HomeMy WebLinkAboutPermit Plumbing 2009-7-20
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Plum bing Permit Application
225 Fifth Street + Springfield, OR 97477 + PH(541)726-3753 . FAX(541)726-3689
I Permit nbL:Ow1Z00 ( - 0 fO~ 7
I Date: ~/2cy0 i 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.
IJ..Jl;'~!Ia!:Ii()CAIi!G()VERNMENTJ;APRR0YA,"~~J.1lllJ~lJ!sJ.1lllJ;I
1 Zoning approval verified? 0 Yes 0 No I
I Sanitation approval verified? DYes D No I I New residential
IF.iiJi";'y!jJiJl!F1i;.CATEG0RY!Ji0F;071C:C>NSTRt.J<:TI()N7:'''i\,Ji:~'l;:h!:I!'1 I bathroom/I kitchcn (includes first,
IIV'! Residential I D Government I D Commercial I IOOleet olwafer/sewer lines, hose ::
loBI bibs, ice maker. under floor low-point
J,!;J.1lllJF~()B;lSIT:E'i:INFlORM.6.TION:I!'ANDJdII()c:ATIONFf:1j.F;.II1 drains and raill-drain packages) II
I Job site address: 9 hh , ') l..I fflll7 Ir 7)tfrv,t:' 1 I 2 baulfooms/I kitchcn II $374,00 $ I
1 City:3PuNc;.r:r:EZ" I State: e>1Z 1 ZIP: 97'1771 I 3 bathrooms/l kitchen $439,00 $ I
I Each additional bathroom (over 3) $95.00 I $ I
I Subdivision: /703 '3 lill I Lot no,06J /Sf 1 I Each additional kitchen (over I) Ii $95,00 $ I
l~it4Ef1j5E~3t%~~1[jESC-RI~TION~bF4~"'lbRKW;;i0iliilrmBtfJlili:'illI11 I Residential fire sprinklers (include's plan re\'iew) I
I ~, L !'} ..L, A r '. r L I 0 to 2,000 square leet II' I $58,00 $ I
-'" ''1":_ ~T~vnv ::~... If:; y -:-.~ j.!T"-"'7 I 2,001 103,600squarei"eet II $116.00 $ I
fJ I (n r/~-r.A'- "l/..:;J)....) r;; ';r'VJf~_'? ..
r~~~;;;~;~~,;'~:~l:i~ii,i~i;g?~,:~'i+./,:: I : i
- //r;~-;r7r:./rI ffl\._. ", If:.-_ - ._.-I~. : \I7~ .. ~ ~FI'€o.mirie'rCial industrial and dwellings other than one..- or I
I I t"jG!<tIOl\V,","-- othrOUg\'V~ t-~I ' , II
Phone:ST,-,J <'_ h3'14 No II EaXc0J,'li-80i " _'_0'" tf,two!fa'inily,
1 E-mail: . in U""y"-- may obtaIn ,.v""~;hE tel.tMihiihuiTI fee:! I I $58,00 I $ I
~,",n(\ aU . . 1h.\r"'Ilp.. I .<~, ,....'nl1 I I
This installation is being mad~o~&~~~4~.ri'iial o[fa~m~P'\op.~rt)0ti\it) N ).Ea~h;fixturc $19.00 $
owned by me ~r a ~ember ?fm~hnlnf~a,ia:.t~\familY?~friql~~\_?3'2~2 341.\.Mlscellaneous fees I
exempt from Iicensmg reqUirements unae.[jg/M~.\9JI:8-695-0020. I 100' stonn, sewer, waler line $76.00 $ I
Ilr~;~;:~~:i~C()NT:RAC:TOR~INST:AI.!~TIONJif;j:~0li;![J(2i.~1 I ~:~f::::'~~:'~~::/::~:~I~:~ ~~~;~~y ;;::~~; -:
1 Business name: r771:;q1) OI...J LI"INf))(A'P.,- . Jt:./ZV't/. I Irrigation systems , II $19,00 $1'1 m I
1 - - -- ----- ~ ----- ~ Plpmg or pnvate stonn dramage I! I
Address: /7.)') (' )j7:h:!t.J,q 7[De_ I./-I-rv",- svstcms exceedin" thc first 100 leel II $19,00 $
1 City: )?jZTNn;~7'67J\ I State: J1<- 1 ZIP: 97'-17.f' I I Specialty fixtures II $19,00 $ I
I h . -- I J I Reinspection (no. ofhrs. .x fee per hr_~') $58.00 $ I
P one"S'f1 -)JJ.. - qq () , Fax:5'f1-7.1b- 99 0-'5 I Special requestcd inspections (no, of, 'I' I $ I
1 h $58.00
E-mail: j hrs. x fee per r.) :;
1.tGll1ficense no,: t,b9,)' 1 BCD license no,: I Each add;t;onal ;nspect;on: (t) $58,00 I $ I
-I Plumbing license no.: j Minimum fee I $ I
I Print name: ~fJ12.f)~ ,--r; 7)1hJ6Y I I Entervalueofinstallationandequipri>enl$~, II
I /7 '" 1 I Enter fee based on installation and eql.lipmenl value. $
Signature: / -" (} <) _ ~
_ 1~:,1i!,1'1i1!\ilf~~)1"al.l',~~~L:lCA:NT1USE-_' '.. ''ly--- _, 'v-' ,I
01\CE: E'i\P\m\:.A\rEhrer~r~twi\qI'above fees 1 I
N ERWlIi SH~LL \~'(l\lijijhlAt ~~mj'/l;ec $58.00) $~.('()
lHIS P RIlED \IN\)Ef\ 11-\ '1:!I,l.Y,Q~i~Ali~ lee (equal to [A]) I, $ - . I
)1.\11\10 NGED O~ 15, P,\3Al!1'C) Enter 12%su~charge (12 x IA+BJ) $ I",'i (., 1
GOMME DI\.'.O)B~\l)!), I (D)TechnologyFcc(5%0I[Aj) ,,' $ ~1qo;'\l
)l.NlI J B\:) ,,' I TOTAL fees and surcharges (A through D): $ 1,,7,9-. L.
$238.00
$
. 440-2500-J (1I/08/COM)
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Sta tus
Issued
eIT"1 OF SPRINGFIELD
I
Building/C6mbination Permit
. II
.,
PERMIT NO: COM2009-01047
ISSUED: 07/20/2009
APPLIED: 07/20/2009
EXPIRES: 01/20/2010
VALUE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54]-726-3676 Fa.
541-726-3769 Inspection Line
SITE ADDRESS: 966 Summit Blvd
ASSESSOR'S PARCEL NO,: 1703341106301
1~
Springfield TYPE OF WORK: Bac~now Device
TYPE OF USE: New]:
Residential
PROJECT DESCRIPTION: Backnow device
Owner:
Address:
PHELPS MARK M & TERESA A
966 SUMMIT BLVD
SPRINGFIELD OR 97477
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I CONTRACTOR INFORMATION'
Contractor Type
Use Initials
Contractor
. ANTHONY F DAWES
I BUlLD]N~ INFORMATlON" to
ATTENTION: ~re~~~~';~'the Oregon UtlhtV ,
\low rulesItOf:St(Jq~s~Yse rules are set lor\~
R~\ilication (}lelgh~,of.t((f8SU1rtlAR 952-00i
. OAR 952.G\}P~~!}I~~Bpies 01 the rules bV
V~090. You nW\lt'efTYi}/'io\e: the te\e,phO~e
calling \h<R\in~e0fyl!e:, Uti\i\V Notlhcat,on
nurnber IOEI.'ei'gQrpil'th1_332-2344),
CES'p~in%J.i''Building: n/a
License
'I
E . .il D t Ph
XpJratlOn a e ' one
II 541- 726-9903
II
Lot Sizl:
II
Sq Ft 1st Floor:
II
Sq Ft 2nd Floor:
"
Sq Ft Basement:
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Sq Ft Garage/Carport
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Sq Ft Other:
II
Occupant Load:
II
# of Units:
Primary Occup'ancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION'
REQUIRED PARK]NG
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
. Handicapped:
Compact:
I,PUBLlC IMPROVEMENTS,'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
, I
N01\CE: DownsPoi'R~Wtm WOR1<
T\-\\S PERMIT S\-If;.ll V:\S PERMIT IS NOT
AUTHORIZED UND~: f;.Bf;.NDONED FOR
('('\MI\I\ENCED OR._n II
. - p Jl.~ rt:i"J~.
I M.n 10Uj
,Valuation Descrmtion
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Valuer
II
Date Calculated
Page I 01'2
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I
CJT~I OF SPRINGFIELD
Building/Combination Permit
II
lC
PERMIT NO: COM2009-01047
ISSUED: 07/20/2009
APPLIED: 07/20/2009
EXPIRES: Oil20/2010
VALUE: I
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa.
541-726-3769 Inspection Line
Total Value of Project
Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$6.96
$2,90
$19.00
$39.00
7/20/09
7/20/09
7/20/09
7/20/09
Receipt Number
II
22009000000000008]7
"
2200900000000000817
2200900000000000817
"
2200900000000000817
I
II
Total Amount Paid
$67.86
Plan Reviews .1
To Request an inspection call the 24 hour recording at 726-3769, All inspections rJquested 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 Reollired ~nsnections I
Backflow Device: Prior to covering and provide a copy of the test report on site at the time Jf inspection.
, I
By signature, I state and agree, that I have carefully examined the completed application and do hJrebY certify that all
information hereon is true and correct, and I further certify that any and all work performed shaliibe done in accordance with'
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the wci'rk described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Servi~es Division, Bu'ilding 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 wi'" remain on the site at all
times during construction. "'" . ;
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City of Springfield Official Receipt
Developm~rt Services Department
Public Works Department
II
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Date: 07/20/2009 10:41:31AM
..
225~th Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-01047
COM2009-0 I 047
COM2009-01047
COM2009-01047
Payments:
Type of Payment
Check
cReceintl
RECEIPT #: '2200900000000000817
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
MEADOW LANDSCAPE
SERVICES
Received By
djb
Page I of I
Item Total:
Check Number Authorization Il
Batch Number Number How.Received
"
Amount Due
19,00
39,00
2,90
6,96
$67,86
Amount Paid
6617
$67,86
In Rierson
I
Payment Total:
$67.86
7/20/2009