HomeMy WebLinkAboutPermit Plumbing 2009-10-6
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I Permit no C q - L '1 1--3
I Date: /.e- -h' ,- 8'1
Plumbing Permit Application
SPR.INGFIELD ~i:
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225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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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,
1~1~1&}W!~,4:~2i)I~:G."lii;<Gt)YERNMENJ:iifAe,~f{O.VA~~[:~q~'i~f~1 1~&t:*1J~~~€4b1~~Wt~~EEflS:G81:_O:V~E_~~rif'}gi~'&i~~r~aif:~~
I Zoning approval verified? 0 Yes 0 No I I~P;~~l~![~i_1~~1)~tfi~~'~~lgi~11~~~I~~I~J;t~_~~~,!~
I Sanitation approval verified? 0 Yes 0 No I New residential
1 . CATEG.ORY,"OF; CONSTRUCtION,": .,J.,:: ' ,'1 I balhroom/I kitchen (includes.'first
1 0 Residential 1 0 Government 1 0 Commercial IOOfeet afwater/sewer lines, hose
bibs, ice maker, under floor low~point
1j;\!((iL~~]JOBRSI",E'iINF.bRMMTQN~ANDl1tOc:.:P"'fJON~i:%i&J;1;'i drains and rain,drain packages)
I Job site address: -:7~'-'~ 320 ,~('.0 Sfrc,:.CI 1-12 bathroomsll kitcben $374.00 1 $
1 C" CAr' J " Is. IV) 1 ZIP CiH:1...1.1 13 bathroomsll kitchen $439.00 1 $
tty. j/ Vl tate. VI'<.. . 1 ("" Each additional bathroom (over 3) $95.00 1 $
I Reference: ~rll:1Q?i\ ~ 1 Taxlot.:r):;ro\ 1 I Each additional kitchen (over I) $95.001 $
r~(I~~~(:~~:Yil;~~~CR~T:~,F,!f~;:K"!7i~i1:~rrlk'r~JJt.fcW~i : ~~;i~,~~t~a:q~:;eS;:~;klers (includes plan reVieW)$58.00
1 , ('iit)!> ;;~,.(j~RORERTY!1j0WNERi;f~Zif(~(I\:#''4f;;%:t4f~&~t~11 : ~:~~: ::~:~~~ ::~:: ~::: :~~::~~
I Name: '(<; -{- \/'lt71a.lv{s I I 7,201 square feet and greater $232,00
. . S ~. I Manufactured dwelling or pre-fab (circle one)
1 Address: .3 ~ t) So.:-l-/1 \.~ Mf .~ I I Connections to building sewer and I I $58 00 I $
I C' . ~(\ lis . On ZIP' ('1..1 -111 water supply .
!ty. ':'>\ rI7~, . tale., rc... . 1 n 1"" r I Commercial, industrial, and dwellings other than one, or
I Phone: )/- fl.., )20'( I Fax: I two-family
I E.mail: '?T-riM(trilv]Lj @ t,1W{ ~wsr ,1 rc.r I I ~inimum fee I I $58.00 I $
Th" ....,. . b' . d 'd' 1 c . I Each fixture $19.00 I $
IS mstallutlOD IS emg ma e on reSt entIa or larm property .
owned by me or a member afmy immediate family, and is [ Miscellaneous fees
exempt fro~nsmg reAuirements under OAR 918-695-0020. 1100' stor,m, sewer, water line
Signature (r;;r-,-~r M?VfII15 I Each fixture, appurtenance, and piping)
I ' " ,CON~A~toR" INSTALLATION ., I," ,)::.. i. j" .\,' I I Stonn water retention/detention facility
I Business name: W/tz.... -r ])tr.eN'.> I I Irrigation systems .
I Plpmg or pnvate storm drainage
I Address: I systems exceedinethefirst 100 feet
I City: I State: 1 ZIP: I i 'Specialty fixtures
! Reinspection (no. of hI'S. x fee per hI'.)
1 Phone: I Fax: I
I Special requested inspections (no, of
I E-mail: I hI'S. x fee per hr.)
I CCB license no.t."2- 4-~:?- I BCD license no.: I I Each additional inspection: (I)
1 Plumbing license no.: I
I Print name: I
I Signature: I
$238.00
$76.00
$19.00
$19,00
$19.00
$19.00
$19.00
$58.00
$58.00
$58.00 $
$
$
$
$
$
$
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1
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$16"1
$ I
$ I
$ I
$ I
$ I
$ 1
I
$
Minimum fee
I Enter value of installation and equipment .$ _'
I Enter fee based'on installation and equipment value. I $
1':::""'0!7':""""i:<!W~1ll'A'''''''I'C'' "AtN"Tmi:i:S-"E'1i!Ii_~t'_=
tf?~T'cgt0i!?T0J:i~.'!f~~",*(~'i'i~ ," /:'4 . ilai~. '..m~..ilLi"r6~-.ttiiy~,\t~;
1 (A) Enter subtotal of above fees $
(Minimum Permit Fee $58,00)
I (B) Investigative fee (equal to [A])
I (C) Enter 12% surcharge (.12 x [A+B])
I (D) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through 0):
.~~~~
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440,2500,J (11/08/COM)
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$ 1
~8.'77_1
$
$
Status.' . Issued>i~'{;; .
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. 225 Fifth Stree't/Sjii-iilgfield, OR
:,541-726"37~3 P~co~~,:,:,:;". .
.; 541-726-3676,F~"';'.t";i:,;;;. '" :"" d.'
"541-726-3769 Iii~pection'Line;o';;-;:i:;;d..'.,
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01473
ISSUED: 10/06/2009
APPLIED: 10/06/2009
EXPIRES: 04/06/2010
VALUE:
',.
. SITE ADDRESS:.' 320 S G ST' ',X,. . Springfield TYPE OF WORK: Single Family Residence
ASSESSOR'S PARCELNO.:,'{io33534030in
.t';:~;f:i;\(':iL;!{r:?fr:;:' r . TYPE OF USE: Repair Residential
PROJECT DI!:~tRIPtION: Replace Santary Sewer Line
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law reqUire" yvu :.-
ATTENTION: orego~ b the Oregon UtIlity
folloW 'rules adopte Th;se rules are set forth
Notification coe~t~~i 0 through OAR 9521-00~y-
in OAR 952-0 - 'n copies of the ru es
0090, You may obtai Note: the telep\1One
calling the center. (on Utility Notification
_,,~hpr for the Oleg,_ nM ",<ddl.
Center '" ,-vu- --
I CONTRACTOR INFORMATION I
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: ,Owner; , 'WELTMAN ETHEL I> .
Address: ' . PO::BOXIl96' ,.- , 'co!!"',;:::":: '." ~
SPRINGFIELD OR 97477
Owner: ADAMS PATRICK J _
Address: PO BOX 896 "",~;, .
SPRINGFIELD OR 97477
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Contractor Type
Plumbing
Contractor
WALT DREWS
License
Expiration Date Phone
541-513-8241
" I BUILDING INFORMATlON~
1.'-' ~ ';.i" 'H.'- . ..
# of Units: . .:~' .' 1r d~;': ','.
.",. ,'''' ." . ,
Primary Occu~!,lncy,Group:
8,econdary Occupancy Group:
. t. _ .
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
.j. "t-
...:.
"f \.,
R3
# of Stories:
Height of Structure
Type of Heat:
Water Type: .
Range Type:
Energy Path:
Sprinkled Building: n/a Rlf
ft.~""Il"'C. _-;\....Tue'''-If) l\.
T\i,~DEV.EI\OPMENT;NFORMA1Ji(j)N\:' N01
f>,U1\-\ORIl.tU UIW~S" "B' "NDONED tOR
.~cn (\R I ""
COMMH0verla:i: Dist:
, ," tjL'1\lI'"
f>,NY 180#.5tne'- '-"FreesRqd:
Paved Drive Rqd:
% of Lot Coverage:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
.,.' VB
.I~;~", t.~;~~
,r , t ;::
Frontyard Setba.ck:'
Side 1 Setback,!::' . ,;. .::
Side 2 Setback: 'i' "0. ;' 1.
Rearyard Setback:
Solar Setbacks: .
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, .,
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REQUIRED PARKING
Total:
Handicapped:
Compact:
7.
Street Improve~entr . ~, "
. Storm Sewer A ";ailable:
Special Instruct/pn: ;i ..
Notes:
.~, '1::'-
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I PUBLIC IMPROVEMENTS I
.
Sidewalk Type:.
Downspouts/Drains:
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Page 1 oI2 ,
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Status . Issued':'
225 Fifth Street, Springfield;' OR
541-726-3753 Phone ,.'_ ,;
~:~: ~i~:~~~~ r#P~~!i~;~Lin~f<1IjJI;{;;::':H'
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01473
ISSUED: 10/06/2009
APPLIED: 10/06/2009
EXPIRES: 04/06/2010
VALUE:
,~ ..
. .1 ValuationDescriotion I
Description
Tvpe of Construction'
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value.
Date Calculated
:;'.\.'>0':
Total Value of Project
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Fees Paid I
Fee Description
.,. Amount Paid
Date Paid
Receipt Number
t)
Total Amonnt Paid
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$0.00
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I Plan Reviews ,
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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. t. ,.,
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I Rfollired Insnections I
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Sanitary'Sewer Line: Prior io filling trencb and including required testing.
By signature, I state and agree, tbat I have carefully examined the completed application and do hereby certify that all
information hereou is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances ofthe City of Springfield and the Laws ofthe State of Oregon pertaining to the work described herein, and
that NO OCCUPAN:Cy'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 to ensure that all required insp'ections 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 constru.ction. '"7 "\-.
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Owner or Contractors Signature [ .,.
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Date
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Page 2 of2
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225 Fifth Street'
Springfield, Oregon 97477
541-726-3759.Phone-2-~ .
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RECEIPT,,#:
City of Springfield Official Receipt
Development Services Department,
Public Works Department
,
,3200900000000000694
Date: 10/06/2009
Job/Journal Number.>.: ~e.s~ripUo~', ,:'/:;~?:t;:\::(.: . ','
CO M2009-0] 4 73:;i;.!.ff:;J~Milarys~;;;6i:~: i '51 I 00 Feet
. COM2009-0]473i';i'." )+5% Technology Fee
COM2009,O]473 ,.,';,(,:"".:+.12% Slate Surcharge
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Payments:
Type of Payment
Check
,;.: ,.
Paid By
ETJtEL WELTMAN" "
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Item Total:
l.:heck Number Authorization
Batch Number Number How Received
6684 klk]n Person
Payment Total:
2:47:51PM
Amount Due
76.00
3.80
9.]2
$8K 92 ,
Amount Paid
$88.92 .
$88,92
10/6/2009