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Home My WebLink AboutPermit Plumbing 2009-2-17 ~~fJiDEFrAR'$MEN:mrsE10Ni!~i'!1Iil 1i.~~;;'W,ir.it.-;:,~~~~.~J;gitSts;A~3;~ I Permitno,:c?'1 -',;;2.,-;--:>1 I Date: illl'? jCJ(' I PluQIbing Permit Application -' . 225 Fifth Street. Springfield. OR 97477 . PH(541)726-3753 . FAX(541)726-3689 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 nof started within 180 days of issuance or if work is suspended for 180 days. ' ~~~1l!:(Q!'i~~![G:0Vt:R.(\IMENfr"A~P'R~VA..l'IJX_1~if.jtr~ ~t,0.iliii\.lil~jjfliBIllF,EE;\[s_cHEjjliJl!Elf~11~~l.t1 Zoning approval verified? DYes D No :.~.', ,",:!ill~i_,", ,c:..iiili, '~~,' ", ""4f,,:~.-",' liil;\':1Il"'\'I-.'~I.~€Ost~I8lli,':r,otal11i:,1 ~12~~~,rJpt'o,Q~':~t~~'i:~ ,~tY.: I:t!J'ia~\~' ~~cost~ I Sanitation approval verified? DYes D No 1- ~:::'"r:::i~;I- '~'c_' .lr",_",~ ,,->'-'" .1. ".,*1'1:."', ." -" I l!iIltr'~~CJ.t/jEG0.BY:10fiC:0/IJ$JJiJ{0cml(Q/IJ~1 I batbroom/J kitchen (inc/udes,jirst ~~~~~~~lmE~I/IJ~~R.~;m;~~NP1~~e~~~~N:~~ ff{{1~~~~S~:f~Ti~rii!i;;I~int $238,00 $ I Job site address: 0 ,"') q.. aNT E./tIJW /flL ilL /1\ 2 bathrooms/l kitchen $374,00 I C' ('?;) -I. ;. I S a.... I ZIP 9} All '1 3 bathrooms/l kItchen $439,00 Ity:, \ I r. ') tate: cJ :..., 1 Each additional bathroom (over 3) $95,00 Subdivision: I Lot no,: _ I Each additional kitchen (over I) I $95,00 ~~1[;~~'1lI[jESCR.rF!,ml(QIil~<:)Fdl",WQRKi:jr~~1![~~~iji~~ 1 Residential fire sprinklers (includes plan review) U) /J.r~a. S~arJl L t7 lc'5 p 4C,;:-,t/4!<ttO to 2.000 squarefeet ' $58,00 I ' I 1 2.001 to 3.600 square feet $116,00 ~~,:jl~if"~'"'RR0I!ERi!Y,[0WNERY'''''!1'''''n_:"wfuj~ful 1 3,601 to 7,200 square feet $174,00 ~~:'~:;~;; ,N, ,.,',..?i;J M ()~~~:~""""'''''''-' 1 7.201 square feet and greater . $232,00 I . . --- - I Manufactured dwelhng or pre-fab (Circle one) Address:' W ~-4 C5/V I/?IVN; ilL fiUJI] Connections to buildingsewerand I I $58,00 I $ I Ci' "(? ;:; t: ' I State' ~J:1\ 1 ZIP' 9 7AJ" , water supply ty. __ \...)1 I U . ~-- . T J Commercial, industrial, and dwellings other than one- or Phone':J1/-o/7 4al'i I Fax: I two-family E-mail: I 1 Minimum fee I Each fixture I Miscellaneous fees. 1100' storm, sewer, water line I Each fix~ure, appurtenance, and piping I Storm water retention/detention facility Irrigation systems . Piping or private',storm drainage systems exceeding: the,first 100 feet I Specialty fi:<tures I Reinspection (no. orhes. x-fee per hr.) I Special requested inspections (no. of hrs. x fee per hr.) 1 I I I 1 I I 1 I I I I 1 I' 1 $'7(d~1 $ 1 $ I $ 1 $ I $ 1 $ I $58,00 $ I I 1 Enter value of installation and equipment $ _' I ~ Enter fee :ed on inst~I~:~~:'"~'l.~~~:n.';.~u';,;, 1_ $ , I ~~~~Rl!I.!>'At:lJT'l'iUSEJI!i.~1 I (A) Enter subtotal of above fees '7~ ---I (Minimum Permit Fee $58.00) $ 1 (B) Investigative fee (equal to [A]) $ I 1 (C) Enter 12% surcharge (,12 x [A+B]) $ '1'-.L-J I (D) Technology Fee (5% of[A]) $ '? W I I TOTAL fees and surcharges (A through D): $ !5S '12.1 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, Signature: ,1~"II'.e:()NTi~!'i!t.<:)R.iliIN$JI'~8l!Aj11l0N!'Ii!-'i''.:i.~'i1!il'l\1f''lml I Business name:,i12/lJCOtlff h/Vilj{} M/J/5/VT.dl I Address: 4-63 21V'/i(;( IJtll.f I I City: lit' / ;; If/[) s I State: .ot1L I ZIP: c;.. } 4"771 I Phon~"416R9 J --; /1 I Fax: I I E-mail: I I CCB license no,: / ff ,) 02, J I BCD lic~nse no.: ' I I Plumbing license no,: .it:. 0 rf' \.\;J I I Printname:/Nd:JjJEr.R /':2.0))/)/1)/ I I Signature: !~ J' !~ > ' I I I I \ 1 1 I 1 1 Each additional inspection: (1) i''''''''''!F'w''''''''''''__~3t~''''''''1 ,1:M~~_QlcaJfg!:l~iPjp_U~g'~'ii&~f~'~~ 440-2500-1 (11/08/COM) $58,00 1 $ $19,00 1 $ $76,00 I $19.00 $19,00 $19.00 $19,00 $19.00 1 $58.00 $58,00 $ Minimum fee I $ $ $ $ $ $ $ $ $ CITY OF ~rKll~l:iJ.<lELD Building/Combination Permit PERMIT NO: COM2009.00222 , ISSUED: 02/17/2009 APPLIED: 02/1712009 EXPIRES: 08/17/2009 VALUE: _;;;;:g~.!~:~~~~~: ~.I,I,t~!,o1l~ 'if; ,; ,-- Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 654 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264310900 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: TYPE OF USE: Repair Residential _.oj,., ATTI:GeNllAA0TOR IINFORMATION:,y follow rules aaop'''U uy '''~ -~ ~'1~9 set forth Contractor Notification ?:~ter. Those ru~eO~,!.C~Y.L'~lb01' Expiration Date JENCOURT Rlif(O,R01511ER -O.O.i_O!h!~~;~o nil,m~Jles bV 06/11/2009 OU~~I ,_BiiiLDIN6',iNFORMAT-ION'lho~en - ' f 'th uregull uumJ ...__u.catlo number or e 344) (ft,llfrStilrih?,OO-332-2 . Height of Structure Type of Heat: Water Type: Range Type: ,~nergy Path: 'Sprinkled Building: Owner: EDMONDS LYNNE CHARMAINE Address: 654 CENTENNIAL BLVD SPRINGFIELD OR 97477 Contractor Type Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Cimstructinn Type Secondary Construction Type: # of Bedrooms: n/a Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: N<hmNBLOPMENT INFORMATION' THIS PERMIT SHALL t^rlt'lC II IIIL. . ORK 'AUTHORI;!(-&.w}llii~:THIS PERMIT IS NOT COMMENe~D'l@RI1&v\~DONED FOR ANY 180 /la/le1'!?Amrnqd: If.Iof Lot Coverage: I PUBLIC IMPROVEMENTS I Phone 541-689-1711 , Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: I Valuation DescriDtion , Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Paee I of 2 Value Date Calculated Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 12% State Surcharge + 5% Technology Fee Water Line - 1st 100' Total Amount Paid Amount Paid $9.12 $3.80 $76.00 $88.92 Total Value of Project Fees Paid' Date Paid I Plan Reviews I 2/17/09 ~/17/09 2/17/09 CITY OF ~t'Kll~GFlELD' B uilding/CombinationPermit PERMIT NO: COM2009-00222 ISSUED: 02/17/2009 APPLIED: 02/17/2009 EXPIRES: 08/17/2009 VALUE: Receipt Number 1200900000000000109 1200900000000000109 1200900000000000109 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 Rp-ouired 'nsnee{o" ~ . ". I l 1111....IJiII Water Line: Prior to filling trench and including required testing. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all iuformatiou 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. tlJ ,&~ Owner or Contractors Siguature Paee 2 of 2 2/./7/9 '" Date 225 Fifth Street Springfield, Oregon 97477 541~726-3759 Phone Job/Journal Number COM2009-00222 COM2009-00222 COM2009-00222 Payments: Type of Payment Check cReceint 1 RECEIPT #: Description Water Line - 1st 100' + 5% Technology Fee + 12% State Surcharge Paid By JENCOURT ENVIRONMENTAL City of Springfield Official Receipt Development Services Department Public Works Department 1200900000000000109 Date: 02117/2009 Item Total: Check Number Authorization Received By Batch Number Number 'How Received cjc 1072 In Person Payment Total: Page I of I 9:19:IOAM Amount Due 76,00 3,80 9,12 $88.92 Amount Paid $88,92 $88.92 2/1 712009