HomeMy WebLinkAboutPermit Plumbing 2009-6-25
Plumbing Permit Application
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I Date: & I;;> --5/0 rJ , I
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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1 Zoning approval verified? DYes D No 1
1 Sanitation approval verified? DYes D No 1
I 'CATEGOR'("OF;CoNsTRuC;rloN,,'" I
, 0 Residential I 0 Government I 0 Commercial
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I Job site address: J-4r. oS. ,q-6- 1
I City S ptil\ct~:e"I~ 1 State: I ZIP 1
I Reference: ~'1b~-aeAQ... eiil.1 Taxlot:('M(XJ _
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" I Se.~."., 'Se.rU'\'Gc. I
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689
-':""';;'?';:'Oo: ',\r; ;:PROPERTy;jbwNER\;i!,J:'~'?~~;;i:~.',!~~,:~:\\(;:!l'~
I~am;~ \U'(\\~'" . ." '.' .=', ,..,.h,., ',.
I Address\r) ~. ~ all..... .
1 City f ~e... 1 State: J: lj 1 ZIP93 -:-; lo \(?
1 Phone: - - I Fax:
I E-mail:
This installation is being made on residential or fann property
owned,by me or a member afmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020,
Signature:
I~'~sm~:s n~~~NTR~C~::~N:~l~::IO~~::~t~>"i';i
1 Address 38~ I ft4.....Il:e&>J~Cf
I City SA/e.",,- 1 State:f)R-j ZIP 913,!JL
I Phone:o$D!-$Ut-1S"" 1 Fax:-S"03-37/-/.i37
E-mail:
CCB license no,: " ~ l' , 1 BCD license no,:
I Plumbing license no,: 24 - J "'4, P 8
Print name: ffi; ktt. ':~"'-
Signature: ~("c., . ,
'I
440.2500.) (II/OS/COM)
li"<~"'.'-'l"!")!k"'!.11ii')f"'f<&'~:;,';F.E'EiiiS'C;H' EDU "E;:r~'?",;'ti!!"";7~!!r';;;,,',"''''''~i~.11 '
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I New residential
1 bathroomll kitchen Ut'lcludes: first il
J 00 feet of water/sewer lines, hose II
bibs, ice maker, under floor low~point"
drains and rain-drain packages)
I 2 bathrooms/! kitchen $374.00
I 3 bathrooms/I kitchen $439,00
I Each additional bathroom (over 3) $95.00
I Each additional kitchen (over i)" $95.00
I Residential fire sprinklers (includesi plan review)
I 0 to 2,000 square feet I I I $58,00
12,001to 3,600 square feet $116,00
I 3,60\ to 7,200 squarefeet I $174,00
I 7,20 l' squarefeet and greater $232,00
I Manufactured dwelling or pre-fab (circle one)
I Con~ections to building sewer and I' I $58.00 I $
water:supply ::
Commercial, industrial, and dwellings other than one- or
two-family .
Minimum fee
$238,00
$
$
$
$
$
I
I
I
I
I
$
$
$
$
Each fixture
I I
$58,00 I $
$19,00 $
Miscellaneous fees
100' storm, sewer, water line
Each fixt.ure, appurtenance, and piping
Storm water retention/detention facili~
Irrigation systems
Piping or private storm drainage
systems exceedinl! the first 100 feet
Specialty fixtures
Reinspection (no. of hrs. x fee perhr.)
Special requested irispections (no. of I
hrs. x fee per hr.)
1 E.ach ad~itional inspection: (1) , ..1 $58.00 $
1~'~~~kil!1t~;;;pfpr~~if~,~~~@\lti~i&~W~JI Mi.nimum fee $
I Enter value of installation and equipIDent $ _'
I Enter fee based on installation and eqjJipment value. I $ I
~\;'i.~"'i)li~_.ii:eej{I'Ci(NT!!!ilisE~_i\f~~1
(A) Enter subtotal of above fees ~..J<.:/
(Minimum Permit Fee $58.00) $.((1/ .. Vi
I (B) investigative fee (equal to [A]) $ f. W
I (C) Enter 12% surcharge (.12 x [A+B]) $ 9. I Z
I (D) Technology Fee (5% of [A]) $'
I TOTAL fees and surcharges (A through D): $ 0.8 '; 92-
$76,00
$19,00
$19,00
$19,00
$19.00
$
$
$
$
$
$
$
$
$19,00
$58,00
$58,00
CITY Or ~rt<ll~\JFIELD I
Status
Issued
Building/C,ombination Permit
"
PERMIT NO: COM2009-00938
ISSUED: 06/25/2009
APPLIED: 06/25/2009
EXPIRES: 12/25/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 146 S 19TH ST
ASSESSOR'S PARCEL NO.: 1703364204900
Springfield TYPE OF WORK: PlnmbingOnly
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Sewer line replacement
Owner: WHITSON JOHN H III
Address: pO BOX 492
'EAGLE ID 83616
I CONTRACTOR INFORMATION I
Contractol'Type
Contractor
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size: ,
Sq Ft 1st Floor:
Sq Ft ?nd Floor:
Sq Ft ~asement:
Sq Ft 9arage/Carport
Sq Ft Other:
Occup'ant Load:
,
nla
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
C """t" yau ta
O an lav. ompac .' , '
ATTENTION: reg d b the Oregan UtilitY
lallaw rules a.dapt\h Yse rules are set larth
,,~t"'~otion Center. .0 _,~h nAR 952-001-
I PUBLIC IMPROVEMENTS IJAR 952-0UI "V~t~~'~;pies .01 the rules ay
, uuJO, Yau may ~'"r INate: the telephane
ca\lin~ide,valk TYl'e:, Utility Natilicatlon
bor lar the 01 eg9n 0 2344)
num Downsnoo!sl,Drains:'32" .
lJe! Ill.;. '
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements: "
Storm Sewer Available:,
Special Instruction: IV On CE:
. THIS PERMIT S
AUTHORIZED U HALL EXPIRE IF THE '
COMMc,,",,~_ NDER THI."- Dc"..,_ WORK
, ,
ANY 180-~u Vi'll:) " u,,/ I O^""" ~~" r;:.; I
DAY PERIOnl VaVfuati6Q Dk5criotion ,
Notes:
Description
-'T'
Type of COIistruction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of2
_~~~IN"'Ii!I~~ "
~f
~t
Status'
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00938
ISSUED: 06/25/2009
APPLIED: 06/25/2009
EXPIRES: ]2/25/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Sanitary Sewer - 1st 100 Feet
Amount Paid
Date Paid
$9.12
$3.80
$76.00
6/25/09
6/25/09
6/25/09
Receipt Number
,3200900000000000486
32~0900000000000486
3200900000000000486
Total Amount Paid
$88.92
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.
I Reouired I nsnections I
Sanitary Sewer Line: Prior to Iilling trench 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 further certify that any and all work performed shall be done in accordance with
the Ordinimces 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 strnctnre without permissinn 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 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 permitfard is oeated at the front of the property, and the approved set of plans will remain on the site at all
times during c struction. . .
C If/L,??--bl~ 1--2)-01
Owner or Contractors Signature'
Date
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
54]-726-3759 Phone
~f~~;.'...'.'.'.."
1ir..,..K .,.
. ~'"
,. ~"""""""""""""',
City of Sp~ingfield Official Receipt
Developmlmt Services Department
Public Works Department
" .'
Job/Journal Number
COM2009-00938
COM2009-00938
COM2009-00938
Payments:
Type of Payment
CreditCard
,cReceintl
RECEIPT #:
3200900000000000486
Date: 06125/2009
1:39:04PM
Description
Sanitary Sewer - 1st 100 Feet
+ 5% Technology Fee
+ 12% State Surcharge
Amount Due
76.00
3.80
9.12
$88.92
raid By
MIKE KEEN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
njm
515283 In Person
;1
Payment Total:
$88.92
$88.92
Page 1 of 1
6/25/2009