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HomeMy WebLinkAboutPermit Plumbing 2010-4-9 'r Plumbing Permit Application ~J~~~~D~EP;:RTME;N'$~UsE;O'NIryj1!~~?~ : '_',.':' ,.'. " '. ',' _....J,. :.._.~~.-. ',. ~ """"~.~,~;W': This permit is issued under .oAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for] 80 days. &'i{~~)i{~~;;'i?JI1i0CAlC~\GO\lERNIViEN:T':;'J.\I!F'Rb.\lAl!'1;1%~Jftl\.'~ Zoning' approval verified? DYes D No Sanitation approval verified? DYes D No CATEG.oRY'OF: CONSTRUCtiON 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 o Residential 0 Government 0 Commercial ~i)f2rf~.JbB1sl;r;E' 'INF.oRMA:l'lbNi)AND1qfOCATloN~1:;'il'~irii Job site address: '52 > F7ff City: State: &?,z, ZIP:?;;:"",,?? Reference: Taxlot.: ;V3\,'?1*"i'~I:(i\ili","3;.i;D'E'S'C Rln"I'O.,'N'00"';W ORK.3~~{t','''''''\Y':*'il'%~ '''-'>..;.~..;.''''3>I;. ,-.',,-,~-,;'~-:o','>1Y ", __ ,'-;::,:1,,_ .............. ;-5- [7;".,_._,., ..,.. ,..~"c.._&","l".".0;j;y: m^.)JiX...)';'"~y_. -- /;,,<< t", .( L.- :'-r:" S"1'~ .r;. ZIP: 97Y7~ This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature, , CONTRACT:OR"INSTALLA liON" :r. '.I .~..-, bl96 BCD license no.: Plumbing license no.: Print name: Signature: Jd~ \,~ tJ'~ \.\ 440-2500-J II 1/08/COM) COw.. "l-OIO -00 L-fl..(L( Permit no.: Date, -/0 ~j; >'i."t. ';';-'1<; ':~\"_~~":;':; ,:;-;.;!i'.';:TI~';:>,~_it-\'XI8::~'i.;r~.:;!;-i'1";; '-:'~,"-"f'...l.:~,~, - "j4C'- 't-;?3'-' -'_:~ T" Tl'i!I' ;:jDescrlptlonlj~'::c.;~t~~;F-,,"'fi~i>~~,~}J{~\O;.~':' .Q!Y~; ~;;t~".J)~N~i)~-i ''';!i.o ~',A~ f1,.r\~;!.\'_" 7~:~jt",_'_;""A'i<'{L'j;;:~;;$~!&;"'€,}I~~4~t~.\;>.i~_i:"'~tl z""~,,,,'X :?t<idi e;1:JJJf.i: !.\\,b~,C.~SJ~L~, 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~~ ~e\lOl\\a"..':o~~ ~E.l'\'n<1ltA'f ~~il '0'1 \n fIlleS ale :Si..oo~. ~"OVllllltR ~~ ~~Jg" O~ . f\l\96 tI'I ~otif\Cat\(j1I f'~ copies~~e~Q III o~~ 'teRm ph: lNo\~~ tlo\~ 009 caillll IlWI6'OIR~~~i.i344)' I\IlI!ltlQJ~e\\\0'I<\!B\il\\'ini: n/a 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: . ". '.' "':~j.i.""-" ~i.~S.\';"Ik:Type:"'" . 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 ~ ~.M";:''''. . ..,; r' I~\, '; 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. ..' Date1j;; lJ ,::;'t,cr;!, 'iffY';'- ~, ..." ..c" -~, r .'~. . ", ", Pa2e 2 of 2 ~;jtj Wit 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 ."C. '.1": _t, t '.~;. " '.' Page I of 1 4/9/2010