HomeMy WebLinkAboutPermit Plumbing 2009-4-9
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Plumbing Permit Application
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I Permitno,:e9- i7} I
I Date: Lf! 7/ /) ;7 I
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 not started within 180 days of issuance or i~ work is suspended for 180 days.
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I Zoning approval verified? DYes D No I
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I f:}Residential I 0 Government I 0 Commercial I
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I City: 1""u L././ I State: oil I ZIP..;' J~7 .v I
I SUbdivi;ion: J J Lot no,:
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Name: ('"~. L /L-_~..... I
I Address: jcrL.C ...,~~J,,;. A.- I
I City: s>?_,)~/./ I State:~ I ZIP:5'74 tfl I
I Phone:~/"I- ?26-?:v~'" I Fax:J"'/-~-i/,('7 I
I E-mail: :r/K"A'~/ to c,a. ~_""'< ,J~_ I
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 tequirements under OAR 918-695-0020,
Signature: '
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I Business name: ~;~ L',...e.~A p/c:...... A-._t-<o" I
I Address: /" ,-' 71.J~//' I
I City: r4,i'~ , State: tJZ," ZIP: tf'?t?""r
I Phone: - - I Fax:
I E-mail:
I CCB license no,: <fqlf6/ I BCD license no,:
I Plumbing license no,:
I hint name:
I Signature:
. .... .
225 Fifth Street. Springfield. OR 97477 . PH(5~1)726-3753 . FAX(541)726-3689
440-2500"J (llI08/COM)
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I New residential I
1 bathroom/l kitchen (includes: first
100 feet of water/sewer lines, hose
bibs, ice maker! under floor low-point
drains and rain-drain packages)
I 2 bathrooms/I kitchen $374,00
I 3 bathrooms/] kitchen $439,00
I Each additional bathroom (over 3) $95.00
I Each additional kitchen (over I) I $95,00
I Residential fire sprinklers (includes plan review)
I. 0 to 2,000 square feet I I $58,00 I $
I 2.001 to 3,600 squarefeet I $116,00 $
I 3,601 to 7,200 square feet I I $174,00 $
I 7,20] square feet and greater I $232,00 $
I Manufactured dwelling or pre-Cab (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
11'00' storm, sewer, water line
I Each fixture, appurtenance, and piping
Storm water retention/detention facility
I Irrigation systems
I Piping or private stonn drainage
, svstems exceedin2 the first 100 feet
I Specialty fixtures
I Reinspection (no. ofhrs. x fee per hr.)
I Special requested inspections (no. of
hrs. x fee per hr.)
Each additional inspection: (1)
$238,00
I
$76.00
$19,00
$19,00
$19.00
$19.00
$19,00
$58.00
$58,00
$58,00 $
$
::",ryfi;"":"'S.'00',,"Sl;~r:~:-~tGW^rl51f;tffI~05'~/f,f.fiJI'Z;i03&"2Ejiil ' ,
t~::t~~.I_~~Hg::l,S.'PIPII!l!5,~~~k't~,~fS%1Jt1i MInImum fee
Enter value of installation and equipment $ _'
[ Enter fee based on installation and equipment value.
$
$
$
$
$
I.
I
I
$ I
$ , '( +5 JMwlr
$ I
$ I
$ I
$ I
$
$
$
I (A) Enter subtotal of above fees,
(Minimum Permit Fee $58.00)
I (B) Investigative fee (equal to [A])
I (C) Enter 12% surcharge (,12 x (A+B])
I (D) Technology Fee (5% of[A])
I TOTAL fees and surcharges (A through D):
$ 5'b I
$ I
$"~ I
$"J~I
$lH.t '
Status ,Issued
225 Fift" Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINut<mLD
Building/Combination Permit
PERMIT NO: COM2009-00471
ISSUED: 04/09/2009
APPLIED: 04/09/2009
EXPIRES: 10/09/2009
VALUE:
SITE ADDRESS: 3566 VIRGINIA AVE
ASSESSOR'S PARCEL NO.: 1.702314303106
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE:
Residential
PROJECT DESCRIPTION: Replace Elect water heater
Owner: KNAPP STEVEN L
Address: DIRECTOR OF VETERANS AFFAIRS CONSERVATOR OF STEVEN L
KNAPP
SALEM OR 97301
I CONTRACTOR INFORMA nON ~
Co:ntractor Type
Plumbing
Contractor ATTENTION: Oregon law requIrJ~ev~teto
RIGHT WAY 11!;"H\'\~Il~'Q.; adootp.rl hv thA Or~~,;;~~ I Itili",
NOtl1ll~:BUlI~I)(NG 'INFORMJ\:'flON let forth
In OA .. _, _ .", __"''' _, ,,', _:32-001-
0090, You#rnet~ISntbt,qin copies of the rules by
. 0' ones. ,
R 3 calling tl,~ ,.'e,,'l!.erl, siNo!e: the telephone
- b f'Helg t.o. tructu"e I" 'f' ..
num er (ji Un=' \!lt"!\..lUII UtllIlY 'IlotIICat10n
C T.ype 01 Heat: 3
e,,, '" 10 ,-uvv- 32-2344),
Water Type:
Range Type:
Energy Path:
Sprinkled Bnilding:
Expiration Date
12/16/2010
Phone
541-484-3787
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:'
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFOR~AnON I
NOTICE: Overlay Dist.
THiS PERMISticl!Ai:!e~\fi'q'ilE IFTHE WORK
AUTHORIZp\?VHiJOo/\el{\i:<!:: PERMIT IS NOT
COMMENco~o(1.:p!g::A'W\fllSONED FOR
ANY 180 DAY PERIOD. '
I ~UBLIC IMPROVEMENTS I
REQUIRED PARKING
Total:
Haudicapped:
Compact:
Street Improvemeuts:
Storm Sewer Available:
Special Instruction:
Sidewalk Wi'le:
Downspouts/Drains:
,
N o\es:
I Valuati?n Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amonnt
Value
Date Calculated
Pace I 01'2
Lll y' OF ~rKINtJl'lELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-00471
ISSUED: 04/0912009
APPLIED: 04/09/2009
EXPIRES: 10/09/2009
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 D.cscription
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Minimum/Adjustment Plumbing
Amount Paid
'Date Paid
Receipt Number
$6.96
$2.90
$19.00
$39.00
4/9/09
4/9/09
4/9/09
4/9/09
2200900000000000352
2200900000000000352
2200900000000000352
2200900000000000352
Total Amount Paid
$67.86
I Plan Reviews,
To Request an inspection call the 24 hour recording at 726-3769. All inspections requesfed 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 Rellllired! nsn~ct!ons I
Rough Plumbing: Prior to cover 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 "pplication and do hereby certify that all
inf~rmation 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 compliauce 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 tbe property, and the approved set of plans will remain on the site at all
times during constru~tion. .
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Owner or Contractors Signature
4' /'1/17<7
Date
P~ee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541:726-3759 Phone
Job/Journal Number
COM2009-00471
COM2009-0047I
COM2009-00471
COM2009-00471
Payments:
Type of Payment
Check
c
eRccei otl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000352
Date: 04/0912009
11:21:33AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due:,.
19,00
39,00
2,90
6,96
$67,86 ,
Description
Fixture
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
'S CREDIT UNION MONEY
ORDER
Amount Paid
cjc
14282284
$67,86
In Perso.n
Payment Total:
$67,86
Page 1 of 1
4/9/2009