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HomeMy WebLinkAboutPermit Plumbing 2009-10-21 Plum"ing Permit Application '~~l)EF?ARTM'E'NTiusE10NbY~~~~ .:. :~,.:._" , '-',"l.f-"'~"'" :-.,-.,,-,~' ':-'~" l";.:, ---" -.;.~"",:;;:.:' ."{~::MK~; \~.>(\ 225 Fifth Street. Spcingfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 . . I Pennit no. G"f -- .1- 5-'(-1- I Date: 16 - 21..-~1 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',~:.;p},'':j';;''-li'''}.~itt;~j0'iir''''\;';'x'''r-o'EE:;;jS.C'' "1'1' E" "D'" "Ur i:'E"j"t',~?'!"r_~(YI-..f~"J"~"l'.lili!i.Ki)'+;''' ;;;.~_1~k~~;r;;;.<<~~;:~~"',:fiii~g~+,;\r;:; h. _'.. _ _'__ ',~ _'Uk'f"fr.~\:,1\,il;')Jit10~.;;X;'pJ:l'2,i't~/.t: li:rD~g~li~ti'g~~~{!jt~~~~ti~:~<<~ri~t~:~~~IQt~jl~J~tg9<~H,~11~tEr~t~.!~I ~Kn@.!i;;-'::':ttk...~~'h'1~~~~,;t'Jfui!(~,~(f~j;~W!'J~;r t;.dXf, ~~l.~.~_~Yii~ru ~f~c.~_~hfS-i;!; I New residential j: - I bathroom/1 kitchen (includes: first J 00 feet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) 1 2 bathrooms/I kitchen $374.00 $ 1 .1 3 bathroomsll kitchen $439.00 $ . I 1 Each additional bathroom (over 3) f $95.00 $ I 1 Each additional kitchen (over I) i: $95.00 $ I . I Residential fire sprinklers (includes;;plan review) I I 0 to 2,000 square feet $58.00 $ I I 2,001 to 3,600 square feet $116.00 $ . Name 5lt-Pit~~;'E?;;~ER;(~:~~~;:~::: 0 i t~~;u:~~~:;:;:~:~i~;:~rpre_fab(Lle one) :~:::~~: ! Address: (nil MA1JSFIEL\) V. I Connections to building sewer and 'it I I $58.00 I $ I. I City: SV R.\Nc' F1 RO r State 0 f!- I ZIP: 97 '-/77 I I wcater SUPPIYI . d ,,' h h I I ommerc.la, mdustrial, and welhngs ot er t an one- or I I Phone:SYI-7l-'o- rlv r Fax: two-family " I E-mail: I I Minimum fee I I $58.00 I S I I Each fixture $19.00 $ I This installation is being made on residential or farm property . owned by me or a membeT'of my immediate family, and is. I Miscellaneous fees I exempt from licensing requirements under OAR 918:695-0020. I 100' storm, sewer, water line $76.00 $ Signature: I Each fixture, appurtenance, and piping $19.00 $ I I, ,,,,., ,."CONTRACJl0R,iINS1;ALLA1;ION"".'":;,.i,,,j),fi,,::.,{.:j I Storm water retention/detention facilitY $19.00 $ I I Business name: TV 1"MIl- (A-tJD\(M,. ~ J 1ff./GIG!tTl~ we, I Irrigation systems I' $19.00 $ 1 L'~ I Piping or private storm drainage 1: $19.00 I I Address: 'V.t\,R",- '),.,'In ' svstemsexceedinethefirsllOOfeel " $ I City: ?:-uC.H\JL I State: oIL I ZIP: q,Vnv I.Sp,c;,Iq-""t,,,o, SA-ek/t,n,JPW/,'P: ~.<O~< '$ t'i'm1l I - > Reinspection (no. ofhrs. x fee per hr.) $58.00 $ I Phone:5'11-' r1><- q,. I' { Fax: <1// -blt- ~3. --.' I hYl\ '1 Y ...,,., I '-1 Special requested inspections (no. of I $58.00 $ I E-mail: 1.H.iU10f;l.:t-A- e--ltoL. WM hrs. x fee per hr.) CCB license no.: I BCD license no.: I Each additional inspection: (I) M1Jv $58110- $ 371 Plumbing license no.: UJ< it fo ~l 1~;ijb~Tgiji(g~SfPrPi~g~~Wt~{~~t~~l~~~~ Minimum fee $..g... I Prt.nt name.. T; L I Enter value of installation and equipm~nt $ _' I \ Q:(..{L,L ". T\-l-"Il.,v I Signature ~ f~ _ i~~;~~~~;~-4;;;~~~'~~&~lIT~~~~lI-~~~' ~ I (A) Enter subtotal of above fees $5'57.~' C'\~ / (Minimum Permit Fee $58.00) O.""'-U A 0... ....(}." ~ {\~ 0^- 1 (B) Investigativefee (equal 10 [AD :: $ I \.,.W\~.rn"V '. ,\\ ''VV It J I (C) Enter 12% surcharge (.12 x [A+B]) $ ,'\, \\) I:..O~ I (D) Technology Fee (5% of[A]) I, $ :~v.'- I TOTAL fees and surcharges (A th'roughD): $ ~. I:\!G!?\\i1il~\r~Il!Q,G;o.llt;;GOVERNMENi:!jAgI?,ROVAtr~l;W(1!~~~1 I Zoning approval verified? DYes D:No I I Sanitation approval verified? DYes D ,No I 1 ' C,l\TEG.OR'COF;CONsTRuc;noNj,' ..' .,'1 I 0 Residential I 0 Go~emment I 0 Commercial I . fu!P.,'J'I;)2j~:JOBjfS[mE~INF.O~MAi:IONikANPiq[0GATIQN:l1l'?\;~~Iii!1 lob site address Inl\ M/tt\!-\.Ht:"U) $I. I City S\l~IJ,,(iJ51_iI'> I State: 00/2- I ZIPO qi<./11 I I Reference: \fl~~ ~"'t I Taxlo!: \ \ t Co I 1,.",w''''''"'''''C~',"\C''DE' S- "'R. .1 "r.IO.N. "0 F."W 0'R..K."'"!~'"'."',"'""t',e""'''''1 'V>~-i~':,;;.iA,~'f'-,;.f,f'f_':f\j~-t,;f'! . . _ I,~,____~", : '. ~;. '. tJ!.;..., _.,' ,_.'h,o>~0i:;ric)~}~~','f'-T::!i,;<'t~,,~&,; I $238.00 $ IN \lfJ1.It. RA-aftAnIJ ~K.J;W:W-rhL 440-2500-J (11I08/COM) Status Issued CITY: OF SPRINGFIELD Building/Cqmbination Permit PERMIT NO: COM2009-01541 ISSUED: 10/2112009 APPLIED: 10/21/2009. EXPIRES: 0412112010 VALUE: $!'4,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 611 MANSFIELD ST ASSESSOR'S PARCEL NO.: 1703233411200 Springfield TYPE OF W.ORK: Single Family Residence .. - ..., "'TYPE OF USE: Residential PROJECT DESCRIPTION: Backl10w Owner: PETERS HARRY D TE Address: ,6],] MANSFIELD ST .. - I requIres you to SPRING,F1ELD OR 974 ~I I ~lrnON: Gregodn bf!NIy the Oregon Utility . ~*,,!QW rulesadopte at forth Owner: HARRY D PETERS T"N'&/lication Center. Those NleosAaRre :S2-001. Address: 611 MANSFIELD ST AR 952.Q01.Q010thrOugh SPRINGFIELD OR 97111.0#1 You may obtain copies of the Nhles by . . 'b'd9O. . l"w' ..... ,~lftR one callmg """ "",...vn _ IIti\~Jlli!\lIIcatiOn . numb~w~~'~,~B.4H~IATION . Contractor Type Contractor License Expiratii'n Date , j~ Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R3 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1St Floor: Jr Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: j' Occupant Load: r VB No Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION' . NOTICE: Overlay Disl: . ,. ,,, ,. THIS PERMIT .JI.~.tre~.t Trees Rqd: . AU ~u.mdll€J(f. THE WORK THOR/ZED UQftqiffi8vfi'll!mMIT IS NOT COMMENCED OR<;S ABANDONED FOR .ilMV 1 ~~ I),"i," rr~'I" , , .. I PUBLIC I~PROVEMENTS' REQUIRED PARKING . Total: , Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: "~';~': Sjdewalk Type: . ~ .," 1 Downspouts/Drains: ......,; Notes: Paee 1 of2 .,1\ ." :.'" " CITY OF SPRINGFIELD Ii Building/O~mbination Permit " Status Iss u ed PERMIT NO: COM2009-01541 ISSUED: 10/21/2009 APPLIED: 10121/2009 EXPIRES: 041: /21/2010 VALUE: $'4,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Valuation Descrilltion I Estimate Tvpe of Construction Estimate $ Per Sq I;'t or multiplier $1.00 Square Footage or Bid Amount 4,000,00 Value $4,000,00 $4,000.00 Date Calculated Description 10/21/2009 Total Value of Project Fee~ Paid I ' $6.96 $2.90 $19.00 $39.00 10/21/09 10/21/09 10/21/09 10/21/09 Receipt Number ~~ 1200900000000001170 120Q900000000001170 120Q900000000001170 1200900000000001170 j, , Fee Description + 12% State Surcharge + 5% Technology Fee Backflow Device Minimum/Adj"ustment Plumbing Amount Paid Date Paid Total Amount Paid $67.86 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wilJ!'be made the following work day. I, . R.eouire~ lnsnections I Backflow Device: Prior to covering and provide a copy of the test report ou site at the time of inspection, Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete, By signature, 1 state and agree, that 1 have carefully examined. the completed applicatiou and do hereby certify that all information hereon is true and correct, and 1 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 pertainiug to the wo'rk described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Servifes Division, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 further agree to ensure that all required inspections are requested at the proper time, that each a'ddress 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 HmeSdU~ir~Z~ IDr~/-O ~ . ~ -----." . Owner or Contractors Signature Date Paee 2 on 225 Fifth Street Springfield, Oregon 97477 541-126-3759 Phone v' City of Springfield Official Receipt DevelopmeJ:lt Services Department Public Works Department 1! - . RECEIPT #: 1200900000000001170 Date: 10/~1/2009 1O:34:13AM Received By Item Total: Check Number Authorization Batch Number Number How Received Amount Due 19.00 39.00 2.90 6_96 $67.86 Job/Journal Number..,~' COM2009-0 1541 COM2009-01541 COM2009-0 1541 COM2009-01541 Description . .. Backtlow Device MinimunnJAdjushnent Plumbing + 5% Technology Fee + 12% State Surcharge Payments: , Type of Payment Check 'Paid By DELTA LANDSCAPE & -.IRRIGATION INC Amount Paid 2187 klk In ~,erson $67.86 paym.int Total: I' Ii I' , $67.86 cReceiotl Page 1 of 1 10/21/2009