HomeMy WebLinkAboutPermit Plumbing 2009-6-12
Plumbing Permit Application
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1!lpermit no': C9'- &S-.S I
1:'Date &//J-/O 7' I
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This permit is issned nnder 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 issnance or if work is snspended for 180 dhs.
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1 Zoning approval verified? 0 Yes 0 No l[rr~if~/r~ti~ffi!\~tti\it?\~~;;:tJ,f1~~r~j~l~i~:!li;t:!g~'~lg;JI~jiFOtat~11
1 1:~Y,~~!'~"'t'~1:t""""';<;<*"".~~i:r<,,\.its:<)1J:~\Jk"':J,S"'!i'-~1,-t:1 to;....:.".~~, ..'f,kl.~_~_~.L~4.:b i!>.~'_,:5:.~~~t~";,,
Sanitation approval verified? 0 Yes 0 No I New residential 11
I .CATEG.OR'COF CONSTRUC.TIOIII,," I bathroomll kitchen (includes. first
f~1~~~~~~~~lmE",IN~.~~~A;7;~~~~lDlq~~C~:~~~~~~&~";)il ~rf!nl~~~~~tf~~~~'~~I~:;Pinl. $238,00 $
1 Job site address: 703 (., Me, ,:.. .s r I I 2 bathroomsll kitchen $374,00
City: 50r/,.1 I State: Or IZIP:S7\<77 Ilbathroomsllkitchen $439,00
I Each additional bathroom':( over 1) $95,00
. Referenc~: \fJ.t1i.. ~ \ I TaxIOt.{~J\b\ I Each additional kitchen (over I) $95.00
i~y',,~i~:j~~iSf<<.;,;,~~*;:~;t(;D' E'S'C""R InT:-I'O::'N'--~~orl~W O""RK" '~:(~~-:~{~r~;~t'i1Yl!t~'~~mTII I Res,'dent,'al fire spr,'nkler'ls (,'ncludes': plan rev,'e,,')
Ir"...';,.i""''t...,'f:i.....'~,!C:.;..:;!,~'.,,~.j,1<'' _ .. d _'~" __ _re;'_,',_ ._....... . _~+ . r;."",_., ' '.. '. ,.S~"~:r;.-l",'~.\,;,;.;,!""'.",.,,~~.,''"'..
I R.."L,.2 . )J/:J~ r L ,;'..e Pro'"" /)1"t~" I I Ot02,000squarefeet $58,00
1,\:-;. . ,1P,ROgE~T,Yfj()WNE~j;lf;!'i!~~iil\\'1!I4\~;~~i!\(i~;,~11 ~:~~: :: ~:~~~ ::~:: ~::: :;;::~~
1 Illl I / I I 7,20 J square feet and grea.ter $232.00
. Name: ;rlc.v E, A/Orr,"
Manufactured dwellin2 'Or pre-fab (circle one)
1 Address: . PO. eu>" 31 I . I Connections to building s~wer and 'I I $5800 I
1 1. L I "'" 1 I water supply , ,$
City: o....,~ l State: vI ZIP: 97i;'5'2
I . '.G1 I I Comme~cial, industrial,iand dwelli~gs other than one- or
Phone: 64.1 'Tf2-1{15C:v1 Fax: two-fam,ly. II
I E-mail: I I Minimum fee 'I I I $58.00 I $
I Each fixture I $19,00 $
This installation is being made on residential or farm property
owned by me,or a member afmy immediate family, and is I Miscellaneousfees il
exempt from licensing requirements under OAR 918-695-0020. 1100' storm, sewer, water fine
Signature: /?tcv.,o)' ~ I Each fixture, appurtenanc~, and piping
I'~~s;ne;; n~~~NT~yjJ.iNSTALLATlO~;, ',!i~,~',' I ~:~~:i::t:;~::~tion/detention facility
/ I / Piping or private storm drainage
I AQdress: / systems exceeding: the first 100 feet
I City~, I StaW/' 1 ZIP: Specialty fixtures " Ii
1 -.... /1 I Reinspection (no. of hrs. ~ t-ee perhr.)
Phone:' /' Fax:
I Special requested inspectjons (no. of;\ $58.00 $
I E-mail: '/ hrs. x fee per hr.)
I CCB license no,: / I' BCD license no.: I Each additional inspecti'on: (I) $58,00 $
I Plumbing life~ no.: ITSf~dT~~~'i~'g~'S1prpr~g~r~~~~I~~~irf4~ii~1 Mi.nimum fee $
I Print Ila~: "- I Enter value ofinstallatioq;.and equipment $_.
I ,;,"fure i~!t:;~~~ 6'0
I (B) Invesiigativefee (equ~l to lAD $ ...s,) 0
I (C) Enter 12% surcharge (.12 x [A+BD $ q .1/2-.
I (D)Technology Fee (5% "f[AD $ I
I TOTAL fees and snrcIlarges (A throngh D): $ \(0,1 f 2---
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225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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$76,00
$19.00
$19.00
$19.00
$19,00
$19,00
$58.00
440-2500-J (1It08/COM)
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Status
Issued
I CITY OF SPRINGFIELD'
Buil~ing/combination Permit
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PERMI:f NO: COM2009-00855
ISSUED: 06/12/2009
APPLIED: 06/12/2009
EXPIRES: 12/12/2009
V ALVEi,:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 7036 MAIN ST
ASSESSOR'S PARCEL NO.: 1702353100901
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Springfield TYPE OF WORK: Plnmbing Only
PROJECT DESCRIPTION: Replace water IJine
TYPE OF USE: New
":1
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Residential
^
Owner: NORRIS MAX E
Address:' PO BOX 311
LOWELL OR 97452
I CONTRACTOR INFORMATION'
Contractor Type
Plnmbing
Contractor
OWNER
License
I
~r
::Expiration Date
"
Phone
BUILDING INFORMATION.
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Group:
Primary Constrnction Type
Secondary Constrnction Type:
'# of Bedrooms:
# of Stories:
Height of Strnctnre
Typeof Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Bnilding:
Lot Size:
Sq Ft1st Floor:
, Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
n/a
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Fronlyard Setback:
Side I Setback:
Side 2 Setback: '
Rearyard Setback:
Solar Setbacks:
'I
ATTENTION: Ore 0
follow rul"c o...J__P ,n law requires If"" ._
I PUBLIC IMPROVEMENTS I ;~~~Rcati~n Genter:-Th~~~';~1 uregon Utility
. _ ,9g2-001-0010th es are setforth
009Side'w~lkl:r"yl',\Jtain c~ough OAR 952-001_
callina the r;',-' '" .., pies of the rules b
NOTICE' nUlRO\ynsponts/Dr~IIIs:ote: the tele h Y
I . THE WORlftJ ',ur me Oreaon U . , Pone
THIS PERMIT SHALL EXPIRE IF N'OT Gynter is H300_33~lty Notification
AUTHORIZED UNDER THIS PERMIT IS I' " -2344).
rmllMFNCED OR IS ABANDONED FOR il I
ANY 1 blJ ,-,;..,:,' ;';": :::.::,: . I
Valuation DescriDtion
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instrnction:
Notes:
Description
Type of Construction
$ Per Sq Ft
or mnltiplier
Sqnare Footage
or Bid Amonnt
Valne
I
Date Calculated
Page I 01'2
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............,...................
. CITY VI' ~rRINGFIELD .
il
Buih!ing/Combination, Permit
Jf .
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMI:T NO: COM2009-00855
ISSUED: 06/12/2009
APPLIED: 06/12/2009
EXPIRES: 12/12/2009
VALUE:
Status
Iss u ed
Total Valne of Project
Fees Paid.
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Water Line - 1st 100'
Amonnt Paid
Date Paid
$9.12
$3.80
$76.00
6/12/09
6/12/09
6/12/09
Total Amonnt Paid
$88.92
I Plan Reviews I
Rece~pt Nnmber
2200900000000000670
2200900000000000670
22~0900000000000670
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To Request an inspection call the 24 hour recording at 726-3769. All inspections ~equested before 7:00
a.m. will be made the same working day, inspections requested after 7:001Ia.m. will be made the following
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work day. ~ ?- 7-/" '"
I Reouired I nsnectio~s ,.
Water Line: Prior to Iilling trench and inclnding reqnired testing.
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By signatnre, I state and agree, that I have carefnlly examined the completed application and do hereby certify that all
information hereon is trne and correct, and I fnrther certify that any and all work perf6rmed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertainirig to the work described herein, and
that NO OCCUPANCY will be made of any strnctnre withont permission of the Community Services Division, Bnilding Safety.
I fnrther certify that only contractors and employees who are in compliance with ORS 701.005 wiII be nsed on this project.
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I fnrther agree to ensnre that alll'equired inspections are reqnested 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. ,Y :
Owner or Contractors Signature
Date
Paee 2 of 2
225,Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00855
COM2009-00855
COM2009-00855
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Water Line - I st 100'
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
MAX E. NORRIS
City of Springfield Official Receipt
De~elopment Services Department
Public Works Department
2200900000000000670
)1
Date: 06/12/2009
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2:43:54PM
Item TO~,al:
Check Number Authorization
Received By Batch Number Num~er How Received
Amount Due
76.00
3.80
9.12
$88.92
Amount Paid
nJm
2221
$88.92
$88,92
In Person
Payment Total:
Page 1 of I
611 2/2009