HomeMy WebLinkAboutPermit Plumbing 2009-6-1
Plumbing Permit Application
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I Permit ~od 7- '7 s.!;,
I Date 6/I/tJ /'
225 F;!lh St,eet . Sp,ingfie]d, OR 97477. PH(54])726-3753 . FAX(54])726-3689
This permit is issued under OAR 918-780-0060. Permits are issued only to lhe 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
I Sanitation approval verified? 0 Yes 0 No
I CATEGORY'OF CONSl'RUCTION;;
I 0 Residenlial I 0 Government I 0 Commercial
l<8fJ~ii'~'JOBfSlmE',INFJ:)RMA",rONiYi.NDk)1i:o(;AT'ION~!iN'~\[lPl
I Job site address: ~I --:J-) m ('-.,Iclwl
I City: :Sf' ~ '-- \) I Slale: Ci 6'-. I ZIP: '7 '1"1' J 7
I Reference ~'1()-::)Q'13' , I Taxlot.~\90
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I- Name:
I Address: q"2 S-
I City 'h~ t:-W:J
I Phone:
I E-mail:
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 requiremenls under OAR 918-695-0020,
F~._\'''' ",I ".JJJ "'\-.
I State:O/l..,' I ZIP: q74
I Fax:
Signature:
I" ,"'."CONTRACl!OR,INSTALLATION,.,',.~.~,!("i':, ",~,'.,I
I Business name 'Q';~ lr.-I- 'u.! ~ P~Ll"J.,,~ I
Address: Po p;;',,!<. ',<lS:l--.(" I
City: ";=::.__."_" I Slate: CJ/l- I ZIP: 0., ') '-'-0 I I
IPhone~W4.\~-3)1r1 I Fax: I
I E-mail: I
I CCB license no,: '-\ '1 ~{" I I BCD license no,: I
I Plumbing license no,: I
I Print name: \\ v.ri'I Ar" ,. lei I
'Signature~ ~ ~ I
/
440-2500-J '(] !lOB/COM)
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I New residential
I bathroom! I kitchen {includes: first,
J 00 jeet oj water/sewer lines, hose
bibs, ice maker, under floor 10W'poinl.1
drains and rain..,drain packages}
I 2 bathroomsil kitchen $374,00
I 3 bathroomsil kitchen $439.00
I Each additional bathroom (over 3) J' $95,00
I Each additional kitchen (over]) , $95,00
I Residential fire sprinklers (includes plan review)
I 0 to 2,000 square feet $58,00 I ,$
12,00] to 3,600 square feet $116,00 $
I 3,60] to 7,200 square feet $174,00 $
j 7,201 square feet 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
I Commercial, industrial, and dwellif':gs other than one- or I
two-familv' .
I Minimum fee I 'I $58,00 I $ I, I
I Each fixture r $19,00 ${'l6'DlvJ,M
I Miscellaneous fees I .
1100' storm, sewer, water line $76.00 I $ I
I Each fixture, appurtenance, and piping $19.00 I $ I
I Storm waterretention/detention facility $19.00 $ I
Irrigation systems $19.00 $ I
Piping or private storm drainage $19.00 $ I
svstems exceeding the first 100 feet
I Specialty fixtu,es $19,00 $ I
I Reinspection (no. ofhrs. X fee per hr.) $58.00 $
I Specia,l request,ed inspections (no. of', $58.00 $ I
hrs. x fee Rer hr.) ,
I Each ad~itjonal inspection: (1) $58.00 $ I
$ I
I
I Enter fee based on installation and equipment value. ! $ I
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I (A) Enter subtotal of above fees -e; DO I
(Minimum Permil Fee $58,00) $ ) ~",-
I (B) Investigative fee (equal to [A]) $ I
I (C) Enter 12% surcharge (,]2 x [MB]) $ &:.5: I
I (D) Techno]ogy Fee (5% of [A]) $ )- ~~ I
I TOTAL fees and snrcharges (A lhrough D): $ c::rl,~
$238,00
$
$
$
$
$
Minimum fee
I Enter value of installation and equipment $ _0
~IilINGlf':IELO,
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,
"
Status
Issued
CITY OF ~t'Kll~\.JJ:<IELD
Building/Combination Permit
"
PERMIT NO: COM2009-00733
ISSUED: OS/26/2009
APPLIED: OS/26/2009
EXPIRES: 11/29/2009
VALUE:
225 Fifth Slreel, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspeclion Line
SITE ADDRESS: 975 FAIRVIEW DR
ASSESSOR'S PARCEL NO;: 1703273102100
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE: New:
Residential
PROJECT DESCRIPTION: Tankless water healer
Owner:
Address:
AlltNTION' 0 I '
CHURCHILL JOHN L & PAULA 1011 I' regon aw reqUIres you !'clton~ Number:
975 FAlRVlEW DR N rOW ru es adopted by the Oregon Utility"
SPRINGFl,ELD OR 97477 in ~~~a9tI502n OcOe1nter. Those rules are set forth '
_ _ - -0010 thrr'lll.....h r'\Ar-; ""'....^........,
VUt:fu. YOU may obtain rnnj~C!' ,..,f fh..... - -, ...e.
I C@N:rRAOif0RllNFORMAnON"liprhuesby
_ I II I II.... one
"""'U"f fur me, uregon Utility Notifie 'on
Contractor Center IS 1-S00-:13weO&Il), ~xpiration Date
COMFORT FLOW HEATING CO. 460 06/27/2009
541-747-8945
Contractor Type
Mechanical
Phone
541-726-0100
BUILDING INFORMATION I
# of Unils:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Conslruclion Type:
# of Bedrooms:
# of Slories: Lot Size:
, Heighl of Slruclure Sq Fllst Floor:
Type of Heal: Sq Fl 2nd Floor:
NOTlOO~ler Type: Sq Fl B~sement:
THIS P~~m-J~:LL EXPIRE Sq Ft Garage/Carport
AUTHO~I~B: ~ ~ IF THE WOR~q Fl Olher:
~.?~Fy1~~t-~W&1 ~~i~l,~;~~~I~~ NOTOccupa~1 I;oad:
(ljjtVi1f.!OPMH:I'Il1HIrJ:1JfORMATiON I '
REQUIRED PARKING
Fronlyard Selback:
Side I Selback:
Side 2 Selback:
Rearyard Setback:
Solar Selhacks:
Overlay Dist:
# Streel T,'ees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
, Tolal:
lHandicapped:
'"Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Slorm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspOUlslDrai,ns:
Notes:
I V aluation DescriDt~on I
Description
Type of Construction
$ Per Sq Fl
or multiplier
Square Footage
or Bid Amounl
Value:
Dale Calculalcd
IfD\)((> ((U)..\ll'\f311J7
Page I of 2
CITY OF SPRINGFIELD'
Building/Combination Permit
"
225 Fifth Slreel, Springfield, OR
541-726-3753 Phone '
541-726-3676 Fax
541-726-3769InspeClion Line
PERMIT NO: COM2009-00733
ISSUED: OS/26/2009'
APPLIED: OS/26/2009
EXPIRES: 11/29/2009
VALUE:
Status
Issued
Tolal Value of Projecl
Fees P,\lid I
Fee Description
+ 12% Slate Surcharge
+ 5% Technology Fee' ('
Isl Appliance
Cas Oullels 1-4
Miscellaneous Mechanical
+ I~% Slate Snrcharge
+ 5% Technology Fee
Fixture
Minimum/Adjuslmenl Plumbing
Amounl Paid
Date Paid
$12.36
$5.15
$79.00
$7.00
$17.00
$6.96
$2.90
$]9.00
$39.00
5/26/09
5/26109
5/26109 '
5126109
5/26109
611/09
611109
611109
611109
Tolal Amounl Paid
$]88.37
Plan Reviews J
Receipl Number
2200900000000000562
2200900000000000562
2200900000000000562
2200900000000000562
2200900000000000562
1200900000000000581
1200900000000000581
1200900000000000581
1200900000000000581
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. will ,be made the following
work day.
Reo,,~ir~d In~re,~tjo~s I
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complele.
Final Cas: When all gas work is complele.
~,
By signalure, I slale and agree, thaI I have carefully examined lhe compleled application and do hereby certify lhat all
informalion hereon is lrue and correcl, and I further certify lhal any and all work performed shall',be done in accordance with
lhe Ordinances of lhe City of Springfield and lhe Laws of lhe Slate of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any slruclure wilhout permission of tile Community Services Division, Building Safety.
I further cerlify lllat only contractors and employees who are in compliance with ORS 701.005 will be used on lhis projecl.
1 further agree to ensure tbat all required inspeelions are requested at tile proper,lime, lhat eaell address is readable from tile
street, tllat tile permit card is located at the front of tile property, and tile approved set of plans will remain on tile sile at all
limesdu~'1i~:~g~--- . ~
fl{~ - I.J~~ 09
r
Owner or Conlraclors Signalure Dale -
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