The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 2009-5-12 Flumbing Permit Application 1~~iiCi7JiL<i!f;1f;:f.'lZ~J"YFY:U"'J'.iI.-~Rt'U~:j'b.~~1 ~~~Bc~I~~1:!lt~~~<i>~~~J!~~ I Permit no,: C 1 - ~61)1 I Date: :5 - IZ-~()tj 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 if work is suspended for 180 days: 1~_~l!'O(1;~L'IG0~EJ{NMi:I':!lli"p<~.~~OVAlE;1~i?~;N~:r I Zoning approval verified? DYes D No 1~~;:~t:~;;~v~~~;;F,;iC~~N~;s~8,erIllO~~~~~ I~J~~~,mE~fN~g~~i;7;~~~NI)J~~C:~~~~;~~ 1 Job site address: L, \ 3 q YY\e< ~ '" s+ ' 1 City: ~e"~ 1 State: ClIIL I ZIP: 97'17.8 li=~I'tl"E''''C~R-I,?f'I'''N~ i!:0_r;ifW0J~~j;~~:;; 6ni?",9':';;~'V.t:yor "'~~. _,_r;.iIL~ _.m.: _.rvt..i-.. ",' "....~.~,'!H"'.;u:.....g.:&{i."',_,''''1ti~^ 1 ,-<-LV'>. ~ hJ",k,x- \ ,..:..c C-..D-<n ",,-<-'kT-+O 1~~~~R~&Eglf<<il0WNER~~~~il1!~~ I Name: C'kr.<\e~ Cr-,~ -I I Address: '7'1520 ,Qbh"+-+\...'" 1 1 City: GH,,>;, b<mr< 1 State: ()~ 1 ZIP: (17'hJ 1 I Phone:6'/I-q~c- "Jz." \J 1 Fax:5~' -'14e .301'l!. 1 1 E-mail: +V-<.to. "'- 01[) ~ "'"',,(\, ~ 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, , ' 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 Signature: 1D!""_"~f'"~''''0' "'RA"TO'R'INS"'A"""ATI0N"""""''''''''''-cc< v' (}f}!~':~Y:i;J;}_v_' NIll.___..' \,;;oilL',_ ~_ , _ }It,rl!d '(II '_ _ 0#~'~J,~,:izz'~;e=li I Business namev()W/Vbre./ I Address: I City: I Phone: 1 E-mail: I CCB license no,: 1 Plumbing license no,: I Print name: I Signature: I State: I Fax: 1 ZIP: 1 BCD license no,: 440-2500~J (t 1/08/COM) 1~r.;1:~~t5~f;J-~~jlfif$(;~SCH_~,D~,W;M~~~ 1'''''''''iii9il\'1ilfJcY:ii!.'''' 'fllll' :::iJ!41g!iif~';)oi1ii'''I''~"~II)€~osll?'I''!''''~~t''ll~~': ~l)eSCrtRttOn ,'~, '-l?f!~~ Qty, ~, '-", ~<iV:,,-_ai.\l! ~~;*~~;d:tz"E%g0iHfh\i " _~__ _" _ ",M1>".;-;'i1%li5i;1l1E; ~;';;'~1~ e,~i.dt~,,,, l:{~~,~~:-r,;,~ I New residential I 1 bathroomll 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 $ I 3 bathroomsll kitchen $4i9,OO I $ I Each additional bathroom (over 3) $95,00 1 $ I Each additional kitchen (over I) $95,00 1 $, I Residential fire sprinklers (includes plan review) 1,0 to 2,000 square feet $58,00 I 2,001 to 3,600 squarefeet $116,00 /3,601 to 7,200 square feet $174.00 1 7,201 squarefeet and greater, $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 1 Minimum fee I I $58,00 I $ 1 Each fixture ' $19,00 $ I Miscellaneous fees [ 100' storm, sewer, water line I Each fixture, appurtenance, and piping I Storm water retention/detention facility l.lrrigation systems I Piping or private stonn drainage svstems exceeding the first 100 feet I Specialty fixtures I Reinspection (no. of hrs. x fee per hr,.) I Special requested inspections (no. of hrs. x fee per hr.) , I Each additional inspection: (I) $58,00 I $ I~M~ii"I~ijgwpfpI~r~"~~BSA' Minimum fee I $ I Enter value of installation and equipment$ _' I Enter fee based on installation and eq"uipment value. $238,00 $ l/ $76,00 I ...-/$19,00 $19,00 $19,00 $19,00 $19,00 1 $58,00 1 I 1 1 I 1 1 1 I I I I I I I $? Un) I $ I $ 1 $ 1 $ I $ I $ 1 $ I I 1 I $ $ $ $ $58,00 $ I (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) I (B) Investigative fee (equal to [A]) 1 (C) Enter 12% surcharge (,12 x [MB]) I (D) Technology Fee (5% of [A]) I TOTAL fees and surcharges (A through D): $ qr;. UO $ I $\\ .A.LJ $ A" .\~ $ //I,,(S _~r:I'!)Iig!'lI~I:?, I ir ~) ! ' " Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection, Line SITE ADDRESS: 6139 MAIN ST ASSESSOR'S PARCEL NO,: 1702343400500 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00660 ISSUED: 05/12/2009 APPLIED: 05/12/2009 EXPIRES: 11/12/2009 VALUE: Springfield TYPE OF WORK: Plnmbing Only PROJECT DESCRIPTION: Water line Owner: GREEN CHARLES D & CONNIE A Address: 79520 ABBOTT LN COTTAGE GROVE OR 97424 TYPE OF USE: New Residential I CONTRACTOR INFORMATION I Contractor Type Plnmbing Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Unils: Primary Occnpancy Gronp: Secondary Occnpancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Heighl of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMA TlON I Sidewalk Type: DOWllspouts/DraiIls:" require:3 ~'Ol' to ATTEr" ,'VI , d~p7od by the Oreooll Uti,i:'J follow ru ,es a ' <0 . et forth Notification Center, Thhose ru~e~:~e ;52-001- , OAR 952-001-0010\ roug b ~(\Qn Vnll maY obtain copies ofth,e r~I:: ^ y I nC~~i~~r tfo~ ~:;~;,~d~,~'uiil'it;nNo~tifiG~tion Center is 1-800-332-2,)44), Square Footage or Bid Amount Front yard Selback: Side 1 Setback: Side 2 Spback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: , I PUBLIC IMPROV~MENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: ~iOTlCE: IlflV rcnlVlI1 0nHLL CAl'Jr1t:.... ,....- ,,,..,....... AUTHORIZED UNDER THIS PiIJWII~a1i~wDescriDtion COMMENCED OR IS ABANDONI::U ~UH , , ANY < Rn n^" ocn.nC', $ Per Sq Ft DeSCriptIOn 1-vpe-of. Const"ucOOn It' I' ormu Ip lef Paee 101'2 REQUIRED PARKING Total: Handicapped: Compact: 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 I Date Paid I Plan Reviews I 5/12/09 5/12109 5/12/09 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00660 ISSUED: 05/12/2009 APPLIED: 05/12/2009 EXPIRES: 11/12/2009 VALUE: Receipt Number 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, Reouired Insnections I 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 herehy certify that all information hereon is true and correct, and 1 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 Divisiou, Building Safety, 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 further agree to ensure that all required inspections are requested at the proper time, that each address is readable from tbe 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. (J~dA/ JL Owner or Contractors Signature Page 2 01'2 --- -~ -/:2 -09 Date 225 Fifth. Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00660 COM2009-00660 COM2009-00660 COM2009-00661 COM2009-0066I COM2009-0066I COM2009-00661 COM2009-00662 COM2009-00662 COM2009-00662 COM2009-00663 COM2009-00663 COM2009-00663 COM2009-00663 Payments: Type of Payment Check cReceintl RECEIPT #: Description Water Line - 1st 100' + 5% Technology Fee + 12% State Surcharge 'Water Line - 1st 100' Water Line - Each Addtll00' + 5% Technology Fee + 12% State Surcharge Water Line - 1st 100' + 5% Technology Fee + 12% State Surcharge Water Line - 1st 100' Water Line - Each Addtl 100' + 5% Technology Fee + 12% State Surcharge Paid By CHARLES CONNIE GREEN 4:;Q~~ ai:: ' City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000520 Date: 05/12/2009 1:54:48PM Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 5362 In Person Payment Total: Amount Due 76,00 3,80 9,12 76,00 19,00 4,75 I] .40 76,00 3,80 9,12 76,00 19,00 4,75 11.40 $400,14 Amount Paid $400,14 $400,14 Page I of I 5/1 2/2009