HomeMy WebLinkAboutPermit Plumbing 2007-10-9
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01527
ISSUED: 10/09/2007
APPLIED: 10/09/2007
EXPIRES: 04/09/2008
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 180 S ST
ASSESSOR'S PARCEL NO.: 1703262301300
Springfield
TYPE OF WORK: Plumbing Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Replace water line and shower valve
Owner: KEVIN DERSHON
Address: 180 S ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor
OWNER
License
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
R-3 Height of Structure:
Type of Heat:
VB Water Type:
Range Type:
Energy Path:
Sprinkled Building: n/a
~fo;~:~~ON I
Notification center.1. h...OpSe I'Ih.OAR 952-00'.
,n OAR 952-001-OO~. ."'lst the rulea bf
0()90. You may obti'\..ao I~i:il~~h~'_
ca\l\ng the cent8i1?aven i ~
rwmbef tor the e:
Center " t
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Residential
Phone Number: 541-953-9013
Expiration Date Phone
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
NOTICE:
THIS PERMIT SHAll EXP1RE" mE WORK
I =IZED UNDER THIS PERMIT 15 NO r
Valuation Descr" NeeD OR IS ABANDONED FOR
A~~rl4QJ1^~ PERIOD.
. Va~e
or Bid Amount
Notes:
Description
$ Per Sq Ft
or multiplier
Type of Construction
Pae:e 1 of2
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01527
ISSUED: 10/09/2007
APPLIED: 10/0912007
EXPIRES: 04/09/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid t
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Fixture
Water Line - 1st 50 Feet
Amount Paid
Date Paid
$6.60
$3.30
$5.28
$16.00
$50.00
10/9/07
10/9/07
10/9/07
10/9/07
10/9/07
Receipt Number
1200700000000001284
1200700000000001284
1200700000000001284
1200700000000001284
1200700000000001284
Total Amount Paid
$81.18
I . Plan Reviews I
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.
I Reouired Insoections t
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Final Plumbing: When all plumbing work is complete.
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.
~~
b / qh7
/ ;- I
Date .
I
Owner or Contractors Signature
Page 2 of2
. ConsfructionContractors Board
700 Summer St NE Suite 300.
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621'
Web Address: www.ccb.state.or;us
Pennit #:
)
C0u.1z.o-o710/ S-2 7
/%0 s\ 5,..f-
Address:
Is~ued by:
'--"""'" ?
Date: I~/ y{ 7
. Statement: Information Notice to Propeity Owners
About Construction ResponsibUities... .
Note: Oregon Law, ORS 701.055(4) requires residential construction pefmit applicants who are not
licensed with the Construction Contractors Board to'sign the followingitatement before a b~ilding
permit can be issued. This statement is requiredfor residential building! electrical, mechanical and
plumbing permits. Licensed architect and engi~eer applicants, exemptfrbm licensing under ., ·
. 1
, ORS 7~1. 010(7), need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2; ~d eith~r box 3A or 3,B: .
y:'
~.
I own, reside in, or will reside in the completed structure. .
I understand th~t -I must become licensed as a construction contractor it'the structure is sold or
offered for sale before or on completion. . '. ~
o . 3A. My general contractor is
(Name)
(CCB #)
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board. .
/' OR
,,121 3B. I will be my own general contractor,
/
/,
If I hire subcontractors,J will hire only subcontractors licensed withtheConstritction Contractors
Board. If! change mymind and hire a general contractor, I will contradtwith a contractor who is
. I
. licensed with the CCB and will immediately notify the office issuing tIlls building permit of the
name of the contractor. (
I hereby certify that the above information is correct and that I have read and do ILnderstand the Information
Notice to Property Owners about Construction Responsibilities on tbe reverse sidyfthiS form. .
i1C(Signa4iemrit applicant) . 1:/$&7
(White copy to issuing agency permit file, pink copy to appli-:ant.)
Property- owner.doc 06-01-04
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INFORMATION
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Information Notice to Property Owners about Construction
Contractors Board in accordance with ORS 701,055(5); passed
the
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on
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is a combi1!~s!
503-945-8091 or \\TI,vw.dor.stute.or
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you are subject to
employees. If
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fHI c1aim1co'sts
Divisimi at
Internal Revenue
You 'will
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06-01-04
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
Date: 10/09/2007
1200700000000001284
Job/Journal Number Description
COM2007-0 1527 Fixture
COM2007-01527 Water Line - 1st 50 Feet
COM2007-01527 + 5% Technology Fee
COM2007-01527 + 8% State Surcharge
COM2007-01527 + 10% Administrative Fee
Item Total:
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received
Cash KEVIN DERSHON djb In Person
Change KEVIN DERSHON djb In Person
Payment Total:
Job/Journal Number Description
COM2007-01527 Fixture
COM2007-01527 Water Line - 1st 50 Feet
. COM2007-01527 + 5% Technology Fee
COM2007-01527 + 8% State Surcharge
COM2007-0 1527 + 10% Administrative Fee
Item Total:
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received
Cash KEVIN DERSHON djb In Person
Change KEVIN DERSHON djb In Person
Payment Total:
cReceintl
Page I of I
1:21:16PM
Amount Due
16.00
50.00
3.30
5.28
6.60
$81.18
Amount Paid
$85.00
($3.82)
$81.18
Amount Due
16.00
50.00
3.30
5.28
6.60
$81.18
Amount Paid
$85.00
($3.82)
$81.18
10/9/2007