HomeMy WebLinkAboutPermit Plumbing 2009-10-6
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? DYes D No I
I Sanitation 'approval verified? DYes D No I
[ CAtEGOR'(iOF: CONSTRUCJION::'~ ,:. '
I 0 Residential I 0 Gove'2'ment I' 0 Commercial
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I Job site address:, S :'::'''Sx., ,~i S~t 7
I city<:;'N~v(> I State: 0/( I ZIP~ Cf.-f'fi,+
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Plumbing Permi~ Application
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225 Fifth Street. Springfield, OR 97477. PH(541)726,37S3 . FAX(54]llt~3689
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'fState ol( I ZIP: ct 7-ifFl-
es '6/+-- I Fax
. Name: (~<2f1
Address: 2.J'G
I City: <:",,/)I-o{
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Phone: t ~ 7 ,
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E-mail:
This installation is being made'on residential or farm property
owned by me or a member afmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020,
Signature:
"U' CONTRAc:r:ORt)lNSTALI.:ATION. ,,;.,:';.1i,Jt~:,i,: .
Business name: WIt1.-, Plt.EwS-'
Address:
City:
Phone:
I E-mail:
I CCB license no,:Li1-S4-k
I Ph.imbing license no.:
I Print name:
, Signature:
State:
I Fax:
I ZIP:
I BCD license no,:
....~
~ (\;C\:\'
440,2500,J (I1108/COM)
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;-.':',Y';iDEPARTMENT'USE!ONL:Y,'f,,'c'l'
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I Permit no:C1 ~ 1 f?6 I
I Date 1 (3- - {; r d '1 I
SPRINGFIEL.D
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I iJ'I)~~J~;ii"pHi)'fi~1~~~!t~1JJt!,fil:~8~}~{~~}S~~1':IQt-':~ltJ;'2";~q~'~~~:'~*I;'~:1;~X~t~.t~~
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I New residential -
I bathroom/I kitchen (includes:first
100 feet of water/sewer lines, hose
bibs,.ice maker, under floor low-point ~
drains and rain~drainpackages)
. I 2 bathrooms!] kitchen $374,00
I 3 bathroomsl\ kitchen $439,00
I Each additional bathroom (over 3) $95,00
I Each additional kitchen (over ]) I $95,00
I Residential fire sprinklers (includes'plan review)
I 0 to 2,000 square feet I I $58,00
12,001 to 3,600 square feet $115,00'
I 3,601 to 7,200 square feet I I $174,00
I 7,20] squarefeet and greater I I $232,00
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer arid $58.00 I $
water supply
Commercial, industrial,'and dwellings other than one- or
two-family
Minimum fee
I Each fixture
I Miscellaneous fees
I ] 00' storm, sewer, water line
i Each fixt_ure, appurtenance, and piping
I Storm water retention/detention facility
Irrigation systems
Piping or private storm drainage
systems exceeding the first 100 feet
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: (I) $58.00
l~iji~T~~~I":~i~~'lRiPr~hgQ&~~~~i1iJf~;~1~~)1 Mi.nimum fee
I Enter value of installation and equipment $ _'
I Enter fee based on installation and equipment value. I $
1~~~il\~a~P[~BilfC~NtiilisEli?!iii!'B._~1
I (A) Enter subtotal of above fees $-
(Minimum Permit Fee $58.00)
I (B) Investigative fee (equal to [A]) I
I (C) Enter] 2% surcharge (,12 x [A+B])
I (D) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through Dj:
$238,00
$
$
$
$
$
$
$
$
$
I I
$58,00 I $
$19,00 $
$76,00
$19,00
$19,00
$19,00
s7-l"()
$
$
$
$
$
$
I
$19,00
$19,00
$58,00
$58,00
$
$
$
I
I
$ I
$ f?'R '1'2J
$
$
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CITY OF SPRINGFIELD
Building/Combination Permit
I
Status Issued;,:::'- :~.,';,,:.~;.,':K':e :.'..
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225 Fifth Street!.Spryngiield; OR
,,541-726-3753 Phone; '.,
: ,541-726-367{\ r~; :;:.;,,,,Jr ;,.,' "
541-726-37691nspection Line;;;,:'!: ,~~
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PERMIT NO: COM2009-01476
ISSUED: 10/06/2009
APPLIED: 10/06/2009
EXPIRES: 04/06/2010
VALUE:
SITE ADDRESS: 326 S G ST :', '"
. ASSESSOR'S ~ARCEL.No.::.}7.03353403000
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PROJECT DE~CRIPTION: Replace Sanitary Sewer Line
'{' ,.' ~TTI=~ITlnN: Oreaon law requires you to
,;;", ,.... foilow rules adopted by me uregull UIII'~Y
Owner: ,BAXTERBENJAMIN'. Notification Center. Those rules are setfOlth
Address: 326 S G ST'. ') ,..;;:' ~: 'in OAR 952-001.0010 through OAR 952,001-
SPRINGFIELD OR. 97477 nnQn YnJJ may obtain copies of the rules by
'_d'':Rllina the center. lN01e: HIt;:: It:I~~IIUII~
nllrGON1(RA:@T~R[INFORMA'FI0N~1 v, I
l./enlld' I::) I-OUU-vv_ .........-, 'J"
Springlield TYPE OF: WORK: Single Family Residence
TYPE OF USE:
Alteration
Residential
.' ~ J~ h',,~~,! ': .::-
Contractor Typerr' Contractor
Plumbing 'I';,. WALT DREWS
License
Expiration Date
Phone
541-513-8241
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BUILDING INFORMATION I
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# 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 Basement:
Sq Ft Garage/Carport,
Sq Ft Other:
Occupant Load:
# of Units:. I
Primary Occupancy Group:' R3
Secondary Occupancy Group:
Primary Construction Type' , :; VB
Secondary Constr\,ction'Type: "
# of Bedrooms: " ;
nla
, DEVELOPMENT INFORMATION I
, ,
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQVlRED PARKING
Total:
Handicapped:
Compact:
Frontyard Setback:
Side I Setback: .i
Side 2 Setback:";" '., !:~
I' ~. 11" ~
Rearyard Setback: " .,
, Solar Setbacks'-:'
,,: 1,_
; :\
Street Improvements:
Storm Sewer Available:
Special Instruction:
NOTICE:
I ~I~ lifliBUieiMPRQViEiMENTS'lE WORK
, AUTHG, ,,~~'~ V'''JLII i n'0 rct\IVIII. IS ~'(,]T
COMMENCED OR IS ABANDONED FOR S,tl~walk Type:
~..ANY 180 DAY PERIOD, Downspoutsmrains:
Notes:
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I, Valuation Descrintion I
Descriptinn
Tvpe nf Ennstruction
$ Per Sq Ft
'or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
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Page I of 2
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CITY OF SPRINGFIELD
225 Fifth Street, Springfield; OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691rispectionLine'o:'
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Building/C9mbination Permit
PERMIT NO: COM2009-0I476
ISSUED: 10/06/2009
APPLIED: 10/06/2009
EXPIRES: 04/06/2010
VALUE: '
Status
, Issile'd" .,
,.'\"
'";';~'''
Total Value of Project
1,',-
.i-(
Fees Paid I
Fee Description: J. 'r :
"; -~~[::;~ ~~ ;':}h~NWf~:~~ '!;~ ~;:]':,
~~:.: .Arno'hnt Paid
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().),:?::i;:):' ~
Date Paid
Receipt Number
Total Amou';t Paid
, '.
$0,00
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,
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Plan Reviews ,I
Ifil
To Request an insp~ction call the 24 hour recording at 726-3769, All inspections requested before 7:00
a,m. will be niade the same working day, inspections requested after 7:00 a,m, will be made the following
work day. ".."
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I Reouired In~nections I
Sanitary Sewer Line:' Prior to filling trench an~ including required testing,
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By signature, lstate'an<i agree, that I have carefully examined the completed application and do hereby certify that all
information heteon 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 nsed on this project.
I further agree to ensure th'at all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at theJront of the property, and the approved set of plans will remain on the site at all
times during construction. ,
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Owner or Contractors Signature
Ir~l, d';;' ' _~, .". ...J
Date
,J f
Pa2e 2 01'2
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2~5:Fifth Streetiti.y-;'~;.t: ":'.!ri, .,". ~
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Springfield, Oregon 97~77 "
541-726-3759 Phone' .
"
City of Springfield Official Receipt
Development Services Department
Public Works Department
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RECEIP.T #: '
" ,....
3200900000000000695
Date: 10/06/2009 .
2:56:20PM
Job/Journal Number~:.'
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::. D.escription
Sanitary: Sewer - 1st 100 Feet
<,':Ie,57o Technology Fee
. '-t' 12%State Surcharge
7
Item Tot:ll:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
76,00
3,80
9.12
$88,92
COM2009-01476
COM2009-01476
COM2009-01476
Payments:
Type of Payment
Che~k
Paid By
"ETHELWEI;TMAN.;...' ,
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Amount Paid
6685
klk In Person
Payme'nt Total:
$88,92
$88,92
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cReceintl , Page 1 of 1 10/6/2009
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