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Home My WebLink AboutPermit Plumbing 2009-10-23 1~~tf~~~!~RTM~:~T~:~~:~g~'y~~~}!~ I Permit n~ (11 - () /55 ~ I Date: IGp2/ 0'7 ' Plumbing Permit Application 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 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 ';Vithin 180 days of issuance or if work is suspended for 180 days. 11~>z;;f;o~,in)':,~nJg;t:'at.!p'}pL!rtoo'vca<'AI-vl.!e::-r'~]~]oe'dY?-"ER.NI\IIEDN:ry0e'As'P,.RReVDAI!I'~N:~0l0~;:;;:@''&~~ 11~:11~1;~il!:~2~~~~.\;I1k~"ii7i"EE!ZSC.HE,Dl'J'~Ef,JIr1'\f~~~;.',(-!l1;0G" ~l!i:~7!1 II I ~fD~l~~atrj'Wi:t3W~~j~~i;fu\~i1~W~1J;\~ti1~~;*'~ic~~~11'Qti:jl~tf.:gq~~1:~il~*,[9t~,!]i'1 L~:,'iii1JjN;~c0~if;,.<R.-{1';~{;Ae~'Yfml-:,;;t;,s:;tt,','i!r(':2~t';:&jiAY;40&; ~~:"".;':j,; ~l~i:,~,~~.'i('l,;j ;;:.:i,~.<;Q.st:tf::>':{:, I Sanitation approval verified?, 0 Yes 0 No I New residential I ' , CATEGORY:'OFJCoNSTRl;JCTI<::lII!':,'- " -; I I bathrooml1 kitchen (includes, first I'_~ ,'Residential .1 D Government I D Commercial I JOOftet of water/sewer lines, hose ~ bibs, ice maker, under floor low-point 1~<<i&1'J;)J<::lBfsf:t:E';;INFORMAJIONI~i\Np;~lfocAmOI'-ll'ii1i'i'~:it:Ql1 drains and rain.drain packages) I Job site address: / /.q' ? L- S-I-R..ee.-f I 1 2 bathrooms/I kitchen $374.00 I ~ I 1 3 bathrooms/1 kitchen $439,00 City:SPD /NC_ /"/~/aI State: 012. ZIP: 6/7'J? 7 I 1 1:" (. I "..L Each additional bathroom (over 3) , $95.00 I Refere~ce: \~~ . I Taxlot.:CW:V I Each additional kitchen (over I) 1 $95,00 1;~,~~JZi~J.i;~~;;i::~li~j,jPESCRIJ?~libN:)Y(l~.~ivv,ORK~~~'l~i~~t~r~1~fi~fj1~l~ I Residential fire sprinklers (includes plan review) , / , 0 I. ' / L 1 0 to 2,000 square feel $58,00 ''''1. -e/L- /I..LJP" K.p A? .A C g .IV>" A/ -r f I 2,001 to 3,600 square feet $116,00 ~iPR~QR;Ef"{f~~{tOWNE8Vl~lf,f~~;~1~);g;tSl~i~9E~~:~~~i~ I 3,601 to 7,200 square feet $174.00 I r-" . _ / 1 7.20) square feet and greater $232_00 'Name: ~......., ,/- /o,tZr /".1 I Manufactured dwelling or pre-fab (circle one) I Address: ? t) l~ ^ '" " ? Jf! I I Connections to building sewer and I I $5800 I /.. 11 :1 C I 9. / I water supply , $ City:Bof..L dPA -C",u~ State: A ZIP: ,<;'OOb I ' -- --- - _ Commercial, industrial, and dwellings other than one- or Phone:5"~/ S"cr6 - o3S:Q I Fax: ~11- '33<1- 2.9'19 two-family I I Minimum fee I I $58,00 I $ E-mail: r p, 'd.n. /"' I Ifl> ~'~b 0 _ 0) N\ , "1 ~ I Each fixture $19.00 $ This installation is bein!fmade on resi ential or farm property owned by me or a member of mY immediate family, and is I Miscellaneous fees 'exempt from licensing requirements under OAR 918-695-0020, 1100' storm, sewer, water line Signature:, I Each fixt.ure, appurtenance, and piping i '~"~~in~:; n~~~~T~~~~I(k~LAT:lO~i'~i~ \ ~ ~r~~~:i::t:;~:::tion/detentionfaclli~ I ~ u ~ - I Plpmg or private storm dramage Address: g!.f"lZ-'S ~~Pc.Jr:4.{ r.J. , svstemsexc~edinQthefirst 100 feel .I City P6.'0<A.t- {.j..1i I r State:'-.ID R.. r ZIP: q 7 'i ))1 1 Specialty fixtures IS' I' I 1 RelnSpectlon (no, of hrs, x fee per hr.) Phone: ~~S;7'l-'1D "II? Fax: Special requested inspections (no, of I E-mai1:\.S.-!e..nCdYl.s-\--/..jrJQ...1J-.Co ""'- hrs, x fee per hr.) I CCB Iice;:;;e no,: ) tZo 2..i9'/1 BCD license no,: Each additional inspection: (I) 1 I I I 1 I 1 1 ' I 1 I I I I I I $7b~ $ 1 $ I $ I $ I $ 1 $ 1 I I I I I Enter fee based on installation and equipment value, I $ I 1~~llililf~>>~.4:R~i.!IQp':j(j:rilli.!fS.Et(~m"'~~I, I (A) Enter subtotal of above fees '/ ~9 (Minimum Permit Fee $58.00) $ 7 p '1 I (B) Investigative fee (equal to [A)) $ 3. J'LI/ I (C) Enter 12% surcharge (,12 x,[MB)) $ 7', fzL (D) Technology Fee (5% of [A)) $ I I TOTAL fees and surcharges (A through D): $ jf i5 .,ffL- $238,00 $76,00 $19,00 $19,00 $19,00 $19.00 $19,00 $58_00 $58,00 Ue.('I\~er , r:~:~:~~~:!:~~;~~!~t~~~:~~ $ Minimum fee $58,00' $ $ Plumbing license no.: Print name:h, "', Signature: V- I. . .,~~, ~ \;'v1O : \j0~ cf- ~~ ~ 440-2500-) (1I/08/COM) $ $ $ $' $ $ $ $ $ $ CITY 01< ISf'RINUCl<lJ'.,LU Status Issued Building/Combination Permit PERMIT NO: COM2009-01556 ISSUED: 10/23/2010 APPLIED: 10/23/2009 EXPIRES: 04/23/2011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS:' 1148 L ST ASSESSOR'S PARCEL NO;: 1703264406800 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New PROJECT DESCRIPTION: Replacement of approximately 35 feet of sewer line Residential Owner: FIDRYCH TOM JR Address: ,PO BOX 387, " BOULDER CREEK CA 95006 I CONTRACTOR INFORMATION I Contractor Type General Contractor JEREMY STEINBERGER License 180201 Expiration Date 01123/2010 Phone 541.844-1879 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Gro'1p: Primary Construction Type: Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Patb: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basemen.t: Sq Ft Garage/Carport Sq Ft Other: Occupant 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: ~PUBLIC IMPROVEMENTS I I, T",~ires you to Street Improvements: AiTENTION: OregSllIe~~~ crRatln Utility Storm Sewer Available: folloW rules adoPteQA~!MlIglllsm:tafiBl, forth Special Instruction: Notification Center., hOAR 952-001- In OAR 952-001-0gt~~~h;~~i~S of the rules by Notes' 0090. You may 0 (Note' the telephone . NOnCE: oalling the center. n Uiility Notification _,. _, ,~__'M thp nreao '\ ""oJ "enrVIII ~HALL EXPiRE IF Tire VVUK(\ ..-..., , vel 'er is 1-BUU,;';'''-'''''~~I' !\UTHORIZED UNDER THIS PERMIIr\faluatlOn Description' COMMENCED OR IS ABANDONED JO:no D ,Ll,~IV 180 l'l.t\Lnr;Cr;r;\""t t' '$"P~r Sq Ft Square Footage escnpl'il>l1 Ul1\lIJ.....""""" rue IOn I' I' B'd A . or mu tip lef or I mount Value Date Calculated I;' I: , ;~!. Pa2e 1 of2 _~~Ill,"",,~If.~""'~ ,'{ ','*'-" " ,', ." . I " Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01556 ISSUED: 10/23/2010 APPLIED: 10/23/2009 EXPIRES: 04/23/2011 VALUE: 225 Fifth Street, Springfield,OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid J Fee Description + 12% State Surcharge + 5% Technology Fee Sanitary Sewer - 1st 100 Feet Amount Paid ' Date Paid Receipt Number $9.12 $3.80 $76.00 10/23109 10/23/09 10/23/09 2200900000000001215 2200900000000001215 2200900000000001215 Total Amount Paid $88.92 Plan Reviews I jl - To Request an inspectio,n call the 24 hour reco'rding 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, Reo,uired Insnections , Sanitary Sewer Linei' Prior to filling trencb and including required testiug. :1 By signature, I state and agiee, that I have carefully examined the completed application aud do hereby certify that all information hereon is true ahd 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 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 cortractors and employees who are in compliance with ORS 701.005 will be used ou 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 frout,of the property, and the approved set of plans will remaiu on the site at all times during construction. :~ ,I owner.'~{l::nature J D /1_ '1 /rJ VI Date I ,; / Page 2 of2 225 Fiftb.streef Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-01556 COM2009-01556 COM2009-01556 Payments: Type of Payment Cash Change Job/Journal Number COM2009-01556 COM2009-01556 COM2009-01556 Payments: Type of Payment Cash Change cReceiotl RE€EIPT #: Descripti~in . , ' Sanitary, Sewer" I st 100 Feet + 5% T~chnology Fee + 12% State Surcharge' Paid By JEFF GREGORY JEFF GREGORY Description Sanitary Sewer - 1st 100 Feet + 5% Technology Fee " + 12% State Surcharge , Paid By JEFF GREGORY JEFF GREGORY . a~,~,'N_:P.,_.,.~, ~,''''~'W'I;I,,''','''''''''': '".. .. " , :, .:l'..;:"".,l -'.., ' , ,~.., --, '.- "-" --., ,~. ,-" ' City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000001215 Date: 10/23/2009 Item Total: Check Number Authorization Received By Batch Number Number How Received njm In Person njm In Person Payment Total: Item Total: Check N umber Authorization Received By Batch Number Number.. How Received njm njm In Person In Person Payment Total: Page I of I IO:17:00AM Amount Due , 76,00 3,80 9,12 $88.92 Amount Paid $100,00 ($11.08) $88.92 Amount Due 76,00 3,80 9,12 $88.92 Amount Paid .. $100,00 ($11.08) $88.92 10/23/2009