HomeMy WebLinkAboutPermit Plumbing 2010-5-5
Plumbing Permit Application
225 Fifth Street. Springfield, OR 97477 . PH(54])726-3753 . FAX(54])726-3689
SPRINGFIELD ~,
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Permit no, (2/0 -- 60 7
5'~S-dOIO
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.
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Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEGORY OF, CONSTRUCTION
E-mail:
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:
Business name:
ZIP: ? 7,/01.
E-mail:
CCB license no,:
Print name:
Signature:
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440-2500-J I] ]/OS/COM)
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New residential
I bathrooml] kitchen (includes: first
100 feet of water/sewer lines, hose $238,00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathroomsll kitchen $374,00 $
3 bathrooms! 1 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 $
7,20] 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 dwel1ings other than one-or
two~family
Minimum fee $58,00 $
Each fixture $19,00 $ I
Miscellaneous fees
]00' storm, sewer, water line $76_00 $
Each fixt.ure, appurtenance, and piping $19,00 $
Stonn water retention/detention facility $19.00 $
Irrigation systems $19,00 $
Piping or private storm drainage $19,00 $
s\lstems 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: (]) $58,00 $
rijidfg~lrg~~;ipi'pi~~g~1~~t[t~\~~~;~~~'J#J~:; Mjnimum fee $
Enter -Value of installation and equipment $
Enter fee based on installation and equipment value. I $
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(A) Enter S~I'afabOve fees, --/ Sf.
(Minimu!)l,; .,mit Fee $58,00)----- $ <
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(B) lnvestigauve-fee (equal to [A]) $ 2- C/ r.)
(C) Enter 12% surcharge (.12 x [A+B]) $ / /'.
(D) Techno]ogy Fee (5% of[A]) $ '17 "
TOTAL fees and surcharges (A through D): $ ~-J. j, ~
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Status
Issued
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00567
ISSUED: 05/05/2010
APPLIED: 05/05/2010
EXPIRES: 11/0512010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 998 W L ST ' : Springfield TYPE OF WORK: Plumbing Only
ASSESSOR'S PARCEL NO.: 1703273401816': "". \'. .....
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TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Hose Bih - Fixture",)., .."
Owner: OTT JUDITH D
Address: 998 W L ST
SPRINGFIELD OR 97477
Owner: GLEASON SUSAN
Address: 998 W L ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION ~
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Contractor Type
Plnmbing
Contractor
BERNARDPETERSENINC
License
93126
Expiration Date
08/23/2011
Phone
541-343-9339
BUI LDING INFORMATION ~
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of St,'ucture
Type of Heat:
,~.ater,TYI~e:, .
RangeTyjJe:
" En.ergy Path:
'Sprinkled Building:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION ~
Front yard Setback:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Sethacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I 11'.1I8~IC IMPRO~EMENTS ~
M' Oregon law requ res~;o"
Street I~Gl\lr.!~s~' t d by the Oregon Uti ':!.,. Sidewalk Type:
11~~~s adop e les are setfO'UI
Storm S I . ~enter. ThoseruhOAR952.()01- NOTICE: Downspouts/Drains: I
Special i J{~iwl-001-00:;~i~S oflhe rules bY THIS PERMIT SHALL EXPIRE IF THE WORK
N . 0090. You maY::r (Note: the teleph:~ AUTHORIZED UNDER THIS PERMIT IS NOT
otes. ca:g tro~:'e Or~gon Util~ NO)t\fl COMMENCED OR IS ABANDONED FOR
nu er Center Is 1-800-332-2344 . ANY 180 DAY PERIOD.
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-00567
ISSUED: 05/05/2010
APPLIED: 05/05/2010
EXPIRES: 1II05/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description ~
Description
Tvpe of Constrnction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
l~feesPaidJ
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Date Paid
Receipt Number
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Minimum/Adjustment Plumbing
Amount Paid
$6.96
$2.90
$19.00
$39.00
5/5/10
5/5/10
5/5/10
5/5/10
2201000000000000460
2201000000000000460
2201000000000000460
2201000000000000460
Total Amount Paid
$67.86
I Plan Reviews ~.
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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.
I Reuuired Insoections I
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Final Plumbing: Wben all plumbing work is,co!l1plete.c,;,
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By signature, 1 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 hereiu, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, 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 fnrther 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 ocated at the front of the property, and the approved set of plans will remain on the site at all
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Owner or Contractors Signature Date
Pa2e 2 of 2
225 Fifth ,Street
Spningfleld, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000460
Date: 05/05/2010
8: 12:44AM
Paid By
PETERSEN PLUMBING
Item Total:
Check Number Authorization
Reech-'ed By Batch Number . Number How Received
Amount Due
19.00
39.00
6.96
2.90
$67.86
Job/Journal Number
COM20 1 0-00567
COM20 I 0-00567
COM20 I 0-00567
COM20 1 0-00567
Description
Fixture
Minimum/Adjustment Plumbing
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Amount Paid
nJm
047782 In Person
Payment Total:
$67.86
$67.86
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5/5/2010