HomeMy WebLinkAboutPermit Plumbing 2009-5-12
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I Pemitno,: C. 9 - ~03 I
I Date: S - ( Z --- Q 7 I
This permit is issued under OAR 918-780-0060, Permits are issued only to the person or contractor doing the work. Permits
~xpire if work is not started within 180 days of issuance or if work is suspended for 180 days.
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I Zoning approval verified? DYes D No 1',;,"D"'ill'1'h~'-t:'~~,'E_',' '''i''~ c"~,',', .">;','I'~t:W~llI';;€Osffll1SII' ;rofill~,'
" eSCrI[! IOn;:10 . ., ' '!~l~~" 'r '" r~ m. .,~ '. '-C"i
I D 0 ;f')$':*-w~,4fii\.~'L~ ..<:"..<: - ",!'iM.~.t-~,,< r~ ';,_,.&~:ll': ,~!J:~M~ ,,~~q~-~~
r~:~~~~~v~~v;~~~~f7;4[C:QN~~Ri!.Jc;m'QN~1 I, ~::;r~~~~t~::chen (includes first I
I I 100 feet of water/sewer lines, hose
o Residential 0 Government 0 Commercial bibs, ice maker, under floor low-point $238,00 $
~~~JQal{$imE:!!lU'";.Q~MJMIjIQNlf~Nl:5jl!'!1):q:A.JfiI(:)r\I~~ drains and rain-drain packages)
~~~l~:i;~~i i E~;,:f~;~~~:;::.".,.. ,.5:~: !
I ru,^ 'A"'.k, \,~.'::, ~Y"'. ~ Y"-'-~r,:> IOt02,000squarefeet I $58,00
I I , t \ . I 2,00 I to 3,600 squarefeet. $116,00
'+\) f't'~ YVJv... '-'J>
l~eR0'F!,E~1r,Y"QWr\lE:B,~~{~~ I 3,601 to 7.200 square feet I $174,00
I Name: (' ,\v,...1 Vo> G~ II 7,20] sq~are feet and greater $232,00
Manufactured dwelJin~ or pre-Cab (circle one)
I Address: 7'1 S;< 0 Ah b^ J+ L vi. I Connections to building sewer and I I $58,00 I
I /U I l.n. L water supply $
City: LA 1+""" / h,--nv-e State: b f?- Z]P,-/7-{ z.. I I
- Commercial, industrial, and dwellings other than one- or
I Phone:5'l1 -'11~' '12. \! II I Fax: '5i 1- 91z- 3 D' 0;: two-family
I I Minimum fee I I $58,00 I $
E_mail: \-c<-k~.:>.e.1/50<2..fY..S(\.C!...D~
I Each fixture $19,00 $
This installation is being made on residential or farm property
owned by me or a member afmy immediate family, and is I MisceUaneous fees
exempt from licensing requirements under OAR 918-695.0020, 100' storm, sewer, waler line
1~~~~~;N7J~;]~lli~Am'0N~~;~~~~(~~, I ~~::::~::~::~~:~:::~:: ~~::~~
Piping or private storm drainage
systems exceedine: the first 100 feet
I Specialty fixfures
Reinspection (no. ofhrs. x fee per hr.)
I Special requested inspections (no. of
hrs. x fee per hr.) . "
Ea('h additiol).al inspection: (1)
Pluml,Jing Permit Application
225 Fifth Street. Spcingfield, OR 97477 . PH(541)726.3753 . FAX(541)726-3689
I Address:
I City:
I Phone:
I E-mail:
I CCB license no,:
I Plumbing license no,: '
I Print name:
I Signature:
I State:
I Fax:
I ZIP:
I BCD license no,:
,/ $76,00 I
l..,/~ $19.00
$19.00 I
$19.00 I
$19,00 I
$19,00 I
$58,00
l
$58,00
$58,00 $
Minimum fee
I Enter value of installation and equipment $ _"
J Enter fee based on installation and' equipment value.
I
!
I
I
I
$
$
$
$
I
I
I
I
$70 '0'01
$ I
$ I
$ I
$ \0..40
$ 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):
440-2500-J (II/OS/COM)
$
$
$
$
$
95, &-:9
, I
(I .4l~ '
1!J}'j'
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009~00663
ISSUED: 05/1212009
APPLIED: 05/12/2009
EXPIRES: 11/1212009
VALUE:
225 Fifth Street, Spi-ingtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6151 MAIN ST
ASSESSOR'S PARCEL NO,: 1702343400500
Springtield TYPE OF WORK: Plumbing Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Water line
Owner: GREEN CHARLES D & CONNIE A
Address: 79520 ABBOTTLN
COTTAGE GROVE OR 97424
I CONTRACTOR INFORMATION'
Contractor Type
Contractor
License
Expiration Date Phone
,BUlL,D1NG INFORMATION'
# of Units:
'Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Strncture
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
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage: Liires you to
ATTENT!?~~~:;?AO~ ~~~~:6regon ~~~~L,
I PUBLIC IMPROVEMr,~:ii~i:I' ~ti~~ Center, ThhOSe rg~~"'~AR 952~001-
, "952-001-0010 t rOll I by
In Olin . Sidewalkoli e:Dies ot the rLl es
0090, You ,,,ay ~--- j~ ie' the telephone
calling tIDow~mf6iIts/tfra;'ns:y Notitication
. number for the, ur1e~~b'_332~2344),
Center IS -0
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm. Sewer Avaihlble:
Special Instruction:
Notes:
Description
NU 111.". ALL EXFIIHI- Ir I"i;;:' ';;,;::: I
THIS PERMIT SH THn Valuation~ElescriDtion
AUTHORIZED UNDER "'I:I\I,rC[) ~OR
CT'" ..,'-f<,-rc1"\t nil IS ABA'$'Per'Sq-Ft Square Footage
ype 0 _",ons rucuon D' I' I' B'd A
A~JY 180 DAY PERIO ' or mu tip IeI' or I mount
Value
Date Calculated
Page I of 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'
Water Line - Each AddtllOO'
Total Amount Paid
Amount Paid
$11.40
$4,75
$76,00,
$19,00
$111.15
Total Value of Project
,F~~s Paid'
Date Paid
I Plan Reviews I
5112/09
5112/09
5112109
5/12/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00663
ISSUED: 05/12/2009
APPLIED: 05/12/2009
EXPIRES: 11/12/2009
VALUE:
Receipt Number
2200900000000000520
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. '
I Reouired I nsoections ,
Water Line: Prior to tilling trencb and including required testing,
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 fnrther certity 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
tbat NO OCCUPANCY will be made of any structure witbout permission of the Community Services Division, Building Safety,
I furtber 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 tbe front of tbe property, and the approved set of plans will remain on the site at all
times during construction.
~~ .JJ.,
Owner or Contractors Signature
Page 2 of2
Date
s- 12 -0'7
225 Fifth Street
SpYingfield, Oregon 97477
541-726-3759 Phone
Job/Journal Nu~ber
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 AddU 100'
+ 5% Technology Fee
+ 12% State Surcharge
Water Line - 1st 100'
+ 5% Technology, Fee
+ 12% State Surcharge
Water Line - 1st 100'
Water Line - Each Addt! 100'
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
CHARLES CONNIE GREEN
"P,"-"'"P,',.'~, ','" "''',
..)A liJ . . .
8&:-" ,
.
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000520
Date: 05/12/2009
I:S4:48PM
Item Total:
CheckNumber 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
11.40
76,00
3,80
9,12
76,00
19,00
4,75
11.40
$400,14
Amount Paid
$400,14
$400,14
Page 1 of I
5/12/2009