HomeMy WebLinkAboutPermit Plumbing 2009-10-21
Plum"ing Permit Application
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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,
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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
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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
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10/21/2009