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Home My WebLink AboutPermit Plumbing 2009-10-14 Plumbing Permit Application 1~~'J.R~~;~:~~fM';~~N1frQ~~~O:~[~:S~1 I .:i (! () /' /)15/4- PenUlt no': ,1 G ' ( ,I Date: /~ II E// dJ 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, r~:~:;~;~;p~~~~v:\;]i,~~ERNME6rr;:I?,RR()''!61!!=ft!~~~\\i I Sanitation appr,ova] verifie~? " 'D, Yes. '" 9.~0 . .1, I . CATEGORY'OF, CONSTRUCTION" "0' ii:~~~~~~I~E';IN~~R~A;7;~~;ANDk)~~c~~7~~;;~!ti,~f~1 I Job site address: <: / 2 c:- &1,,/ I/Y\- if) I c_ I I City: ,;, ()-f- 'd I State~ /JIL- I ZIP I i~2~~;if1~~;T~ii~s~N~OF.i)W.J~~~;~~}ql I ~U~"J w,"1-<-v );",-z.. .Il..... ~ Mlde-v- I " ;;:.:tct~;~;~(~I~~RERmy;;6wNE~\;:lii~~~f'l\;g:;';%'W~~~),\11~,11 I Name: \2.,,,,,,^<.v-+- D {)/<; .<=-V'- I Address: . f 0 15/)'X I' /S '/ I 1 City: ?_nl-t/O-&-" State:L1L-- I ZIP:q7'l7"OI I Phone:G'II. ICol-~9~7 I Fax:~'i! 6J'&-32'1U I E.mai]: t'- () lIJ (i) .,- ot 0 L <.z:.- '^ . L-- cJ VV\.. I This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing.requ' ements under OAR 918-695-0020, .---. Signature: .. ,..S---- .. '... " .,CONTRACT0R.;INSTALl:ATION,;"\:.;J;.,/(;~i': I ',~ /- I Busiliessllame: /...... . I Address: ~, /,,/' I I City ""-..... I.Stat';' I ZIP I , I Phone: >< I Fax I I E-mail: ../ ~ I [eCB licensenG:: I BCD I1cen'te no,: I I P]u!Jlbiiig license no,: ~ I -.-1 Print name: ~ I I Signature: " I Il~(!"~{.,,,I";:;'I~"f;gY{jiJ"""'''''''i''~~-~-E'UE' J'1S'C'Ci ED' 'lJ-'- iYE''''-~~'''>'1.''''l;>;;P'~~l!!lf~'''''''';'~'k'~'''Q'F.1 ,#;~t:-,~~,t,'t;~~':~:;1:W:iZflU'f}:!:':::';':~ol'!l7 tJ, ,,',n _ _', '__..:: __l'j{~t';t~~:@Z~i;1t0:0.';'0\r4t:H}>:(;1~ ItID~i~riTp" ;jtifjh~jf~S2~~)*~!@i1t..~i{~'i.1';;~,t~}li~I'Q"'~?:jl~~~;,:P~W~i~~I~tX9't~.I~:.~'1 l:~iit1f~,):il\,;'k,,'f!";Jl'i_'f.fi~~ff~:!';;,'#!!~~Yri)Gj;~:i.Y{::~~~ ~;"..E'~~4: ~f;:,;;'t,,~-!!~,tilli:; ~1\C~.9~~,h;,K; I New residential ] bathroomll Kitchen (includes: first I: 100 feet of water/sewer lines, hose i, bibs, ice maker, under floor low-pointl~ drains and rain-drain packages) ;i I 2 bathroomslI kitchen ' $374,00 I 3 bathroomslI kitchen $439,00 I Each additional bathroom (over 3) :' I $95,00 I Each additional kitchen (over I) I I $95,00 I Residential fire sprinklers (includes'!,pJan review) I 0 to 2,000 square feet I' $58.00 I 2,00] to 3,600 square feet 1: $116,00 I 3,601 to 7,200 square feet $174,00 I 7,20\ square feet and greater ' j $232,00 . I Manufactured dwellin~ or pre-fab (circle one) I Connections to building sewer and :; I I $58.00 I $ water supply !; I Commercial, industrial, and dwellings other than one- or two-family I: . I Minimum fee I I $58,00 I $ I Each fixture $19,00 I Miscellaneous fees , ] 00' storm, sewer, water line I Each fixture, appurtenance, and piping \ Storm water retention/detention facility Irrigation systems I' Piping or private storm drainage 'Ii- systems exceeding the tirst 100 feel,' Specialty fixtures I Reinspection (no. ofhrs. x fee per hr.) I Special requested inspections (no. of hrs, x fee per hr.) " I Each ad~itional inspection: (1) I'" - >'V""-~4"""~;8<'i>)&"'-''''''''~'~-~V;''''"ii{;''<''\!'''''~ '~n-;"" ,.."", F;Me~i~~I~g~~5PipiJ)gi~::~\~~~i/~~TlP~t>.Kt~jJ; Mjnimum fee I Enter value of installation and equipm:~nt $ _0 I Enter fee based on installation and eq4iprnent value. I $ II 1"""~c~"",,,;pr0"';%Z~:ti-m'".'.... ..".""w.....""".>l!''''''i;~''i!:_'' I ~J;~~.,~~~~REIC~Nif!!!U.SE~'l,~~~X>\I)&~ I (A). Enter subtotal of above fees ---1/ _ . A:o (Minimum Permit Fee $58.00) $ If?). ''I' I (B) Investigative fee (equal to [A]) $ ~. ,.sro I (C) Enter 12% surcharge (.12 x [A+B]) $ C-j. ("0"..- I (D) Technology Fee (5% of[A]) I' $ I TOTAL fees and surcharges (A th'rough D): $ 225 Fifth Street. Springfield. OR 97477 . PH(541)726-3753 . FAX(541)726-J689 440-2500-) (11/08/COM) $238,00 ! $76,00 $19,00 $19.00 $19,00 $19,00 $19,00 I $58,00 $58,00 $58.00 $ $ $ $ $ $ $ I I I $ $ $ $ I $ I Icr0 $ --J1",1 $ I $ $ $ $ $ $ ib' /IV eITY OF SPRINGFIELD Status Issued II Building/Combination Permit PERMIT NO: COM2009-01514 ISSUED: 10/1412009 APPLIED: 10/14/2009 EXPIRES: 04/14/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone . 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3125 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1702303403300 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New" Residential PROJECT DESCRIPTION: Water line installation Owner: OLSEN ROBERT D Address: PO BOX 1434 EUGENE OR 97402 Contractor Type Plumbing Contractor OWNER I CONTRACTOR INFORMA nON , License " " 'I I Ii Expiration Date Phone I BUILDING INFORMATION. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type , Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft B'asement: Sq Ft qarage/Carport , Sq Ft Other: Occupa'nt Load: ( n/a 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: I PUBLIC IMPROVEMENTS I Sidewalk Type: ATTENTION: OrEl29n law r'l,cm1rA.q vou to follow rules adopYe'cfBV'lh'lf'tJr~~W~:Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR952-o01. 0090. You may obtain copies of the rules by f'--- - ('Allin" thlO f"!t:Jntar '''ll'''Ito.' .h~fol;'pf::l"''''''' VV 111I1:; , I. "U!"U.'" ''I th.e Oregon Utility Notification THIS PERMIT SHALL EXPIRE IF 1" ~al"aho~D~scnDtIO{\Qlter is 1-800-332-2344): AUTHORIZED UNDER THIS PERM,T-,';' ;~~i':'" ' D . furMME'''''--6f€ . $P.erSqFt Square Footage ' esCrIp n lY...:v.p.!) _I: 91)S!WP-M90NEGln-iDUltiplier or Bid Amount Value'. ANY 180 DAY PERIOD. Slreet Improvements: \ Storm Sewer Available: Special Instruction: Notes: Date Calculated Page I of 2 Status Iss u ed eITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01514 ISSUED: 10/14/2009 APPLIED: 10/14/2009 EXPIRES: 04/14/2010 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fe~~ P~i.~.1 . Fee Description + 12 % State Surcharge + 5% Technology Fee Water Line - 1st 100' Amount Paid Date Paid Receipt Number $9.12 $3.80 $76.00 10/14/09 10/14/09 10/14/09 2200900000000001185 2200900000000001185 2200900000000001185 , 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 same working day, inspections requested after 7:00 a.m. will be made the following work day. I R,eollirerll?snedions I I Water Line: Prior to filling trench and including required tksting. I I 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 ariy 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 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. __,n __'/ /k- --.._oO-'--"'''- /' /0-/-:'/- c/'7 Owner or Contractors Signature Date Page 2 012 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-01514 COM2009-01514 COM2009-01514 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Water Line - 1st 100' + 5% Technology Fee + 12% State Surcharge City of Springfield Official Receipt Development Services Department Public Works Department. 2200900000000001185 Date: 10/14/2009 Item Total: Check Number Authorization Paid By Received By Batch Number Number How Received RD OLSON CONSTRUCTION njm . 056269 In Person Payment Total: :) Page 1 of 1 1:05:53PM Amount Due 76,00 3.80 9,12 $88.92 Amount ~aid $88,92 $88.92 10/14/2009