HomeMy WebLinkAboutPermit Plumbing 2009-5-20
Plumbing Permit Application
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I Date: 5-2-19 -'(}-1 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.
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I Zoning approval verified? ' 0 Yes 0 No
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I PResidential, I 0 Government I 0 Commercial _
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I City:::ilY,Vt(J~~ld. I State:6~ r ziP: 9.74:-75
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I Address370D B?hcd:- L.n- -:it, {{ <{ I
I City: ~ , I State: {){L I ZIP:"774t2, I
I Phoneq[{-re0"1<B2. I Fax: I
I E-mail: I
This installation is being made on residential or fann property
owned by me or a member of my immediate family, and is
exempt from I~~ng requirem'e~un r AR -695-0020,
SIgnature: _Z~ O\Z
~~~lic'ON;jjRAC;TlOR'5:INsmAI!iI!AT N~m'\1,!lI*;P:.t'Yr1
I Business name:
I Address:
I City:
I Phone:
E-mail:
I State:
I Fax:
I ZIP:
CCB license no,:
I Plumbing license no,:
I Print name:
I Signature:
I BCD license no,:
440-2500-J (11/08/COM)
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I New residential
1 bathroomll kitchen (includes: first
100 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 bathrooms/I kitchen' $439,00
I Each additional bathroom (over 3) $95,00
I Each additional kitchen (over 1) $95.00
I Residential fire sprinklers (includes plan review)
1,0 to 2,000 square reet I $58,00
I 2,001103.600 squardeet 1 $116,00
I 3.601 to 7,200 square reet I $174,00
1 7,20 I squardeel and 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 $
1 Each fixture 1 $19,00 $
I Miscellaneous fees
I 1 OO~ storm, sewer, water line
I Each fixture, appurtenance, and piping
I Storm water retention/detention facility
I Irrigation systems
I Piping or private stonn drainage
svstems cxceedine the first 100 feet
I Specialty fixtures
Reinspection (no. ofhrs. x fee per hr.)
Special requested inspections (no. of
hrs, x ree per hr.)
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! Enter fee based on installation and equipment value. I $ I
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I (A) Enter subtotal of above fees '
(Minimum Permit Fee $58.00) $ 58-a!: 1"
1 (B) Investigative fee (equal to [A]) $
1 (C) Enter 12% surcharge (.12 x [MB]) $' h, '1(,1
I (D) Technology Fee (5% of[A]) $ ~,'?E7I-
I TOTAL fees and surcharges (A through D): $ /1,7,;;?iJ,
Each additional inspection: (I)
$238.00
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$76,00 I $
$19,00 $
$19,00 $
$19,00 $
$19,00 $
$19,00 $
$58.00 1 $
$58,00 I $
$58,00 $
W~~diSal?gft~pIp~:~~~~~~~ Minimum fee $
I Enter value of installation and equipment $ _0
$
$
$
$
$
$
$
$
$
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
;
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CITY OF SPRINGFIELD I
Building/Combination Permit
PERMIT NO: COM2009-00703
ISSUED: OS/20/2009
APPLIED: OS/20/2009
EXPIRES: 11/20/2009
VALUE: $2,000.00
,I !I
SITE ADDRESS: 5657 THURSTON RD
ASSESSOR'S PARCEL NO.: 1702331100300
/ Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Plumbing Repair to Bathroom.
Owner: HOME EQUITY ASSET TRUST 2006-7
Address: 2141 5TH AVE
SAN DIEGO CA 92101
TYPE OF USE:
Residential
I CONTRACTOR ,INFORMA TlON I
Contractor Type
Contractor
License
Expiration Date Phone
BUILDING INFORMATION'
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
VB
II/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Otber:
Occupant Load:
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amonnt.
Date Calculated
Tvpe of Construction
Page I of 2
REQUIRED PARKING
Tota!:
Handicapped:
Compact:
Sidewalk Type: I
DownspoutslDrains:
Value
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
Fees Paid ,I
Fee Description
Amount Paid
Date Paid
Total Amount Paid
$0.00'
,I Plan Reviews I
CITY OF SPRINGFIELD
"
i;
Building/Combination Permit
I '
PERMIT NO: COM2009-00703
ISSUED: OS/20/2009
APPLIED: OS/20/2009
EXPIRES: 111/20/2009
VALUE: $' 2,000.00
Receipt Number
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To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. win be made the following
work day, c Ii '
,
I R~'l~ire~ I ~~p~cti,~,".s 1
Underlloor Plumbing: Prior to insulation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
, Ii
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hheby certify that all
information hereon is true and correct, and I further certify that any and all work performed shal~ be done in accordance witli
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 Servi,ces Division, Building Safety.
1 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 reqnired inspections are requested at the proper time, that each ~ddress is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans wi'lI remain on the site at all
times during construction.' ?
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Owner or Contractors Sign~ture'
Paee 2 of 2
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4/ti
Date
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City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00703
COM2009-00703
COM2009-00703
COM2009-00703
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
3200900000000000382
Date: 05/20/2009
3:\\:33PM
Description
Fixture
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Amount Due
57,00
1.00
2,90
6,96
$67.86
Paid By
WILMA L LANTZ
Item Total:'
Check Number Authorization
Received By Batch Number Number How.Received
028291 In Person
Payment Total:
$67,86
$67.86
Amount Pllid
Page 1 of 1
5/20/2009