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Home My WebLink AboutPermit Plumbing 2009-5-12 rlumbing Permit Application l~lDERARTM'E,'''Nrr"u, :,S,)EY0N~~-,1 ~~~if.f~';'~';~'f.i1:.~-.:;r~21J~~ I Permit no: Cf1 0.fI';r... I I Date: S ~ I Z ~ 0 7 I 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 not started within 180 days of issuance or if work is suspended for 180 days. 1'll'1"'[jl<"'''''''''irOr--A''~G'O'V' E'R'N"M' 'EN"'i'A' '''P'R''OV'A""""",;l1>1S",'' ''''",1 ~t4h~~#'fcr;~ir$'"~_.L.:;i:_ 0' 'i:m_ 'n'" '" ',' ",11[00' - 'r.: :;.: _ ._' .,. ,L:;;5~~&3o/~A:ri:t:'~}tJ~~ I Zoning approval verified? DYes D'No I I Sanitation approval verified? DYes D No I [i_~IC;AmEG0.RYtKQFJrC:~NSjljRtJ.It!!1i0.N~uilit~l D Residential I D Government I D Commercial 1~~::~I:I:~;~e;M~;.~~Djlf0~t%1!I0.N~~~~1 I City: S~c,~C\'d,^ I State: b~ I ZIP: '1717 ); I ~6n('!0J..2ff6f I Lot(~ I ~P'l,'!0'~"'''''''!:''',"!n'E''S-''''R'I''TION''0'''~.wO' RK.i"y,'il>""~~"'-';:'i'll"}\'1 "it%ji;0!""531,;;t~;~?'6!Y!$U_____ _,~,L I';::jl,' ___', ,fA .\$th" .,_,_-./!i>:;",;,-,"")%,2K?t'D",i~~",~.;,:"i Y"v-.-Y">, wo.kx-\\.:u Cru""" ~~~x I 1t'1J;"&~~"~~~ROF!ERT;Yifil0WNER'Vf!"~"1~1l\l!!;'~"'",~il ~l~M~i4if~I!~'!Lx~;"'d' J'.l.',' "'_.f:fff" .L __, _ _,Y~0:~~'%'.~",_miA~i:i",,~;~ I Name: {\"l,/i,,,,\.e,-, b~ I Address: 7Q5;).0 MbuH k", ,I City: c-'+1-(l,'Y G~ I State: <JV'- I ZIP: '17-'17 II I Phone:5~I-'Hr '12'6'il I Fax:S~I-'NI- 30 \ <.1 I E-mail: "\-n.('~' -:.z (j)'(j, 12 '(Y\"", ~ 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: ~"''''l'-'Ii1",t-0Ni11RA:C:j;0R'l'INSitAl!ilf'AirION~l,f%,''!11~'''"''i~l~\~ tt:f.*llMSYl;;Ltl.,~ _ _ _, '_,"" _ _.' ._ .._ ,l... ._..... !!L..... ...... '.__ ..""'.... ..,,,T\;r'"'\'t>.:~'._",.,,.._...,::,,' I Business name:J )t...l AJGrC--- ' I Address: I City: I Phone: I E-mail: I CCB license no,: I Plumbing license no,: I Print name: I Signature: I Staie: I Fax: [ ZIP: I BCD license no,: 440-2500,) (l1/OS/COM) ;ii;;;; T""l;'''i''''''''''''J18>jR~''EE,]fS'''' 1'1' E"""j;'E' 1l;C"~1!llf."i:lU<",,';;"""'""''' .':!J<A3f,\.:::r.;;I.,l~~iiMl"""~,?ii~ __%.: ~_' ____,I,;IV.~___;i~~~,ih5i,1Ff~~~~ ~','i'."''''','';i1Ii """. 't;~,.g_"":t ""'-"':,- ';"~if!,,;1;lttI;"'" '''"','I~F<i'OSI:''I' ~,:;rotiil~ Cc",escnp Ion "",,,,,, '1;P:l,'" Qty' iPjJ,~,", a-'''' ",'1, ~:k~f;,1,t.i!.s..,;e~"''"''.; ~ tg ,'--~- ~--. Etif~li 4.",.tP~ ~~~~.; _ !r'~~.o~J~ I New residential 1 bathroomll kitchen (includes: first 100 fiet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) ., I 2 bathrooms/1 kitchen $374,00 I 3 bathrooms!1 kitchen $439,00 I Each additional bathroom (over 3) , $95,00 I Each additional kitchen (over I) $95,00 I Residential fire sprinklers (includes plan review) o to 2,000 square feet $58,00 2,001 to 3,600 square feet $116,00 3,601 to 7,200 square feet $174,00 7,201 square feet and greater $232,00 Manufactured dwelling or pre-fab (circle one) Connections to building sewer and I I $58 00 I $ water supply . Commercial, industrial, and dwellings other than one- or two-family . . Minimum fee Miscellaneous fees 100' storm, sewer, water line Each fixture, appurtenance, and piping Storm water retention/detention facility Irrigation systems Piping or private stonn drainage systems exceeding the first 100 feet Specialty fixtures Reinspection (no. ofhrs. x fee per hr.) Special requested inspections (no. of, hrs. x fee per hr.) I I Each additional inspection:. (I) $ I I#M~dIcTi1rg'~~irg~~_* Minimum fee $ I I Enter value of installation and equipment $ _" I fee based on installation and equipment value. Each fixture I I 1 I I (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) I (B) Investigative fee (equal to [AD I (C) Enter 12% surcharge (,12 x [A+BD , I (D) Technology Fee (5% of[AD I TOTAL fees and surcharges (A through D): $238,00 $ $76,00 $19,00 $19,00 $19,00 $19,00 $19,00 $58,00 I I I I I I I I I I ,\ I I I I $ 7L ,o-d $ I $ I $ I $ I $ I $ I $ I I I $ $ $ $ $ $ $ $ $58,00 I $ $19,00 $ $58,00 $58,00 $ $ ""'7c'.IOU $ I $ '1. .n.. $ b.'6(J) ()L $ I)?s~( Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00662 ISSUED: 05/12/2009 APPLIED: 05/12/2009 EXPIRES: 11/12/2009 VALUE: 225 Fifth Street, Springfield, OR 541- 726-3753 Phone 541-726-3676 Fax 541-726-3769Inspeetion Line SITE ADDRESS: 6145 MAIN ST ASSESSOR'S PARCEL NO,: 1702343400500 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Wa!er line replacement Owner: GREEN CHARLES D & CONNIE A Address: 79520 ABBOTT LN COTTAGE GROVE OR 97424 I CONTRACTOR INFORMA T10N I Contractor Type Contractor License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: ' # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: I PUBLIC IMPROVEMENTS I , eo vou to . . 1,..,., real]!\" '" ..' NT\O~ld!~a!k'Type: O'~con Utility ATTE ~rlnnted bv tM ,~~ ttorth tolloW rulelDown'spoutslDrains:. are se 001 ' C nte!, "W~~' R 952- - Notitica\lon _061-0010 through Of" he :u\es bV ~o~~R ;~~ mav obtain ~~f~e~h~l {elephone \iing the center. ( Utility Notification ca . _< .j.ho"'\ (''!rAOon . ~ . .\ -"'lIUvl ,-- . "\ 6UU.,jQt..-'-.... . NOT!r'E' I Wi center IS - v . LL EXP nValuation.II)i'JS'criotion I THIS PERMIT SHA 'c ~ T IS NOT ^' 'Twnp,17Fn UNo.ER THI::$rpe~S~ F) Square Footage 1"'Tvpe'ot ConS/rucHon ABA' "'''^'Irt-' '1!-i"lR COMMENCED UK I~ orJmu ,'p leY or Bid Amount ANY 180 DAY PERIOD, ! Value, Date Calculated Storm Sewer Available: Special Instruction: Notes: Description Pa2e I 01'2 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 P~!d I Date Paid I Plan Reviews I 5/12/09 5/12/09 5/12109 CITY OF SPRINGFIELD ~uilding/Combination Permit PERMIT NO: COM2009-00662 ISSUED: - 05/12/2009 APPLIED: 05/12/2009 EXPIRES: 11/12/2009 VALUE: Receipt Numher 2200900000000000520 2200900000000000520 2200900000000000520 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. ' R~OI.li~~d '~slle~t.ions , 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 wqrk 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 structurewithout 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 he 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. (lL~ ):z -' Owner or Contractors Signature Paee 2 01'2 ~-J2-0Cj Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone , if ji4 Ilk, City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-00660 COM2009-00660 COM2009-00660 COM2009-0066I COM2009-0066I COM2009-0066I COM2009-00661 COM2009-00662 COM2009-00662 C0M2009-00662 COM2009-00663 COM2009-00663 COM2009-00663 COM2009-00663 Payments: Type of Payment Check cReceintl RECEIPT#: 2200900000000000520 Date: 05/12/2009 Description Water Line - 1st 100' +5% Technology Fee + 12% State Surcharge ,Waler Line - 1s1100' Waler Line - Each Addll 100' + 5% Technology Fee + 12% Slale Surcharge Water Line - IslIOO' + 5% Technology Fee + 12% Slate Surcharge Waler Line - IslIOO' Waler Line - Each Addtl 100' + 5% Technology Fee + 12% Slale Surcharge Paid By CHARLES CONNIE GREEN Item Total: .Check Number Authorization "Received By Batch Number Number How Received njm 5362 In Person Payment Total: Page I of I 1:54:48PM Amount Due 76,00 3,80 9,12 76,00 19,00 4,75 11.40 76,00 3,80 9,\2 76,00 19,00 4,75 11.40 $400,14 Amount Paid $400,14 $400,14 5/12/2009