HomeMy WebLinkAboutPermit Plumbing 2010-3-26
Plumbing Permit Application
~"""^"',.1l' ,.~t!t ...'"--_.~'>< .._;<dl,"'.--....I+.,.~~~A..,.., -~."."'~.,
:!~;r i'@I.T'Y' dN:S'pRiN6EIEtiJj'f.,tiRF;~'ON~!f:
',~~,~. ~:""'~'.. -'~""';!€~t.~3.~':'i~~:; ~., _ :~~:i~~t: J4~~ __~.~,.~,!"+--
225 Fifth 51"el . 5p,ingfield, OR 97477 . PH(541)726-3753 . FAX(541)726.3689
;""''iij(.'-''''::'''ri-''~;;',;>'''' -.."... . '?"~'..._,:,' ~-"_l',,\./"'t.o~:.ti:.......;,
"'\'DEPARTMENTUSE ONLy".;Vfj
. '. 0 ." "", ,. .,h"..
7 '!J ~37
0- 2(" _/cJ
Date:
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,i;1~;i::\;lEoCAlj;;c;O'iJERNMENT< 'APp,RO'iJ AlLtil\\';;:{;i'ik~;~'~,:;
Zoning approval verified? DYes D No
Sanitation approval verified? DYes DNa
CATEG.ORY:' OF. CONSTRUCTION
.0Residential D Government D Commercial
{;"':i2:;rJOBi Sn;E. INFORMMI(jN,~AND;';I!OCATJON::[~VY<:~
Job site address: :s~S- ~ - . ~ ,
City: ~
64. W
':' i '1--;., ,"PRORERTY;;'OWN~B.~~~F:j;/.R;W~*,?(~WA~~~~
. Name: b~Z:f.
Address: 6r5
City: <;:
Phone:S4I-51~- QK"N
E-mail: L ('IoIO$WItV\ , COW\.
This installation is being made on resi ential or farm property
owned by me or a member of my immediate family, and is
exempt from licensing re uirem OAR 918-695-0020.
Signature:
. ONTRACTOR.INSTALLA TION
.. ,.;~!;:
","-'...'
Business name:
Address:
City:
Phone:
E-mail:
Plumbing license no.:
Print name:
Signature:
440-2500-) (II/OB/COM)
10 571
:i::;~~:~~:':':.;~;};f~~.f~:~{;,i'1~~;~EEE;rS~C H EDUi.~EqI~j[::;:,~~~~r]lW~;~~~~~~'
"~\\'f:~;t." """-;O;';<'.'j;t.ti'(i.;ri,!~.,\it'.;r~>.,,;,,,j,-;!r,'''-.,: 'i\,~, >'.'i~ ;,C "1"', 'T:{"l";"
:'Desc'riptio'i1l:'1't"~;:''-'j'}~t,,',.r;._}:.:~~\t$~'~1j1;. Qty' ~.' 95, ";:;;:v ~ ',~ 0 ~q,co'
',:, ~{: '.. !{~-'~~'\""~~~.':J:~~;5~{~\V;~.;(i-:t:;,:~ :~,_.....:,i ~;,.~.ea."}~~1;::\:,!c.c)~t~ ~ ~
New residential
1 bathroomll kitchen (includes: first
J 00 feet of water/sewer lines, hose $238.00 $
bibs, ice maker, underjloor low-point
drains and rain~drajn packages)
2'bathrooms/l kitchen $374.00 $
3 bathrooms/l kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over I) $95.00 $
Residential fire sprinklers (includes plan review)
o to 2,000 square feet $58.00 $
2,001 to 3,600 square feet $116.00 $
3,601 to 7,200 square feet $174.00 $
7.201 square feet and greater $232.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and $58.00 $
water supply
Commercial, industrial, and dwellings other tha!l one- or
two-family 'S
Minimum fee I I $58.00 I $
Each fixture I I $19.00 I $
Miscellaneous fees
100' storm, sewer, water line $76.00 $
Each fixture, appurtenance, and piping $19.00 $
Stonn water retention/detention facility $19.00 $
Irrigation systems / $19.00 $ /"1 .
Piping or private storm drainage $19.00 $
Systems exceeding the first 100 feet
Specialty fixtures $19.00 $
Reinspection (no. ofhrs. x fee per hr.) $58.00 $
Special requested inspections (no. of $58.00 $
hrs. x fee per hr.)
Each additional inspection: (1) $58.00 $
~M '[("'i1' ""'" :""'-"ft""'?""&'~V\I:~':"" Mjnimum fee $06,
.; _ e Ica.gas~plplDg~,~<4>~~,,~i.,,: ,Y'~M-'lt:r
Enter value of installation and equipment $
. Enter fee based on installation and equipment value. I $
~~i5~~~e.~L)C:ANJi~i.Js,'E~1~~~1~~~~lij
(A) Enter subtotal of above fees ~q. tr' $
(Minimum Permit Fee $58.00) :53',
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $ cP.y P
(D) Technology Fee (5% of [A]) $ 2 ' ~ ~
TOTAL fees and surcharges (A through D): $ &7,
GL>
oD
--
o-iJ
G:) S,G
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00371
ISSUED: 03/26/2010
APPLIED: 03/26/2010
EXPIRES: 09/26/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 F.x
541-726-37691nspection Line
. ...,\,
SITE ADDRESS: 385 25TH ST
ASSESSOR'S PARCEL NO.: 1703361417600
Springfield TYPE OF WORK: B.cknow Device
~.Jft1'l'
V'"'_ .0'
lW' \J..o\ 0;'1.:
PROJECT DESCRIPTION: B.ckllow Device - Sprinkler system
TYPE OF USE: New
Owner: V ANKINKLE BLOSSOM M
Address: 285 ALV A PARK DR
. EUGENE 'OR 97402
I CONTRACTOR INFORMATION I
Contractor Type
Plumbiug
Contractor
OWNER
License
BUILDING INFORMATION I
, .
# of Units:
Prim.ry Occup.ncy Group:
Second.ry Occup.ncy Group:
Prim.ry Construction Type
Secoud.ry Construction Type:
# of Bedrooms:
Tl{")"~ of Stories:"~1 r-:-..... ;w -'s. '''~'' to
Aii~N, Hej~iii;of s'i~uc'ture. I'" . .
follow rUles :-l.tJ\.,i-',C ' .' . .-' , ' _' ,.'"
rog1~~~~_~;~~\~i;{;u,~~.3otR'9;c~-~~1r~
~090. You rITA~roo'taiYPOOpies of the rules by
calling Ihe~.P{1Ihrte: the tele~hone
number lor&l\~~gdl\1U1lil'tff. Nollflcatilln.
. . 8M .,.,,, ""441
l~alllgl ... I ...---
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Re.ry.rd Setb.ck:
Sol.r Setb.cks:
Overlay Dist: .
# Street Trees Rqd:
r.ved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Av.i1.ble:
Speci.1 Instructi~~nTICE: PIRE IFc1;~OV,05K-
THIS PERMIT SHAll EX MIT IS NOT
Notes: AUTHORIZED UNDER THIS PER. O"'FOR .:
. ABANOONE.
ANY 180 DAY PERIOD. I ~
Valuation Description I
Expiration Date Phone
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Otber:
Occupant Load:
REQUIRED PARKING
Total:
Handic.pped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Paee I ofl
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,\iY:~.
";r ';;"'."
': Total Value of Project
Fees Paid i
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backnow Device
Minimum/Adjustment Plumbing
Amount Paid
$6.96
$2.90
$19.00
$39.00
Total Amount Paid
$67.86
I Plan Reviews I
Date Paid
3/26/1 0
3/26/10
,3/26/10
,3/26/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00371
ISSUED: 03/2612010
APPLIED: 03/26/2010
EXPIRES: 09/2612010
VALVE:
Receipt Number
1201000000000000264
1201000000000000264
1201000000000000264
1201000000000000264
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.,:.f " ':, ':;., , '
~. ,
Reo'tiired Ihsoections I
Backnow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that aU
information hereon 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.
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 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.
~~~ )
own~ Contractors Signature b
"
. '.1'..';
. :~J'j,~
0>"
'I'"
Pa~e 2 of2
3hu((o
,
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
iii_I
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000264
2:01:ISPM
Date: 03/26/2010
Job/Jourmll Number
COM2010-00371
COM20 I 0-0037 I
COM20 J 0-00371
COM20 10-00371
Payments:
Type of Payment
CreditCard
cReceintl
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
BLOSSOM V AN WINKLE
Amount Due
19.00
39.00
2.90
6.96
$67.86
Item Tot"l:
Check Number Authorization
Received By Batch Number Number How Received
nJm 8592 I7 In Person
Payment Total:
Amount Paid
$67.86
$67.86
,
'.-' ..", . "
'!,~..
',',,"" ~,,;~,"'-'.,," ~'-..
'~A~&;.. ..,- ,
'j:
;, .
.'1/,,' .'
'.~::!\.,t
".
Page I of I
3/26/20 I 0