HomeMy WebLinkAboutPermit Plumbing 2009-10-7
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Plumbing Permit Application SPR'NGRELD .. 1};"~p~P.6.~~~E~(Y~E:Q~LY.~~;;1
~ I Permit no.: (Yl--CJI L-ftl I
225Fifth Street. Springfield, OR 97477. PH(541)726.3753 . FAX(541)726-3689' . - . I Date: I () /07/ c;iJ I
Tbis pennit is issued under OAR 918-780-0060. Pennits are issued only totbe person or contractor doing tbe work. Pennits
expire if work is not started witbin 180 days oCissuance or iCwork is suspended Cor 180 days.
1:~~d'S.":"LOCAL:GOVERNMENT>Af>RROVAIi', 1 F' .
I Zoning approval verified? DYes D No I Iq~~C~PtiO~~,
I Sanitation approval verified? DYes D No I 1 New residential
I. ',': ..' 'CATEGORy,''-OF,CONSTRUCTION..;, .':'1 1 I bathroom/I kitchen (includes: first
t"ReSidential I o Government I o Commercial I IOOfeet ofwaterlsewer lines, hose
IXI . bibs, ice maker, under floor low-point
.:>.;.- .JOS:'SITE . INFORMATION: AND,..:LOCATION"'.' ':,';';11 drains and rain-drain packages)
I Job site address: 5liZ- r,DlDfl \ aJ ~. I I 2 bathrooms/t kitchen $374.00 $
I 0-.... r (L I I 3 bathrooms/I kitchen $439.00 1 $
City:.......r.;-rir:f'. ddState: () -. zlP:C{)Ln'7 I Each additional bathroom (over 3) $95.00 I $
Refereoce:. j Taxlot.: I Each additional kitchen (over 1) 1 I $95.00 1 $
(. .~tj,. J. \r~ ":~... E ..;:;:~:~;;:~O~.K:;.;~'~l:. ':~>;:<~.'.i " : ~;;i~,~~~a:q~::~:e.i;klers (includes plan reVieW)$58.00 I $
b4~..r 8-f<.r\\!.L>~ (~, J,.~.w"""~~ ,?I 2,001 to 3,600 square feet $116.00 , $
IN:'::~~;J PR:~= ,~::g,~ I ~:~~: ::2:~e:~:::~er 1 ::::::: : :
- V\ Manufactured dwellin2 or pre-fab (circle one)
I Address: Cllt ~ CD L D()\ a-l..- ~. , Connections to building sewer and I I $58.00 I $
I City: '\,,)V'i-ro,?dtt I State: .Oe.. I ZIP:C(]L/'n I ~::~~~~~~I,industrial,anddWellingSotherthanone-or
I Phone9\I-141J Z..l'--lL-\ I Fax: - - two-family
I E-mail: .5\-&@\(lv-lOV.ccHv-p....C<.M.r.~})(.\.IMinimumfee I .1 $58.00 I
Th. . tall' '~b" d 'd' I f: I Each fixture I $19.00
IS ms atlOn is b..wt ma e on res! entIa or arm property
owned by me or a member of my immediate family, and is _ I Miscellaneous fees
exempt from licensing requirements. under OAR 918-695-0020. 100' storm, sewer, water line $76.00 I $
Signature: Each fIXture, appurtenance, and piping $19.00 $
I '\,:('CONTRACTOR"INSTAI1I.:ATION~,'-., . :'.S'I Storm water retention/detention facility $19.00 I $
I Business name~(\ ov" cJ"V<-c Ay,r ,-I,"AC:... I Irrigation systems. $19.00 I $
I. - '. 1)....\. ,'.1 ..J... I I Plpmg or pnvate storm dralOage I
Address:bl2D ~tt.r\~l{\ o..n/M WI svstemsexceedinothefirstlOOfeet $19.00 $
I City: t=:iA~1 rt; . I State: rLI ZIP(!{)L1D~ I I Specialty fIXtures $19.001 $
I -1 . '. I I Reinspection (no. ofhrs..x fee per hr.) $58.00 $
Phone6~) -lLfu - 11>4 D, FaxELfI 'J.Il,- 'ffJ10) I Special requested inspections (no. of $58.00 $
I E-mail: 6-tt.<.~ ~)(\~/u.l-))/.(l:44/,I}"""_ hrs.x fee:.rhr.). .
I CCB license no.:1 l.:11 QU7_ I BCD license no.: LHl2.ol I I EacbaddltlOnalmspechon:(t). $58.001 $
I Plumbing license no.: 2.02L1;) P l'i\fC'di..-;;1'2aspip'iri2;, ;~ 1 Minimum fee I $
I Print name: ~h 6 r,fV~V\ I. Ente......r. Val. u..e. .Of installation and equipment $_.
I Si ature: . ~-' _ _ -" ~ 1~~~t;e~.f~,b~~dO~I~tallat~~n~deqUlpment~alue.
gn r ~ =""'- -- -- =- I;:.~., .':i'i;..Ar::..L'....tITUSE, .
(A) Enter subtotal of above fees)
Minimum Permit Fee $58.~
I (B) Investig~to [A])
I (C) Enter 12% surcharge (.12 x [A+B])
I (D) Technotogy F~e (5% of[A])
,1 TOTAL fees and surchal'2es (A through 0):
J'EE ,SCHEDULE',,"
~..IQ.~..;I'..
'3>"-" .
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C.ost,'I"Tota.I:1
..; ~a.,-,'.' '.co~t..,
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'$238.00
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$ 1
$ 1'1 j
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$ 10 0/ ~ 1
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440-2500-) (11/08/COM)
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Status
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01481
ISSUED: 10/07/2009
APPLIED: 10/07/2009
EXPIRES: 04/07/2010
VALUE:
Issued.,..,.,
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225 Fifth Stree{Spr'ingfleld, OR"
541-726-3753 Phone' . .
.541-726-3676.F~{)';} ", '.'
" 541-726-3769 Iii~pecti6.rLine)';! .,'
SITE ADDRESS: 562 COLONIAL DR .
ASSESSOR'S PAR!=:EL NO.: 1703221200'500'
. '. .':>,., ;~,'-;'::,':'-.." '" TYPE
:":".,,,> . "'~~"":"}' OF USE:
PROJECT DESCRIPTION: Residential retro fit for hot water heater (tankless)
Springfield TYPE OF WORK: Mechanical Only
New
Residential
; Owner:
Address:
LEWis'T1iRRYM'& DEBRA K
. 562 COLONIAL'DR,rS
SPRINGFIELD OR 97477
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I, CONTRACTOR INFORMATION I
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Contractor Type:'" -: Contractor
Mechanical ::, INNOVATIVE AIR INC
.: Plumbing.k .,\.. ,,' . GARY CHRISTENSEN
License
161742
Expiration Date
10/1112010
Phone
541-746-1040
, BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constructi6n Type
Secondary ConstructionType:
# of Bedrooms: ,: .
\"i!~ 'l-J i;'
"
. -(
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
. .
nla
I DEVELOPMENTINFORMATION I
Frontyard Setback:
Side 1 Setback: ,i ' \:..:,.
Side 2 Setback:; ,';'::'
Rearyard Setl!ack:
Solar Setbacks:!i
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:.
Special Iustruction:;. .:,
. ;1"
"
Sidewalk Type:
ATTENTION: C,?g8"J1,~I1!!u.tsfl)pii\lS': youto
follow rules adopted by the Oregon Utility
Notification Center. Those ru~e~~~e ;;~.fg~~
in OAR 952.001-0010 throU9 I by
0090. You may obtain caples of the ru es
calling the center. (Note: the tel~phone
number for the Oregon Utility Notlftcatlon
Center is 1.800.332-2344).
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Notes:
Nonck,j: ,+. . .
THIS PERMIT SH -
AUTI-IORIZED UN~i~ ~~~~RE IF THE WORK
COMMENCED OR IS A PERMIT IS NOT
ANY i ag, P.AXefRIOD. B~.~DONED FOR
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Pae:e 1 of 3
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Status
Issb'ed\
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 bispection Line .
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Description
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Tvpe of Construciion
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Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Fixture
Minimum/Adjustment Plumbing' "
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TotatAmount Paid
/', '.',' .
'.
I Valuation Des~r~D~!,~~ ~
. $ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
CITY OF ~r.Kll"'lJFIELD
Building/Combination Permit
PERMIT NO: COM2009-01481
ISSUED: 10/07/2009
APPLIED: 10/07/2009
EXPIRES: 04/07/2010
VALUE:
Value
Date Calculated
Total Value of Project
f:~,!l' ~7il,11
Amount Paid
Date Paid
Receipt Number
2200900000000001151
2200900000000001151
2200900000000001151
2200900000000001151
2200900000000001151
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
.1
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day. ~:
,.
$16.44
$6.85
'.) $79.00
$19.00
$39.00
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
$160.29
Plan Reviews I
..r I.Rrm~
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: "When all plumbing work is complete.
! 11 . .
Rough Mechimical: Prior to Co"er
:'
Final Mechanical: When all mechanical work is complete.
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Paee 2 of 3
. 225 Fifth Street,Springfield, OR.
541-726-3753 Phone .
541-726-3676 Fax.,: "..,. .
541-726-3769 ltispectioi)"OLine
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CITY OF SPRINl.il'lJi;LD
Building/Combination Permit
PERMIT NO: COM2009-01481
ISSUED: 10/07/2009
APPLIED: 10/07/2009
EXPIRES: 04/07/2010
VALUE:
Status
Issued
,
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By signature, I .{ate"and agree, that) 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 structure 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 t~ en~ure,that,all:[e<iuired inspections are requested at the proper time, that each address is readable from the
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street, that the permi ard is located at the frout of the property, and the approved set of plans will remain on the site at all
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Owner or Contrac'torsSignature Date
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City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street. .
Springfield, Ofl,go!l?7~7n"
541-726-3759 P~one";' ..
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Job/Journal Number
COM2009-01481
C0M2009-0 1481
COM2009-0 1481
COM2009-01481'
COM2009-01481
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Payments:.
Type of Payment
CreditCard
,-I
cReceintl
",h '"
i ~!" 'RECEIPT, #:
Date: 10/07/2009
1:16:36PM
2200900000000001151
. ~escription
I st Appliance
Fixture
.,Mitiimuml Adjustment Plumbing
.,'-,.,,' "'i_ -," _
"X-t:5% Technology Fee
... '+ 12% State Surcharge
Amount Due
79.00
19.00
39.00
6.85
16.44
$160.29
.... .
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Item Total:
<":heck Number Authorization
Received By Batch Number Number How Received
nJm 006403 In Person
Payment Total:
$160.29
$160.29
. ....,:;..
Amount Paid
Paid By
ROBERT GARVIN'
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10/7/2009