HomeMy WebLinkAboutPermit Plumbing 2009-7-3
PlJ,lmbing Permit Application
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225 Fifth Street. Springfield, OR 97477 . PH(54I)726-3753 . FAX(54I)726-3689
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I Date: 7-- 3 -eC(
This pcrmit 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 snspended for 180 days. .
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I New residential
1 bathroom/] kitchen (includes: first
100 feet of water/sewer' lines, hose
bibs, ice maker, underjloor low-point::
drains and rain-drain packages)
I 2 bathrooms/I kitchen $374.00
I 3 bathrooms/! kitchen $439.00
I Each additional bathroom (over 3) $95.00
I Each additional kitchen (over I) I I $95.00
I Residential fire sprinklers (includes plan review)
I 0 to 2,000 square feet $58.00 $
I 2.001 to 3,600 square feet $116.00 $
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. I I Commercial, industrial, and dwellings other than one- or
I Phone: - ~ I Fax: two-family
I E-mail: III Minimum fee . I I $58.00 I $
\ This installation is being made on residential Or farm property I Each fixture $19.00 $ I
owned by me or a member of my immediate family, and is I Miscellaneous fees r
exempt from licensing requirements under OAR 918-695-0020. 100' sIorm, sewer, water line I \ $76.00 $II/)
Signature: I Each fixture, appurtenance, and piping $19,00 $
~'~;i'n:;;n~~~NT~~,'N=~i~,,,,,,,:i,,j~';;::;''';'i : ~r~:~:i::t;;~:::tion/detention facility I ~~::~~ ~ I
t -I :3 V:\ fJ I I Piping or private storm drainage, $19,00 I
I Address: -\ b - N lJe r CI U<2- systems exceeding the first 100 feet $
I City: <2U\1'I/lJ-, . .1 State: 6rLI ZIP: 1740.:) I Specialty fixtures .' $19.00 $ '/
I U. / <:i('/-- [\ I ~, I Reinspection (no. ofhrs. x fee per hr.) $56.00 $ I
Phone: -'fJ ~ VJ II Fax:- - I Special requested inspections (no. of I
E-mail: hrs. x fee per hr.) $58.00 $
CCB license no.:Lg 2- 53L-I BCD Jicense no,; I Each additional inspection: (1) $58.00 $ I
I Plumbing license no,: Mi.nirnum fee $
Enter value of installation and equipment $ -,--0
I Enter fee based on installation and equipment value. I $
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I (A) Enter subtotal of above fees $ 7/ I':1l r
(Minimum Permit Fee $58.00) Tb.c/C
I (B) Investigative fee (equal to [A]) $ J
I (C) Enter 12% surcharge (.12 x [MB]) $ 1- j 't{
I (D) Technology Fee (5% of [A]) $ 3, ",y
I TOTAL fees and surcharges (A throngh D): $ F2? cr 12-
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'I Zoning approval verified? 0 Yes 0 No
I Sanitation approval verified? 0 Yes 0 No
I '. , CA.TEG.OR'(.'0F;CONST:RUCtION.'
I i'(J Residential I 0 Government I 0 Commercial
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I Job site address: 0() ( lAJ r VVlI'
I City: ~C)(:d) r. _l State: of L LZIP: Cfl Lf7 I
I Reference: V1D?3t..'1Lfo CA1~.:
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$238.00
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Print name:
Signature:
440-2500-) (II/08/COM)
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 601 W M ST
ASSESSOR'S PARCEL NO.: 1703274304700
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CITY OF~rl{lN(jJ:<lELD
Building/Combination Permit
PERMIT NO: COM2009-00979
ISSUED: 07/02/2009
APPLIED: 07/02/2009
EXPIRES: 01/03/2010
VALUE:
Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Sanitary Sewer Line Repair/ Replace
TYPE OF USE:
Residential
Owner: DICKSON SHIRLEY V
Address: 65 BENTWOOD LN
ALlSO VIEJO CA 92656
Contractor Type
Contractor
# of Units:
Primary Occupancy Group: R3
Secondary Occnpancy Gronp:
Primary Constrnction Type VB
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements: .
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
- _..lM_.... 1.....'. fn
AI I t:.1\I I lVI'll. Vlc;.~,-," ,........ .--,- '..
, " "<" - .legon Utility' .
I CON1DRW~"'OR'INF0RMA:T1'ON" are set forth .
, I, 1" r I . .1\ I I I ".
;~uOAR952-00;-OO1O,throUgh OAR 952:001;
0090. You may obtaii\'~l(,'f,I1~S of thii\:Pll1atj'On Date Phone
Mll;nn tho rAntAr, INote: the telephone
~ ,"........ -fiJtlIuy I\l.OUlIlJi;l.lIUIl
BUfLOON(J~~~.~Mln~pN.32_2344). . '
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq. FI Basement:
Range Type: Sq FI Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
I, DE':ELOPMENT INFORMATION I
REQUfRED PARKING
, Total:
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
NOT~~~;~~~~~~PIRE IF THE WORK
~~I~U~i:l17l=n II.NDER THIS PERMIT_~~ NOT
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'A1N"1I.U Ui'\l rLulL.
y 0 Sidewalk Type:
Downspouts/Drains:
I V ~Iuation DescriotioiJ I
$ Per Sq Ft
or mnltiplier
Square Footage
or Bid Amount
Date Calculated
Value
Page 1 of2
Status
Issued
CITY OF SPRlNlj1<1ELD .
Building/Combination Permit
PERMIT NO: COM2009-00979
ISSUED: 07/02/2009
APPLIED: 07/02/2009
EXPIRES: 0l/03/2010
VALUE:
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 II .
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. .
Re.~lli~ed Tn~necti?n~ I
Sanitary Sewer Line: Prior to filling trench and inclnding required testing.
Final Plumbing: When all plumbing work is complete.
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 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 Services Division, Building Safety.
I fnrther certify that only contractors and employees who are in compliance with ORS 701.005 will be used 00 this project.
I further agree to ensnre that all reqnired inspections are requested 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 dur:ng con ~::t:on. 1 /z I cq
J; .~. I I
(lwner or ContF8 :tors Signature Date
Paee 2 of2
,
225 Fifth Street
>' .
Springfield, Oregon 97477
541-726-3759 Phone
. City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200900000000000770
Date: 07/02/2009
3:00:56PM
Job/Journal Number I
COM2009-00979
COM2009-00979
COM2009-00979
Payments:
Type of Payment
INT CHGS
Paid By
61 1-62251-61 1008SEWER
Item Total:
Check Number Authorization
Received By Batch Number Number How.Received
Amount Due
76.00
3.80
.9.12
$88.92
Description
Sanitary Sewer - 151 100 Feet
+ 5% Technology Fee
+ 12% State Surcharge
Amount Paid
KR
SEWER
In Person
Payment Total:
$88.92
$88.92
cReceintl .
Page 1 of I
712/2009