HomeMy WebLinkAboutPermit Plumbing 2010-4-9
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Plumbing Permit Application
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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] 80 days.
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Zoning' approval verified? DYes D No
Sanitation approval verified? DYes D No
CATEG.oRY'OF: CONSTRUCtiON
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
o Residential 0 Government 0 Commercial
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Job site address: '52 > F7ff
City: State: &?,z, ZIP:?;;:"",,??
Reference: Taxlot.:
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ZIP: 97Y7~
This installation is being made on residential or farm property
owned by me or a member of my immediate family, and is
exempt from licensing requirements under OAR 918-695-0020.
Signature,
, CONTRACT:OR"INSTALLA liON"
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BCD license no.:
Plumbing license no.:
Print name:
Signature:
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440-2500-J II 1/08/COM)
COw.. "l-OIO -00 L-fl..(L(
Permit no.:
Date,
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New residential
1 bathroomll kitchen (inciudes: first
J 00 feet of water/sewer lines, hose
bibs, ice maker, under floor low~poinl
drains and rain-drain packages)
2 bathroomsll kitchen $374.00
3 bathroomsll kitchen $439.00
Each additional bathroom (over 3) $95,00
Each additional kitchen (over I) $95.00
Residential fire sprinklers (includes Ian 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
water supply .
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee
$238.00
$
$
$
$
$
$
$
$
$
$
Each fixture
Miscellaneous fees
100' storm, sewer, water line
Each fix~ure, appurtenance, and piping
Storm water retention/detention facility
Irrigation systems
Piping or private storm drainage
s stems exceed in the first 100 feet
Specialty fixtures
Reinspection (no. ofhrs. x fee per hr.)
Special requested inspections (no. of
hrs. x fee per hr.)
Each additional inspection: (1)
$
$
$76.00 $
$19,00 $
$19.00 $
$19.00 $
$19.00 $
$19.00 $
$58.00 $
$58.00 $
$58.00 $
M~nimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value.
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [AD
(C) Enter 12% surcharge (.12 x [A+BD
(D) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through VJ:
Status
Issued
225 Fifth Street, Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00444
ISSUED: 04/09/2010
APPLIED: 04/09/2010
EXPIRES: 10/09/2010
VALUE:
SITE ADDRESS: 525 S 57TH PL
ASSESSOR'S PARCEL NO.: 1702334401619
Springfield TYPE OF WORK: Backflow Device
PROJECT DESCRIPTION: Backflow device
TYPE OF USE: New
Residential
Owner: EHL PROPERTY LLC
Address: 382 S 58TH ST STE B
SPRINGFIELD OR 97478
I CONTRACTOR INFORMA TlON .
Contractor License
STAR LANDSCAPE 6196
I BUILDING INFORM~lll~~
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I DEVELOPMENT INFORMATION ~
Contractor Type
Landscape
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Speciallnstrnction:
Notes:
Description
Tvpe of Constrnction
-- .
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
"
I PUBLIC IMPROVEMENTS I
Expiration Date
02/28/2012
Phone
541.998-2039
Lot Size:
Sq Ft I sl Floor:
Sq Ft 2nd Floor:
. Sq FI Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occnpant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
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NO'f'C~~'C;~~~~~~~:?~s~~~ .
1\1\5 PE\\NI~ ONDER 1\,\\$ ~~NEl) fOR.:
'I.: .', ~WI-IO~~CEO 0\\ \S ~B~N .
$ Per Sq FI
or multiplier
Square Footage
or Bid Amount
Paee I 01'2
Valne
Date Calcnlated
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2010-00444
ISSUED: 04/09/2010
APPLIED: 04/09/2010
EXPIRES: 10/09/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
", "
, ..~~ota):Y:~lue of Project
,"Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backllow Device
Minimum/Adjustment Plumbing
Amount Paid Date Paid Receipt Number
$6..96 4/9/10 1201000000000000321
$2..90 4/9/10 1201000000000000321
$19..00 4/9/10 1201000000000000321
$39..00 4/9/10 1201000000000000321
Total Amount Paid
$67..86
I.. Plan Reviews ~
To Request an inspection caIl the 24 hour recording at 726-3769. AIl 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 foIlowing
work day.
[u ~eoiiired Insoections ~
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Backllow Device: Prior to covering and pro~jde 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 all
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 Divisiori, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readahle from the
street, that e ennit rd is located at the front of the property, and the approved set of plans will remain on the site at all
times dur' ction.
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City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
RECEIPT #:
1201000000000000321
9:48:11AM
Date: 04/09/2010
Job/Journal Number
COM20 1 0-00444
COM20 1 0-00444
COM20 I 0-00444
COM20 I 0-00444
Payments:
Type of Payment
Check
cRecciotl
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 12% State Surcharge
+ 5% Technology Fee
Amount Due
19,00
39,00
6,96
2,90
$67,86
Paid By
SCOTT SCHMALE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
In Person
Payment Total:
$67,86
$67.86
1399
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4/9/2010