HomeMy WebLinkAboutPermit Plumbing 2009-9-28
Plumbing Permit Application
,
225 Fifth Street. Springfield, OR 97477 . PH(541)726.3753 . FAX(541)726.3689
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I Permit nul! 9 - 0/43')
I Date 9 by /d}
This permit is issued under OAR 918-780-0060. Permits are issued unly',tu the persun ur cuntractur duing the wurk. Permits
expire ifwurk is nut started within 180 days ufissuance ur ifwurk is suspended fur 180 days.
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I Zoning approval verified? DYes D No I It~B'~j~Jl1'i~t'i'a'flV'~~{~f~~~~~~~~,;~*{!j]~t~~[~~~)IQiY:jl~J~~g;~'i~lf:Z~'I~'tlPt~.J.~~'
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I Sanitation approval verified" 0 Yes 0 No I I Newresidential ' .'.
I/'. , CATEG.ORY:"QF, CONSTRUCTI()I'C' ,':',;; : "I 1 bathroomll kitchen (includes. first
1 'esidential I 0 Government 1 0 Commercial 1 IOOfeet afwater/sewer lines, hase $238,00 $
~ .K bibs, ice maker, underjloor low-poin(
lif~<<,jHl\i;;.JOBZ.'SlmE;;,INFORMA1)()N~AND}1E(),CATJ()~~.;ii;;;~\!i1JiJ~1 drains and rain-drain packages)
1 ,.., D ^/\ / ~./l I I 2 bathrooms/] kitchen $374,00 $ ,
Job site address:; I: 'v I .A--1 1\ ""'f--n- .1
1 City: ,"', n. 17 I State: 1 ZIP:' '~' 1 I 3 bathrooms/] kitchen $439,00 I $
-"'->-1-:" / 1 Each 'additional bathroom (over 3) $95,00 $ 1
1 Reference: \f'1~'?-O. I Taxlut.:l)\).. I 1 Each additional kitchen (over I) I $95,00 I $ I
li~1:~W;:;,;'Y>1fj;tf3,\Cf:1;2>~JJ~rSES.CRlbT:;IO' .:'N"""-~,rO"::- F' '2iW. O.R"U":).\11/'*~~.l~~l?t,1~)<;f:'});4~11 Res,'d.ent,'al fire sprl'nklers (,'ncludes plan rev,'ew) 1
;',d"N'.'::",~''''';' .t1.f,;n:i';'''''''':;''\:;pU_ .. _ ,_ .,,_ __ IT::; "__On" __ :;-0.._ .....~>;~.. . .'. .... ~"~'l.'."~.~;""'Ii-~,~;,:;J.,...""';bj.'^,,,
I WN/\\l~o ~ ~.tt)D ., IOto2,000squarefeet $58,00 $ I
1 V' ~" .. - I I 2,001: to 3,600 squarefeet $116,0.0 $ I
1.:"'~:"V.::i'-~j:~~i'~~':'1~,~'j,i~~;~ ;'~F,J,R:()BJ:RmY~~:C:>WNEJ~!J-)~$j~)"&l~!~;iff;;~~~BX~~1 I 3,601' to 7,200 square feet $174.00 $ I
1 1\1 1 I 7,201 square feet and greater $232,00 $ I
. Name: F'O (" fl
1 Manufactured dwelling or pre-fab (circle one) I
I Address: Z. \ 2-- t\ n Ai rJ Conn.ections to building sewer and I I $5800 1 $ 1
I City: <::'/?-11 . I. 1 State: /')--<1 I ZIP: '9 ') ., I water supply if '
C/ 71< 1 Commerc.iall industrial, and dwellin. gs other than one- or 1
Phone: "-.:i;-i:Jl 7 ( 0 C, I Fax: two-family'
E"mail: I I Minim. um fee I I $58,00 I $ I (r"->
I Each fixture / $19,00 $ /tj I
This installation is being made on residential ur. farm property
owned by me or a member afmy immediate family, and is I Miscellaneous fees I
exempt trom licensing requirements under OAR 918-695-0020, I 100' storm, sewer, water line $76.00 $ 1
Signature: I Each:fixture, appurtenance, and piping $19.00 $ I
I.. "",,' .,GONTRACllOR,;INSJ;ALLA1;IONJ"j",j,.;"7);:;:;,,,:,,,'oI I Storm water retention/detention facility $19,00 . $ i
I Business name: f/ /2 r f2-1 .f1 (2! I I Irrigation systems $19,00 $ I
.' .L.-1 / _i' ''J'~ {, J 1\.._ ~.~, .(- I Piping or private storm drainage I
1 Address: Si,,;;>,,'9 tV) A-1 ,J h's ,-' "I svstems exceedine the first 100 feet $19,00 $
, 1 City: I State: DR. 1 ZIP:'] ') <r,>yl I Specialty fixtures , $19,00 $ I
~^ I Rein~pection (no. of hrs. x fee per hr) $58.00 $ I
I Phone: I Fax: I I' Special requested inspections (no. of $58.00 $ I
I E-mail: I hrs. x fee per hr.)' \
CCB license no,: i (CJ ,? ::, 0 1 BCD license nu,: \'i;" 3.+- '\.~' Each additioual inspection: (I) $58,00 $ I
Plumbing license ~o.: 5- r.~~ 3f' . I ~"~~icKi!~'~S'~~i'pT~"'~'1tt'ti~~~~~lj;~~~~~t Mi.nimum fee $ I
!Printname: j,L,1~1,.J lL:.t~ I I Enter value ofinSlallation and equipment $_, 1
I Signature: ~ff .--'~ I :~~~~;;~;;';~~I~~ijfZDi-~~~~~j
...-..~'(bf-.Enter'sulitofiil0fiib'6Ve'fee::;J $ I crV
( C (Minimum P""mit Fee.$58,00) 5 2-,
N.~ .....\..W 6"-- (B)]nvestigativefee(equalto[A]) " $ ~
1.~Q.~'(-- ~S /(C)EnterI2%surchaige(.12x[A+B]) $ z.
W ()(),'-.O \\.1 ~ 1 (D)TechnologyFee(5%0f[A]) .. $ to < 0
I)....;,y .... "--~ I TOTAL fees and snrcharges (A through 0): $ ,ft]. ,%0
CJ "~'
440.2500.) (1I/08/COM)
Status
Iss u ed
CITY VJ< ~rKlNGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01439
ISSUED: 09/2812009
APPLIED: 09/28/2009
EXPIRES: 03/28/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phuue
541-726-3676 Fax
541-726-37691nspectiun Line
SITE ADDRESS: 210 MAIN ST APT 1
ASSESSOR'S PARCEL NO,: 1703353204700
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: New
CummerciaJ
PROJECT DESCRIPTION: Fixture fur bathtub
Owner:
Address:
DAVIS JOAN K
.734 SUMMIT BLVD
SPRINGFIELD OR 97477
I. CONTRACTOR INFORMATION'
Contractor Type
Plumbing
Contractor
PRICE RITE ROOTER & PLUMBING
License
159330
Expiration Date
03/30/2010
Phone
541-221-3212
BUILDING INFORMATION I
,.
# uf Uuits:
Primary Occupancy Gruup:
Secundary Occupancy Gruup:
Primary Cunstructiun Type
Secundary Cunstructiun Type:
# uf Bedruums:
# uf Sturies:
Height uf Structure
Type uf Heat:
Water Type:
Rauge Type:
Euergy Path:
Sprinkled Building:
Lut Size:
Sq Ft 1 st Fluur:
Sq Ft 2nd Fluur:
Sq Ft Basement:
Sq Ft Garage/Carpurt
Sq Ft Other:
Occupant Luad:
n/a
1 DEVELOPMENT INFORMATION I
Fruntyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Sular Sethacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% uf Lut Cuverage:
REQUIRED PARKING
Tutal:
Handicapped:
Cumpact:
I PUBLIC IMP~OVE~E~TS I
Street Impruvements:
Sidewalk Type:
Downspouts/Dra~ns:
ATTENTION' 0 ..
follow rules ~d;egon law requires you to
Notification centtrte~ by the Oregon Utility
NOTICE: in OAR 9S?nn1.nn', n ".Cl~e r~'e~ are selforth
J HI;; PERMIT SHALL EXP/RE I'f, TI-!F wnR' I UUtlO, You may obtain co'j~~' ~'''' OJ~-uu 1-
AUTHOR/ZED UNDER THIS PE_Valuation'hescriDtion . calling the center, (Noie: th~ft~~: r~~e~ by
COMMENCED OR IS ABANDOr'$:~:;:' 'CS'~"'F"tU I number for the Oregon Utility N rf. ,e
DescriptiunANY 1J;v..pe1ufIGunstructiun ...<:erl ,q'l' Square Fuutage Centervh 11.800.332 r ,?, Ilcatlon
~c ., \ I U t B'd A t a ue '~Datp. ,Calculated
, L-Il/U. - or ~u Ip Iff or I moun ..
Sturm Sewer A vaHable:
Special Instructiun:
Nutes:
,; Pa2e 1 uf 2
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: GOM2009-01439
ISSUED: 09/28/2009
APPLIED: 09/28/2009
EXPIRES: 03/28/2010
VALUE:
225 Fifth Street; Springfield, OR
541-726-3753 Phune
541-726-3676 Fax
541-726-3769 Inspectiun Line
Tutal Value ufPruject
Fee~ P,\lid J
Fee Description ,
+ 12% State Surcharge
+ 5% Technulugy Fee
Fixture
Miuimum/Adjustment Plumbiug
Amuuut Paid
Date Paid
Receipi Number
$6.96
$2.90
$19.00
$39.00
9/28/09
9/28109
9/28/09
9/28/09
1200900000000001096
1200900000000001096
1200900000000001096
1200900000000001096
Tutal Amuunt Paid
$67.86
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. will be made the following
work day.
I ,Re?uired Insnections I
Ruugh Plumbing: Priur to. cuver and iucluding required testing.
Final Plumbing: When all plumbing wurk is cumplete.
By signature, I state and agree, that I have carefully examined the cumpleted applicatiun and do. hereby certify that all
infurmatiun hereun is true and currect, and I further certify that any and all wurk perfurmed shall be dune iu accurdauce with
the Ordinances uf the City uf Springfield and the Laws uf the State uf Oregun pertaining to. the work described herein, and
that NO OCCUPANCY will be made uf auy structure withuut permissiun uf the Cummuuity Services Divisiun, Building Safety.
1 further certify that unly cuntracturs aud empluyees who. are in cumpliance wIth ORS 701.005 will be used uu this pruject.
I further agree to. ensure that all required inspectiuns are requested at ihe pruper time, that each address is readable frum the
street, that the permit card is lucated at the frunt uf the pruperty, and the appruved set uf plans will remain un the site at all
times during construction.
Ownerur Cuntracturs Signature
Date
Pa~e 2 uf2
225 Fifth Street
Springfield,Oregon97477
541-726-3759 Phone
Job/Journal Number
COM2009-01439
COM2009-01439
COM2009-01439
COM2009-0 1439
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001096
Date: 09/28/2009
Description
Fixture
Minimum/Adjustment Plumbing
,+ 5% Technology Fee
.+ 12% State Surcharge
Paid By
PRICE RITE PLUMBING
Item Total:
Check Number Authorization
Received By Batch Number Number How'Received
njm
505027 In Persun
Payment Tutal:
Page I of I
9:51:29AM
Amount Due
19,00
39.00
2,90
6,96
$67.86
Amount Paid
$67,86
$67.86
9/28/2009