HomeMy WebLinkAboutPermit Plumbing 2009-8-24
Plumbing Permit Application
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,I Permit no,: (]C) - /:2 3 5-
I Date E/ 2. --(/f:J '1
,
225 Fifth Street. Springfield, OR 97477. PH(54t)726-3753 . FAX(541)726,3689
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? 0 Yes 0 No 1 Ij~?D'i~ltt~Pti6ht0li~~~~~&~~~~~~?~';[:~:~;,a~~;~~~IQP';il~~g9~!ft~:I:ft[~t~,~'ril
~~'{~-'j'"'i_,:,;~",\,,~>;;f~U,';~Zff~~~Y~~Kt{@~'~i:~~~'ji:1~~ff~ ~~,..~{i tli;t~~:?:R~tfJ gt,H_C_QstF\t_l
I Sanitation approval verified" 0 Yes 0 No I I New residential
I " ',CATEGORy.'Or:CONSTRLlCIION:"'1 1 bathroomll kitchen (includes,jirsl,
I 0 Residential '1 0 Government I 0 Commercial I 100 feel of water/sewer lines, hose
, bibs, ice maker, under floor low-point
1~~~~il~j'iJOBi\:SIi11E">INnOB.MA",i(jN:4?ANP:9lfO:c::'A-T!IQN~iii1M)il);i!7~1 drains and rain-drain packages)
I Job site address: 9<-(<; .2,') r/=;" I I 2 bathroomsli kitchen $374.00
CitySPr-L--') I State: ~-ZIP: I 13 bathroomsll kitchen $439.00
_ _ Each additional bathroom (over 3) $95.00
Reference: l'l61..7;\ DCJ I Tif21!l>t\\ D\ I I Each additional kitchen (over I) $95,00
Ir&f~~~illi;~~~)~~1};;D'ES~CRIJ?J;I~N*~Q6:,t;iVV,ORK1:~,~;~j[~~${{~fri~fll:$~l I Residential fire sprinklers (includes plan review)
I A.I"'~ vJ ~"'- L..' /Vl:;.---:J 1''1 17 x-j') I I 0 to 2,000 square feet $58.00
I 1 I 2,001 to 3,600 squarefeet $118.00
;;F'RO~ERTYirOVl!NER'Iii~1f;::~!1?IKi\Vj;~N~\,~\11 I 3,601'to 7,200 square feet $174.00
I' Name: MdN1Jr7t:.2.0;. LArJI> ~ DE / I I 7,201 square feet imd greater I $232.00
I Manufactured dwelline or pre-Cab (circle one)
I Address! ?C ') I IVw q 1'< J/ 1 Connections to building sewer and I I $5800 I $
I City! (.J9.7.L v,-0f"4......s I State: CJ?L I ZIP: 7~? JJcJ I watersupply .
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 c.; $19,00 I $1'7 (
This installation is being made on residential or farm property
owned by me Or a member of my immediate family, and is I MisceJJaneous fees
exempt from licensing requirements under OAR 918-695-0020. 100' storm, sewer, water line
Signature: I Each fixt.ure, appurtenance, and piping
I "'o'CONTRAC1l0R,dNSIALLAT,lON,,;;,,,:;,i';i!,~,.i\',',,~<1 I Storm water retention/detention facility
I Business name: (Jff-r!-PI""--/f7l/ ;::tPl I' ,-2&7fp r ~I~' Irrigation systems ,
~ - ng or private storm dramage
I Address: -/ S-'-rl!f? C-IA//:::- Rl> I svstemsexceedinQthetirst 100 feet
City: Tt-<.4' f:'-" I State: J1L. I ZIP:'7'I:;.'O::2-! i Specialty fixtures
,- I' I Reinspection (no.'ofhrs, x fee per hr.)
Phone: Fax: IS' I t d . . ( f
pecla reques e mspectlOns no. 0 $58.00
I E.mail: hrs, x fee per hr.)
I CCB license no.: 12')'2-,-/ I BCD license no,: I Each additional inspection: (I) $58.00 I $
I Plumbing license no,; It'ij~_~~mt~s(pr~'i!fg"&W!~~~~~'?~lf~~~~~ Mi,nimum fee I $
I Print name: J Enter valueiof installation and equipIT!ent $_.
I "'"'''''' ~1~E'i~;~;ij7~
. ~~ q,.~ ' ,~~~~ [ ~~~~:t::t~~:~vs:::~~;~U~\~ ;~~+B]) : PJ )~:
1(1. ~ V'V c:><T' I (D) Technology Fee (5% of[A]) $ g'::I I
~ ~ I TOTAL fees and surcharges (A through Dj: $ 2-==-]'
$238.00
$76,00 I $
$19.00 $
$19,00 $
$19,00 $
$
$
$
$
$19.00
$19.00
$58,00
440-2500-) (ll/OS/COM)
$
$
$
$
$
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01235
ISSUED: 08/24/2009
APPLIED: 08/24/2009
EXPIRES: 02124/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 945 28TH ST .
ASSESSOR'S PARCEL NO.: 1702310001101
Springfield TYPE OF WORK: Plnmhing Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: rREPALCE WATER LINE TO 9 FIXTURES
Commercial
Owner:
Address:
Contractor Type
Plumbing
BROWNFlELDS LAND & DEVELOPMENT LLC
2851 NW 9TH ST STE D . ATTENTION: Oregon law requires youto
CORVALLIS OR 97330 fnllm~ rules adopted bv the Oregon Utility
Notification Center. I nose rUIB::i tilt: ~tt IVI Ul
I GONT.RA€TORI INFORMA:rION-i; 952-001-
uu~u. YOU [!lay UUlalll vUj-JI<;';,", .....' ."e rules by
Contractor calling the center. (Nlmc~Ws~ele~1:1'8iration Date
. _._ _ ._v .h.... Qr"""'......n I It/q,-y I\lOtlflt:i:111011
READY ROOTER DRA~Nr0UE~NI)~r~.~<R~~~9~~~4)"ALl\ 02/25/2011
Phone
541-744-7991
BUILDING INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
NOTI.~llergy Path: Sq Ft Other:
s/f'Rrinkled.BUiITqg-;'PIRE IF nra: WOPtliccupant Load:
Tl-llc; Pr IVIII c,H"L "A . '.:::,~ .'^,T
---- . .~.." ., . .-0..... ............"'" I I..... ,........
I DEVELOPMEN1"INFORMAIIOr.-lrIFOR
liUIVllVltl~'-'CU V" 'u ,,_. ..,.-
ANY 1&ef.,W dift~IOD.
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Total:
Handicapped:
Compact;
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuatlon Descri.,tion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of 2
Status
Iss u ed
CITYOF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01235
ISSUED: 08/24/2009
APPLIED: 08/24/2009
EXPIRES: 02/24/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691uspection Line
Total Value of Project
Fees Paid.
........,~.
Fee Description,
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Amount Paid
Date Paid
Receipt Number
$20.52
$8.55
$171.00
8/24/09
8/24/09
8/24/09
1200900000000000965
1200900000000000965
1200900000000000965
Total Amount Paid
$200.07
I Plan Reviews ,
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. wili be made the following
, ,
work day. .
I Reouiredlnsnections.
Rough Plumbing: Prior to cover and, including required testing.
Final Plumbing: When all plumbing work is complete.
By signatnre, 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 strncture without permission of the Community Services Division, Building Safety.
1 further certify that only coutractors and employees who are in compliance with ORS 701.005 wi/I 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.
oTd~isi;:::::e
fB/z-tJ(01
Date
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-7.;26-3759 Phone
Job/Journal Number
COM2009-0 1235
COM2009-0 1235
COM2009-01235
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Description
Fixture
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DAVID NICHOLS
~r~'!'I'!'_C!~I...ID.O,..._..- ,..1"....".. ,", :..,
.~.:
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000965
Date: 08/24/2009
Item Total:
l.:heck Number Authorization
Received By Batch Number Number How Received
CJC 02538D In Person
Payment Total:
Page 1 of 1
9:24:40AM
Amount Due
171.00
8.55
20.52
$200.Q7
Amount Paid
$200.D7
$2UU.Q7
8/24/2009