HomeMy WebLinkAboutPermit Plumbing 2009-6-18
Plumbing Permit Application
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I Date: b'- J..r'5?-- 2--6tY-l I
. .
225 F;!\h Street + Sp,;ngfield, OR 97477 + PH(541)726-3753 + FAX(54!)726.3689
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or co'ntractor 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 New residential I
1 bathroomll kitchen (includes: first
100 Jeer of water/sewer lines, hose
bibs, ice maker, under floor low-point,;
drains and rain-drain packages)
I :i bathroomsll kitchen $374.00
I 3 bathroomsil kitchen $439.00
I Each additional bathroom (over 3) $95.00
I Each additional kitchen (over I) $95.00
I Residential fire sprinklers (includes plan review)
I 0 to 2,000 square feet I $58.00
2,001 to 3,600 square feet I $116.00
3,601 to 7,200 square feet I $174.00
7,201 square feet and greater I $232.00
I Manufactured dwelline or pre-fab (circle one)
I Connections to building sewer and I I $58.00 I $
water supply
I Comme~cial, industrial, and dwelli~gs other than one- or
two~famlly
I Minimum ree I I $58.00 I $
I Each fixture $19.00 $
Miscellaneous fees
] 00' storm, sewer, waterline
Each fixt,ure, appurtenance, and piping
I Storm water retention/detention facility
i Irrigation systems
. I Piping Of private starin drainage Ii
systems exceeding the first 100 feet I'
I Specialty fixtures
I Reinspection (no. of hrs. x fee per hr~)
I Special requested inspections (no. of;
hrs, x fee per he)
I Each ad~itional inspection: (1)
1~~1'..'ii?,;~I;Y1\\iG!oC~L;,tG()YERNMENTt~AeI?'R()vA1Et~0i~~1iii.~A'11
I Zoning approval verified? 0 Yes 0 No I
I Sanitation approval verified? 0 Yes 0 No I
I CATEG.oR'('OF:,CONSTRUCJ;ION," I
1 0 Residential 1 0 Government I 0 Commercial 1
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I Job site address: 'CI~ \ 2.\.o~ Sr 1
I City ~Rd- I State!)\{.... I z(ln.:\\\ 1
f ReferenceVlt)~\\ 1 Taxlooo.-u:v 1
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I~.\~ ., -:..<:;:~(;F:::: . ;~PRO ~:ERTY~-Z()W_NER~rS~.€f:t~J~~~lWf~tf€&\~\ttii(~~~
1 Name :::Joe. / DaN I ke.&
I Address: ':if L. / 2.(. i j <; i
I City: 5~v.)vsf.'€!c( 1 StateD4.. '
1 Phone: ~!:-/ r 7 sb "3 17...., 1 Fax:
1 E-mail:
This installation is being made on residential 'or farm property
owned by me or a memberofmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020,
Signature:
I.. ,j , ,c., .CQNTRACJIORdNSTAI.:J-,ATION:,,;,(, :~;J:r.;;j;"';,;:,;.;~,.
I Business name: 1'""'> (,,; }l,-f.'L
I Address:
I City:
1 Phone:
I E-mail:
1 CCB license no.:
Plumbing Iicense~
Print name:/
",
Signature:
I ZIP
1
7717)1
1
1
I State:
/lzlP
440-2500-J (I 11081COM)
$l'\\opD
$
$ I
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I Enter value of installation and equiprflent $ _' I
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~~~~~~11~s~iZ~i~~~l'e~~leANJ:~t1,SE~lJi~~~~f~~
I (A) Enter subtotal of above fees $ " t::..,(j)
(Minimum Permit Fee $58.00) U\ '-.J
.'
I (B) Investigative fee (equai'to [A]) $ (;::?
I (C) Enter 12% surcharge (.12 x [A+B]) $ \ \ .4.L?
I (D) Technology Fee (5% of [A]) $ ~ ,"'\~
I TOTAL fees and surcharges (A through D): $11 \ .\ ~
$238.00
I
$76.00
$19.00
$19.00
$19.00
$19.00
$19.00
$58.00
\
$58.00
$58:00 $
Mjnimum fee
$
$
$
$
$
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CITYOF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00886
ISSUED: 06/18/2009
APPLIED: 06/18/2009
EXPIRES: 12/18/2009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
~
/
, SITE ADDRESS: 821 26TH ST
ASSESSOR'S PARCEL NO.: 1703361109200
.
,Springfield TYI'E OF WORK:
TYPE OF USE: Repair
PROJECT DESCRIPTIOr-:: Replacement of Sanitary Sewer- approximately 150'.
Owner: DANIKEN JOEL H & JILL L
Address: 821- 26TH-ST '
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Contractor
License
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
fAITTI E"flmlIL lliNGl t<rFi) Rm}~-I-I-,;;J\l'll.Oty
o ow r,. _ I 1&' III
Notification Clp~ Tbo~e rules are set forth
in OAR 952-0 qb I'lfllTI'ough OAR 952-001-
0090. You m ,&//1 e6ffi/;!f5hhe rules by
calling the 'ep'f fftate: the telephone
number for t}Nj1lSf~Ulility Notification
Cent8af!g'-8~1le;332-2344 ).
Energy Path:
Sprinkled Building: n/a
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side I Setback:
Side 2 Setback: .
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Expiration Date Phone
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:'
Occupant Load:
REQUIRED PARKING. .
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
l!'IJ>>UC IMPROVEMENTS I
NOnl.t.. '
THIS Prr:RMIT SHALL EXPIRE IF THE WOO'!{Ilk Type:
AUTHORIZED UNDER THIS PERMIT 1:D&1QlpoutslDrains:
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Page I of2
Value
Date Calculated
Status
Issued
CITY vi< ~rRINGFIELD
Building/Combination Permit
PERMIT NO: .COM2009-00886
ISSUED: 06/18/2009
APPLIED: 06/18/2009
EXPIRES: 12/18/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
I'm Paid I
Fee Description
Amount Paid
Date Paid
Receipt Number
Total Amount Paid
$0.00
I Plan Reviews I
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.
Reouiredln.n~ctio~'1
Sanitary Sewer Line: Prior to filling trench and including required testing.
By signature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that 'all
information hereon is true and correct, and I 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 structnre without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this p,'oject.
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 will remain on the site at all
times during construction.
C1-j) n-t- tr~
O>v/e{ or Contractors Signature
b-/);---D'/
Date
Page 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541'-726-3759 Phone
~-
City of Springfield Official Receipt
Devclopmerit Services Department
"
Public Works Department
Job/Journal Number
COM2009-00886
COM2009-00886
COM2009-00886
COM2009-00886 '
Payments:
Type of Payment
Cash
cReccintl
RECEIPT #:
2200900000000000687
Date: 06/18/2009
Description
Sanitary Sewer - 1st 100 Feet
Sanitary Sewer Each Addtl 100'
+ 5% Technology Fee.
+ ] 2% State Surcharge
Paid By
JOEL DANIKEN
Item Total: .
Check Number Authorization
Received By Batch Number Number Uow Received
klk
klk
klk In Person
Payment Total:
Page I of I
II: 19:32AM
Amount Due
76.00
19.00
4.75
11.40
$11 1.15
Amount Paid
$111.15
$11 1.15
6!l812009