HomeMy WebLinkAboutPermit Plumbing 2009-8-3
Plumbing Permit Application
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I Pennit no,: t! 7- / 1(:) I
I Date: J/3/" 7 '. .1
,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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I Zoning approval verified? DYes D No Ir[):~~r;t;~,f_'I'a~I~II~llliJ~~111
I Sanitation approval verified? DYes 0 No I ~:-'~:~::7i~' -~- - - ,:;m1)~/,o:t.'k'~ S!J;>)O~ ~~_....i<.i= <*.a ..,_...3t~1
i=~~~ill~Gi~~~~~~~~~~~JTiRl!J'r~E>~=:~1 1~~~!;~~;~~:;~1~:;:~i~;~1 $238.00' $
l~tlBIslmEiI!INIiQF~M~mION!Y~Nl:)lili(>:CAmIQN~~~1 drains and rain-drain packages)
I job site address: :2.t..~ Mm ~ I I 2 bathroomsll kitchen $374.00 $
I I I I I 3 bathroomsll kitchen $439,00 $
City: S; PYLi'> State: ~ ZIP: "'?tr'l? I Each additional bathroom (over 3) $95.00 I $
1=;~;r~J~~'m~~~a~~K~;~J}~"~~~<<~"ti I ~::~d:~~::~~:~ k:::~~~I:or:e;i~~IUdeS plan reVieW)$95.00 $
I12EPLkr SUI,,~ IJrl-n-7L LI/Vt I Oto 2,000 squarefeet $58.00
1!'t~l~ti~p,~tlaI:B1!:;Yg1fQ}JVNEB~lj~!ili I ~:~~: :: ~:~~~:~~:: ~:::, ~~~::~~
I I I 7,201 squarefeet and greater $232.00
Name: Vt::Je./TV'f-5 /NCb'N1i:: ?Il:t2P LL<:"
Manufactured dwelling or pre-fab (circle one)
I Address: H. &x '1Q6:5'1 I Connections to building sewer and I I $58.00 I $
I City: EiA4 {/vc I Statd-<. I ZIP: "71l/11~ I water supply
I Commercial, industrial, and dwellings other than one- or
I Phone: I Fax: I two-family,
I E-mail; I I Minimum fee I I $58.00 I $
I Each fixture I $19.00 $
This insta to'S being made 0 . dential or [ann property
owned me or member of i~mediate family, and is I Miscellaneous fees
exemp fro ensin qui menis under OAR 918-695-0020, I 100' storm, sewer, water line I / I
s~ _ .re:_ /' \, ~ ----, I Each fixture, appurtenance, and piping
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I City: e-t,U;'(dVc I State:07<-- I ZIP:1?'(tJ/ I I Specialty fixtures I I
I Phone: ?-'t~ '1<7'11' I Fax: I I Reinspection(no,ofhrs. x fee perhr.)
I Special r~quested inspections (no. of I
I E-mail: I hrs, x fee per hr.) ,
\ CCB license no,:t;<;;1.S';L 'f I BCD license no,: ,I Each additional inspection: (I) I $58.00 $
I~::~:~cense no,: : ,~~~f~~:~~~:::~:::~!!~tl $ Mini~um fee $
I '-- I "I Enter fee based on installation and equipment value. $
Signature: ,?'
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~~ ~~~,
~ ~'
225 Fifth Street. Springfield, OR 97477 ,. PH(541)726'3753 . FAX(541)726-3689
$76.00 I
$19.00 I
$19.00 I
$19.00
$19.00 I
$19;00
$58.00
$58.00
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I (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Investigative fee (equal to [A])
.1 (C) Enter 12% surcharge (.12 x [A+B])
(D) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through D):
440-2500-) (11I08/COM)
$
$
$
$
$?~~
$ I
$ I
$ I
$ I
$ I
$ I
$ I
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$ SLO I
$~~I
$ 7b~
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$ 'i '..:!=
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r~: 'r
CITY OF ;Sn~.ll~l>l'U..L1j
Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-011IS
ISSUED: 08/03/2009
APPLIED: 08/03/2009
EXPIRES: 02/03/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 265 MAIN ST
ASSESSOR'S PARCEL NO.: 1703353205300
" (1' ""~
, ~" laW r1),!,'P,EJ0F USE:
PROJECT DESCRIPTION: REPLACE 50Ll\\'YAmERliJINEego~ by the Oregon U\ilitih
\n\loW rules_ ad?~,teTh()Se rules8:e _s_e~ \~~1_
l\\n\ltlcallv" ~_..' othrou9n VI''' ---
Owner: VERITAS INCOME PROPERnES,bb<!;J52-001-001 , 'copies 0\ the rules by
Address:, PO BOX 40031 '\I~90" 'YOU may obtain N Ie' the telephone
EUGENE OR 97404 0 I'ling the center. ( 0 Utility Notification
ca _ ...1-... nrAOon _ ..-
nUrT1Uul,..:'"'._..-..... ic. 1~80U-~,,~~~v"J
I CONTRJ\:CTOR INFORMATION I
Springfield TYPE OF WORK: Commercial Miscellaneous
Repair
Commercial
Contractor Type
Plumbing
Contractor License
READY ROOTER DRAIN CLEANING & R S~92524
I BUILDING INFORMATION.
Expiration Date
0212512011
Phone
541-744-7991 '
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
NOTIC~ight of Structure E \F 1HE WORKSq Ft 1st Floor:
E1'~~I~l'~ll!'-l EXPIR IS N01Sq Ft 2nd Floor:
1HIS P Water. T~Pti::R 1HIS PERM\1 Sq Ft Basement:
I\U1HO~\{,rg~O +y,~e;-S ^BI\NOONEO FOR Sq Ft Garage/Carport
MMr"ro-\ ,,,"\1 ,...
CO Ener Patn:On Sq Ft Other:
I\NY 1 [Spr.'i'ti~iearB1Iili:ling: n/a Occupant Load:
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive'Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact;
IPUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
'$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e I of 2
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-011lS
ISSUED: 08/03/2009
APPLIED: 08/0312009
EXPIRES: 02/03/2010
VALUE:
225 Fifth Street, Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fee~ Paid I
Fee Description
+ 12 % State Surcharge
+ 5% Technology Fee
Water Line - 1st 100'
Amount Paid
Date Paid'
Receipt Number
$9.12
$3.80
$76.00
8/3109
8/3/09
8/3/09
2200900000000000867
2200900000000000867
2200900000000000867
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 sa'me working day, inspections requested after 7:00 a.m. will be made the following
work day.
I, Re/luired hSjleefo 1S II
, " ,111111.1.111.1,."
Water Line: Prior to tilling trench and including 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 Springtield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made orany structure without permission urthe 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
stre,et;tliat the permit card is located at the front of the property, and the approyed set of plans will remain on the site at all
(tiJrieSYihg con2ction. f . ___- . g:. 3,-0 ~ '
/\,~/ 7'_~ ' (
Owne~~Contractors ~nature Date
Pal!e 2 of2
22,5 Fifth Street
Springfield, Oregon 97477
541-726"3759 Phone"
Job/Journal Number
COM2009-01115
COM2009-0 1115
COM2009-0 1115
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
Description ,
Water Line - 1st 100'
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DA VlD NICHOLS
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000867
Date: 08/03/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 03569d In Person
Payment Total:
Page I of I
II :37:25AM
Amount Due
76,00
3,80
9,12
$HH.92
Amount Paid
$88,92
$8H.92
8/3/2009