HomeMy WebLinkAboutPermit Plumbing 2007-8-29
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2006-01514
ISSUED: 03/17/2007
APPLIED: 11/29/2006
EXPIRES: 02/29/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1460 G ST
ASSESSOR'S PARCEL NO.: 1703362204601
Springfield
TYPE OF WORK: Hospital
TYPE OF USE: Alteration
Commercial
PROJECT DESCRIPTION: Modify plumbing in soiled receiving for O.R.
Owner: MCKENZIE WILLAMETTE REGIONAL MEDICA
Address: 1460 G ST
SPRINGFIELD OR 97477
Contractor Type
Plumbing
I CONTRACT~~M~TlON I
~. ure~
Contractor In OAR 'lll/o/) CJ!op~ I~l~iration Date Phone
OREGON CASCADE PLUMBI~4 IJ!!2-oo1'{~r. '1hZ/he ,.,,~~&0(8 503-588-0355
BUILDI 9 throu;%/es a~O/) Utili;
or th 6r. ~ OOPies 04t9.9. Set fOrth
# of Stories: Cer,ter e Ore90'NOte: theO'~~t leOI..
Height of Structure!' 1-600~ Utility J: . fi'tlJlJoor:
Type of Heat: 3J<~<J4 08. )~&d'Floor:
Water Type: ~ - 4).Sq . IfBsement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
N09rJ.,rlay Dist:
rH/S~lStc.et Trees Rqd:
A ~FfMlf.ive Rqd:
cgrHfJ.t:nlfDI ~"Allge:
lvJA1f~1 D UND ExP/p
ANI'k:r."~.Q_''';. .
I PUBLY~ IE)M RM/r~S WOR/(
IJ. WED ItJ/iVJfQrrype:
Downspouts/Drains:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Fixture
Miscellaneous Mechanical
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC Sanitary/Storm Admin
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Total Amount Paid
Public Works Review
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01514
ISSUED: 03/17/2007
APPLIED: 11/29/2006
EXPIRES: 02/29/2008
VALUE:
Total Value of Project
~
Amount Paid
Date Paid
Receipt Number
$10.00
$11.50
$5.75
$9.20
$70.00
$45.00
$59.37
$78.09
$6.87
$4.50
$2.25
$3.60
$14.00
$31.00
11/29/06
11/29/06
11/29/06
11/29/06
11/29/06
11/29/06
11/29/06
11/29/06
11/29/06
8129/07
8/29/07
8/29/07
8/29/07
8129/07
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
1200600000000001695
2200700000000001360
2200700000000001360
2200700000000001360
2200700000000001360
2200700000000001360
$351.13
I Plan Reviews'
11/2912006
11/29/2006
APP JLP
Net DFU change of one sink.
Prepared SDC worksheet & added
fees.JLP
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
UeouiredJnsnections .
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
Pa2e 2 of3
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2006-01514
ISSUED: 03/17/2007
APPLIED: 11/29/2006
EXPIRES: 02/2912008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 of 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.
rJ~ () Q",~
Owner or C~ntractors Sign~Ure
a-'-.~- 07
Date
Pa2e 3 of3
225 Fifth Street
Springfield; Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2006-01514
CO M2006-0 1514
COM2006-01514
COM2006-01514
CO M2006-0 1514
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000001360
Date: 08/29/2007
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
WAYNE JEARLS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 09768A In Person
Payment Total:
Page I of 1
10:50:50AM
Amount Due
14.00
31.00
2.25
3,60
4,50
$55.35
Amount Paid
$55.35
$55.35
8/29/2007
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ZZ5 FrITH STREET. SPRINGFIELD, OR 97477 '. PH:(541)726-3753 · FAX:: (541)726-3689
City Job Number C tJ m d- 0 0 b - 6/,51t/
Job Location It/I:; 0 (f, sT
Assessors Map J 7 033 ,~.; () ,/ ,;, j
. , Tax Lot
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BACKFLO'V PREVENTION ~~ PERMIT FEE~ ('
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Contractor Information . O,eC)O~ '0'1 \"~\e" e.~~ ~~~\er; ~
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Addres~ 1;.,,,8 \fl\1 "^"t\''l;,~'a,.,.iiA~'"s?; Phon"i 5" J\ S 8 B - t>3~),:)
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City Slot L r /i'1 ~~ e,~ ' Stat/> ~ fL Zip 9/ J C) a
Construction Contractors Registration # I ~ .,
Expires Ii - "5 - J. 0 Cl .5
By signing this permit/application, I agree to call for an inspection once the backflow R.~vention device
has been installed and is visible for inspection (726-3769). I also state that all in~'ff~ on this
permit/application is correct. ~"\~ ~ \CO \\()
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Signature i) ~ tj) (1,.,1, .,\('~:.,.j\ c;,"'~~~ '\~~~~~~ 8 - .19- 0 7
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Checked for Delinquencipl< Checked for Historical Status
Date of Application
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Shared Drive (T:)/Building Forms/Backflow Prevention 7-07.doc