HomeMy WebLinkAboutPermit Plumbing 2009-7-14
225 Fifth Street + Springfield, OR 97477 +PH(541)726-3?S3 + FAX(S4\)726-36&9
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I Date: :, rt - \4-0\ I
Plumbing Permit Application
CITY OF SPRINGFlELD, OREGON
This permit is issued uoder OAR 918-780-0060. Permits are, issued only to the persoo'or contractor doing the work. Permits
-expire if work is Dot started within 180 days ofissuance or if work is suspend~ for 180 days. ii
1:'i;),t':fi:2::ILOCA"~l30VERNMENT'ARpROVAI!!~J':IIMv~ii',{':;'1 ':"~:~,&;1i%il\!!t'(<"l~>:il;\V'CI;EE'l.SCHEDtI"E':;:~~;r\K~~::;4,~~lr~il
I D D I """"-",..\,,. <\,""'~:"',w' ''',11'?''''''''';''''''I''', '€,' ost\!~I"'"Total"il
Zoning approval verified? Yes No ~~t~~f!:~~li;~~fb:;~~~1ft'ijj2'~~~~~f.~~!~ !}'ttf l~r~~~ Iic,fi~_t:~~;
I Sanitation approval verified? DYes D No I I New residential I
":\'''AcATEGORv,,~OI;f.,COIIISTR\:JC"ION.lif.~.f<<fJ,;i"1,l'!';:ii1 I bathroom/l kitchen (inc/udes:firsi
'I J d I 100 fiel of water/sewer lines, hose '
. 0 Residential 0 Government . ~".J:ommer~ial . , bibs, ice maker, under floor law-poi~t
':':"7':;':fJOB,"iSITE~~INF.ORMATION";AND~l!OCA'fION,l~illi!:'~I drains and rain-drain packages)
Job site address: Ljo '(, ;11.,.; <;~Nt + 1 2 bathroomsll kitchen $374.00 $ 1
I [ I 3 bathrooms/I kitchen $439.00 I $ I
City: S D ,,~,+ulJ State: ot2- ZIP: Ql't 77 I Each additional bathroom (over 3) ,: $95.00 I $ I
'"",,,;;,k:\101-v\"r\ 1r:'otno.:O"t~ I Eachadditinnal kitchen (over I) I $95.001 $ I
";:~":~;:,,;,,,rt,e'DESCRII>,"nON::;OI:.ilWORKiji;"l..1'iii.i:'i1'\tl",'i<:Ji~!!~1 I Residential fire sprinklers (ineludes plan feviewl 1
I /?,_~ .[,..z-... I~ ~ O,"'~ r:l-<<.Ic I I Ot02,000 square feet $58,00 $ I
I '" Ie rl A' ~ 12,001 to 3,600 square feet $116,00 $ I
D,-..c -rv.-W 'atJl(P.
:'<1~N:;.":"!tc';J"''';W:'''ti'li'F!ROF!ER1iY:''OWNER,~,'''''''';;r.:1.",,,,,,',''''_'~'' I 3,601 to 7,200 square feet $174.00 $ I
'Na~~:'~''''''''''i~'H "<,-J,.;(:~, 7 "f.~~;,~::",,\~~;;~ 1 7,201 square feet and greater. $232.00 $ I
hq (-hAlj . I Manufactured dwellin~ or pre-fab (circle one) ,I
Address: t..r O"['f /11.., <, i-N.. f. <:;', (.'" I DrIA7~' " I Connections to building sewer and I I $58.00 I $ I
C' /" I' II Is. "I'> I ZIP' water supply
Ity: 'f,n ":-n. tate, v IL . f1''17-7- I I
" I' Commercial, industrial, and dwellings other than one- or ,
Phone: - - Fax: ~ two-family '.
IE-mail: I Minimum. fee I I $58,00 I $1
1 Each fixture $19,00 $ 1
This installation is being made on residential or fann property
oWl1ed by me or a member of my immediate family, and is I Miscellaneous fees I
exempt from licensiug requirements under, OAR 918-695-0020. 1100' stOITO, sewer, water line $76.00 $ .1
Signature: I Each fixture, appurtenance, and piping $t9.00 $1
1~.,~,;'I'lt~':l%CONTRACTO~~INS:rAL!l!ArION1f~~:'i;f:r{:iI#~)='i!. I Storm waterretentionldetention facility $19,00 $ I
I () I riD [Irrigation systems $t9,OO $ (". 00 I
Business name: "" l"~ /<.AI'; '1
I ' l I Piping or private stonn drainage $ $'" :1
Ad. dress: ';),'16'\ l"..\.r sh..... r svstems cxceedinQ the first 100 feet'; 19.00
I CIty: s... mPJ I State: 612 I ZIP: 11'10r; I Specialty fixtures $19.00 $ 1
I it I I Reinspedion (no, ofhrs.'x fee per h'i,) $58,00 I $ 1
Phone: S':lI-7lt -(V7S Fax: I Special requested inspections (no. of I $58,00 I $ I
E-mail: ('.t\l~L~ rAl;"~ ''<1.All{c.~ hrs. x fee per hr.) , .
~' CCB lic.ense no,: . 1 BCD license no.: 11.~,:e,h,~,:d~t:,:n~,1 ~:,:::i,:::~~,;cL"ft"ll $58.00 II $ I
I Plumbing license no.:lMedicar~as'pipin~.;'Y;r.:'~~If.:'~.!Jlrij}ii-:Z~ Minimum fee $ I
I ;:ta::~: ~1:: ,~., 'IE;~:~;~,;;,~~~~~a::;~':~;;'~ent":,:~~J>v.~L:,,".,,,,,,J,
~, --I. .r','. ./ _' ~,r2!l,jj"o:f~~~~"jl1~~~~t',.~:1%~~A:F?~mCANT>tUSE~"\'I1'~md,\:!l''4~~,~'1~~~:;IlAl~t.~>~v.:!.
o LA,J<C're c:.~~"",W Ll; u", Jr-O" '\ I (A) Entersubto/alofaboyefees $ C' I
. ., -) if (Minimum Permit Fee $58.(0) J~, oq
o 0 0!f) I (B) Investigative fee (equal to [A]) $ 1
QV)\~~S ~\~ 2.'163" /" (~.r^ W 1 (C)EnterI2%surcharge(.12x[A+I3]) $ (',1/ ',I
~~~:f0'/ 1 (D) Technology Fee (5%0f[AJ) $110 I
. ~ ~ I TOTAL fees and surcharges (A through 0): $ 67.F t 1
. ~\}J
$238.00
$
44,o-25oo-J (t I/08/COM)
CITY OF SPRINGFIELD
.
Building/cQmbination Permit
Status
Issued
PERMIT NO: GOM2009-01023
ISSUED: 07/14/2009
APPLIED: 0~/1412009
EXPIRES: 01/14/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4095 MAIN ST
ASSESSOR'S PARCEL NO.: 1702314104500
Springtield TYPE OF WORK: Backtlow Device
,
il
TYPE OF USE: New
Commercial ~
PROJECT DESCRIPTION: Irrigation system
Owner:
Address:
MILES INVESTMENTS LLC
2175 HWY 101 N
FLORENCE OR 97439
I CONTRACTOR INFORMATION I
Contractor Type
Landscape
Contractor
RELIABLE RAIN
License
15032
BUILDING INFORMATION'
Expiration Date
\1/01/2009
Phone
541-736-6075
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heai:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2~d Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occup~nt Load:
ilia
I DEVELOPMENT INFO~MATION I
"
;, REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
, Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
!!Total:
I, Handicapped:
\Compact:
I PUBLIC IMPROVEMENTSI
Sidewalk-l'ype:.)N' Oregon law requires you I )
AI' L-,," ;,' rl t d by the Oregon Uti I ty
Downspoiits/P't'a'i.)i: ~p eThose rules are set f( rth
Notiticallon L;en_ e~'1 0 through OAR 952-( )1-
m OAR 952-001 ~btain cop'les at the ru\e~ by
0090., You rr;ay t (Note: the telephor 8
calhng_ ~h_~ ;:~1 ~~~nnn Utilitv Nolificati In
"u.. ,- -", . 800 3":<-;0,14'+)
Certiter IS 1- - v .
Street Improvements:
Storm Sewer Available:
. lII_nT~{'Ir:;
SpecIal InstructIOn:,.
THIS PERMIT SHALL EXPIRE IF THE WORK
Notes: AUTHORIZED UNDER THIS PERMIT IS NOT
('()"".nr.~I('::n IlR Ie: ARA~lnONED FOR
ANY 180 DAY PERIOD:
I Valuation Descrintion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of 2
-~_jr;;;?, -,.~,.
-. ~i
'.~ ,,,_, ";",~_".n;' ."....,.'M,e
Status Issued
225 Fifth Street; Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01023
ISSUED: 0~/14/2009
APPLIED: 07/1412009
EXPIRES: 01114/2010
VALUE: 'I
.
Total Value of Projecl
Fees Paid I
$6.96
$2.90
$19.00
$39.00
7/14/09
7/14/09
7/14/09
7/14/09
I
Receipt Number
2200900000000000792
2200900000000000792
2200900000000000792
2200900000000000792
,
Fee Description,
+ 12% State Surcharge
+ 5% Technology Fee
Backtlow Device
Minimum/Adjustment Plumhing
Amount Paid
Date Paid
Total Amount Paid
$67.86
I Plan Reviews J
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. willl~e made the following
work day.
I R~\I~]ired 'nsllectio~s I
Backtlow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
i
"
By signature, I state and agree, that I have carefully examined the complet~d application and do he:~eby certify that all
information hereon is true and correct, aI)d 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 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 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. "
~/~. f2dJ'
Owner or contrac~ Signature
7/i/07
Date
Paee 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
i?~~
Job/Journal Number
COM2009-0 I 023
COM2009-0 I 023
COM2009-0 1 023
COM2009-0 1 023
Payments:
Type of Payment
Check
cReceiotl
RECEIPT #:
2200900000000000792
Description
Backflow Device
Minimum! Adjustment Plumbing
+ 5% Technology Fee
+ i 2% State Surcharge
,
City of Springfield Official Receipt
Development Services Department
Public Works Department
,
Date: 07/t4/2009
Item Total:
Check Number Authorization 'I
Received By Batch Number Number How ,Received
nJm 1126 In Person
, Paymept Total:
,
Paid By
RELIABLE RAIN
Page I of I
10:26:40AM '
Amount Due
19,00
39,00
2,90
6.96
$67.86
Amount Paid
$67,86 '
$67.86
7!l4/2009