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Home My WebLink AboutPermit Sewer Connection Record 2009-3-11 'Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00331 ISSUED: 03/11/2009 APPLIED: 03/11/2009 EXPIRES: 09/11/2009 VALUE: 225 Fifth Street, Springfield,,oR ,541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line , SITE ADDRESS: 1861 G ST ASSESS,oR'S PARCEL N,o.: 1703362115000 Springlield TYPE,oF W,oRK: Plumbing .only TYPE .oF USE: New Residential PRQJECT DESCRIPTION: Sanitary Sewer Line Owner: Address: SKYLINE CREST LLC 42050 HQLDEN CREEK LN SPRINGFIELD .oR 97478 I CQNTRACTQR INFQRMA TlQN ~ Contractor Type Plumbing Contractor License , GARYS RQ,oTER & PLUMBING SERVICE L 174640 BUILDING lNHJRM;\,TIaN I Expiration Date 02/28/20 II Phone 541-935-6350 # of Units: Primary .occupancy Group: Secondary .occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Heigbt of Structure Type of Heat: Water Type: Range Type: Energy Patb: Sprinkled Building: , Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft atber: .occupant Load: n/a I DEVELaPMENT INFaRMATlaN , REQUIRED PARKING .overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage:ATTEi'!T!f"lN' _, follow tlll-~s ' 0,," , '. .. - 11.1-.,',. ... aOLI'Jf,.'_ J I PUBLIC IMPRaVEMEN.TS;, 9'5v2'~0'-'Oe1ntOer. Thv"i~ "u'd~:' 'CtYh ~ 010U ....1\. ~I.t' l( Mf'lTIf'l:. ' VU<1U You' . IIOligh ODr'lgr.. .. Street Improv.ements: C Ii, rSidcwalk:;rYl'.e'ies r' f :>2 J01. Storm sew~~H,k~EI~~fI:IT SHALL EXPIRE IF THEWORK nu~~'ir ~~~D<;';:?J~~0~W76rai~~ t~;:prhuoILnSebY "lIlnRIZEDUNDER ,,' ' "'~u.egonU'l Special Ins ruction: . THIS PERMIT IS NOT Center is 1-00 tI Ity Notification COMMENCED OR IS ABANDONED FOR, 0 0-332-2344). Notes: ANY 180 DAY PERIOD. Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Sular Setbacks: Total: , Handicapped: Cumpact: I, Valuation Desct:iption ,I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 01'2 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-00331 ISSUED: 03/11/2009 APPLIED: 03/11/2009 EXPIRES: 09/11/2009 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 I Fee Description + 12% State Surcharge + 5'10 Technology Fee Sanitary Sewer - 1st 10.0. Feet Amount Paid Date Paid Receipt Number $9.12 $3.80. $76.0.0. ,3/11/0.9 , 3/1lI0.9 3/1110.9 320.0.90.0.0.0.0.0.0.0.0.0.0.156 320.0.90.0.0.0.0.0.0.0.0.0.0.156 320.0.90.0.0.0.0.0.0.0.0.0.0.156 Total Amount Paid $88.92 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I, Ret;, ~!r.ed lnsrecti~ns I Sanitary Sewer Line: Prior to filling trench and including required testing. By signature, I state and agree, that I bave carefully examined tbe completed application and do berebY,certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accord~nce with the Ordinances ofthe City of Springtield and the Laws oftbe State of Oregon pertaining to.tbe work described berein, and tbat NO OCCUPANCY will.be made of any structnre'withoul permission oftbe Community Services Division, Building Safety, I further certify that only contractors and employees who are in compliance witb ORS70.1.0.0.5 will be used on tbis project. I further agree to,ensnre tbat all required inspections are relluested at the proper time, that each address is readable from the street, that the permit card is located at tbe fron't of the property, and tbe approved set of plans will remain on the site at all times during construction. ~ ~ -~' '. ", c3lt~/o/ ~r Contractors Signature D~te Page 2 01'2 , Plumbing Permit Application .'DERA"'R'ffiMEN;T~tis'EJ0N'~~~1 it:::;,~L~~_M':tiTr,hil;<~'W,it:_tejd.~;'~A';~ Permit no,: Ct? -- 'S '$> I I I Date: '3 - /I -- Or:; I Tbis permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing tbe work. Permits expire if work is not started within 180 days of issuance or ifwotk is suspended for 180 days. 1~I.l~~If~!:;~LlIG:~YERNMENjl";%f~p.P'Rc:.t\(~~t~;:~(~,~f.~1 I Zoning approval verified? DYes D No I 1=;;;~~~~vd;;~~~G~~N~~RIDG1UlQ~~J ,I 0 Residential 1 0 Government I 0 Commercial I Illitl:[.JQI3;(SIiJ!E!ilINIiQRI\II~mIQr'lW~NDlllf0J:;AlllQr~ft;;~iri,,1 I Job site address:/K ~ I if '::::,~7 I 1 city:;;:;OLC c/-...,/ 1 StateO f') 1 ZIP: Y7 <./71 1 Subdivi~iJk 1 Lot no,: 1~~OEsGRIF'B;10N!:!Qf.JhW,~R~~~:~~~j)1,i!,,1 l~.lhl ~ ~ Ac$J--;::P(?~ t ~ ~ 1!ii!!:'_:-';i1""'!'~'" c, " " "'''''1P!tr..Jl'11ft!l%J~~''''''';~ ",.~,~"im!<iwilll'ilt!~RoP'j;RiIW;l!oJ.."NER~",~"_"'1B:i:,,ril!1i'J!","~ I Name: ;::)lc:'WlL.N:. Q?C7-0'" lLC' J 1 Address:) 'CC';r ('~ 0'\ . I City:'SyLQrA.. 1 State: 02) 1 ZIP: ~7r.:t71 I Phone: - l ~ ' I Fax: 1 E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020, 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 Signature: I'~"m""";jjj!',' , , " '" " , j " ," - = ""f1!l""'Y"''''''''''1 """"~,,,,'~.,?\C0NmMCIJ!0RI.iINS,mJ1;I:iL!AmION,~j-.:l"'~\"'m'i2" , /" // j' I Busmess name: 1--"7644.-_ ( K_irln-~/ 1 Address: 1'0 i3L - 2. 5"" ') '< ' 1 City: b-(,~ e.. r Stat;: 01< 1 Pbone:$<{( .i:z.,- 7<:;(/'/ 1 Fax: I E-mail: I' CCB lice~se no.: I BCD license no,: I' Plumbing license no,: ~'7 'lK'" 1 Print name: ' A.~;r' ~ \~ I Signature: _r:? _ p~ ~ 1 1 ZIP: f7'1c1L 1 I 440-2500-J (11/08/COM) r;;t,:f;;t~:\;<<i~'~~Jr?;~:~.'~,,~~if~F.,E'---E-- -fISC'.- H-~E' D:l'Ji iijE- t6:~~~:;;f*'td7b;,~;r5,~1 _"""",\-.',,,,?..-;:'~'\f'l7i.%qi'-<-,~::r.l_::: _ __''''~___ ,__ " .L.:,... :ViY,'I~iSRU!~~~~:~<t~ ~D~~m3tiB;;~'fjiGl'~{~'~:IQ1~lillllf€eiia~~I~'fc',Oolsat'~1 ~;1~"!.7p,;;;,~.~M'k~~~~~~~~i: Jik&':ruJ~. ,_"~~ ~l~_ ._'.W 1 New residential 1 I bathraomll kitchen (includes,' first J 00 feet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain.drain packages) ,I 2 bathroomsll kitchen $374,00' $ 1 3 bathroomsll kitchen $439,00 $ 1 Each additional bathraom (aver 3) $95,00 I $ I Each additional kitchen (over I) $95,00 $ I Residential fire sprinklers (includes plan review) 1,0 to 2,000 square feet $58,00 I 2,001 to 3,600 square feet $116,00 I 3,601 to 7,200 square feet $174,00 'I 7,201 square feet arid greater I $232.00 I Manufactured dwelling or pre-fab (circle one) I Connections to building sewer and I I $58.00 I $ water supply I Commercial,:industrial, and dwellings other than one- or two-family I Minimum fee I I $58.00 I $ I Each, fixture $19,00 $ I Miscellaneous fees 1100' storm, sewer, water line / $76,00 $ 7 f^.. I Each fixture, appurtenance, and piping $19.00 $ r I Storm water retention/detention facility" $19.00 $ Irrigation systems $19.00 I $ - Piping or private storm drainage 1 1 svstems exceedin2: the first 100 feet $19.00 $ . 1 Specialty fixtures $19,00 I $ I I Reinspectian (no, ofhrs, x fee per hr.) $58,00 $ 1 I Special requested inspections (no. of $58.00 $ I hrs. x fee per hr.) I Each additional inspection: (I) $58,00 $ I r~~~~=~~~!:==~\; $ Mini~um fee I $ i ~:='~~,_,a~la~:,n.~, ",~'1.u,~~,e~",~~~~~J_11 1~~1k'H1.:; S' ~~~L!I<:;J1;NmlaUSE!i!}j['i;::..'", .".," "" I (A) Enter subtotal of above fees I . .. "l-1, (Minimum Permit Fee $58.00) $ "/1;;,. T I (B) Investigative fee (equal to [A]) 1 $':? ,5f1) I (C)EnterI2%surcharge(,12x[A+B]) $ 9,/1'2- I (D) Technology Fee (5% of [A]) $ , I I TOTAL fees and surcharges (A through D): $ ~9 _ ~ ~ $238,00 $ $ $ $ $ 225 Fifth Street , Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00329 COM2009c00329 COM2009-00329 COM2009-0033I COM2009'0033I COM2009-0033I Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Sanitary Sewer - 1st 100 Feet + 5% Technology Fee + 12% State Surcharge Sanitary Sewer - I sl 100 Feet + 5% Technology Fec + 12% State Surcharge Paid By GARY MUSTIN City of Springfield Official Receipt Development Services Department Public Works Department, 3200900000000000156 Date: 03/11/2009 IO:56:35AM Item Total: Check Number Authorization Received By Batch Number Number. How Received njm 0116948 0116948 In Person Payment Total: Amount Due 76,00 3,80 9,12 76,00 3,80 9,12 $177.84 Amount Paid $177 ,84 $177.84 , Page I of I 3111/2009