8/15/2011 1:26:41PM Page1of3 SP:I.:~~~ ~~ ~OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01940 IVR Number: 811182445115 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: 155 ued ISSUED: APPLIED: 08/15/2011 08/15/2011 EXPIRES: VALUE: 02/10/2012 $0.00 08/15/2011 SITE ADDRESS: 3430 DOUGLAS DR, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802062102800 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Backflow device for irrigation system 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 Tvpe of Construction Unit Amount Unit Tvoe Unit Cost Value FEES PAID ~ Description State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of perm~toJaQ Backflow preventer Balance of Minimum Plumbing Permit Fees Total Amount Paid Amount Paid $6.96 $2.90 $19.00 $39.00 $67.86 Date Paid 08/15/2011 08/15/2011 08/15/2011 08/15/2011 ReciDt # 2011002242 2011002242 2011002242 2011002242 Springfield Building Permit 8/15/2011 1:26:41PM Page 2 of 3 SPRIN.G. FIE,L~ .--' 't1J ;.\ OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01940 IVR Number: 811182445115 www.cLspringfieJd.or.us 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 Issued permilcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 08/15/2011 08/15/2011 08/15/2011 SITE ADDRESS: 3430 DOUGLAS DR, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1802062102800 EXPIRES: VALUE: 02/10/2012 $0.00 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device for irrigation system Plan Review I Deoartment Application Acceptance Received Due Date 08/15/2011 08/15/2011 Completed 08/15/2011 Result Over the Counter PerrriIFi~'uance~ -':"08f1~/2011 08/.15/2011, 08/15/201 f ts~~ed -; i - ,.--,. ~-- Plumbin9 Review 08/15/2011 08/15/2011 08/15/2011 Comments: Over the counler permit Initial Review 08/15/2011 08/15/2011 08/15/2011 Not Required Over the'Counler';: Comments: Over thecounler permH , INSPECTIONS REQUIRED I Inspections 3620 Backflow Device Reviewer Chris Carpenter "'lr......--~ Chri:;;,'Carpenter Chris Carpenter , . Chris Carpenter, " . '" , 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 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 . 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. ~'1A ~ Owner or contractor-;ilZure 01:;)/5;/; I Date Springfield Building Permit 8/15/2011 1:26:41PM Page 3 of 3 S:~N:~~ ~ ~~EGON www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2011-01940 3430 DOUGLAS DR CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 perrnitce nter@ci.springfield.or.us RECEIPT NO: 2011002242 RECORD NO: 811-SPR2011-01940 DATE: 08/15/2011 tDESCRll1.TION ~__--"-~-,-,_:..ic_:2. . _ _ c':::.i~":.:;,:ACCOUNLCODE_/ . c. . ":AM()UNT~DUE Backftow preventer __ _________ ______ 224;5!Q00~~~~~:__ 19.00 Balance of Minim':'''2.Plumbi~!J Permit Fees _..______3~~S!~~OO-425603 _ ______ 39.00 State of Ore90n .surcharge (12% of applicable fees) 821-00000-215004 _____ 6.96 Technol09Y fee (5% of permit total) 100-00000-425605 2.90 TOTAL DUE: 67.86 COMMENtS;-";-',,, ... ":., ,,":'-;;,t!'llOUNT~AID. ",;- :.:, - 0>. .' I 67.86 '.J !C.R~ YJY!Et'iT TY!J!; Credit Card 09696c ~-!?AYQB'; c"'SHIER,Cc':RPENTER;'~-": ": .. WAGGONER CHRISTOHER D TOTAL PAID: 67.86