HomeMy WebLinkAboutPermit Plumbing 2010-5-11
P~umbing Permit Application
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225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
Permit no.:
(j2I (J - ')1 f
Date:
), /! 10
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? DYes D No
Sanitation approval verified? DYes D No
CATEGORY' OF CONSTRUCTION
esidential D Government D Commercial
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-,. .PROPERTY;:OWNERi:,*"u:,';;.~-. .i';:~~'?"~:~~,,'
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. Name:
City:
Phon
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family, and is
exempt ITom licensing requirements under OAR 918-695-0020.
Signature:
CONTRACTOR JNSTALLA TlON,. .d, ';",
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Busmess name~ 7
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Address:
City:
Phon
E-mail:
Plumbing license no.:
Print name: te?~e...-C/r
Signature: ~
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440-2500-J (11!08/COM)
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New residential
I bathroomll kitchen (includes: first
lOOJeet oj water/sewer lines, hose $23B.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms!1 kitchen $374.00 $
3 bathroomsl1 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 $5B.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 $5B.00 $
water supply
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee I I $5B.00 $a~
Each fixture I L $19.00 $
Miscellaneous fees
100' stann, sewer, water line $76.00 $
Each fixt.ure, appurtenance, and piping $19.00 $
Storm water retention/detention facility $19.00 $
Irrigation systems ( $19.00 $ {~
Piping or private storm drainage $19.00 $
svstems exceedinp the first 100 feet.
Specialty fixtures $19.00 $
Reinspection (no. ofhrs. X fee per hr.)' $58.00 $
Special requested inspections (no. of $5B.00 $
hrs. x fee per hr.)
Each additional inspection: (I) $5B.00 $
t'ij;~di~~rg~}s'!piPr~g;~((~~:~;~~~1?,~jkl:!~4;~ Minimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value. $
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(A) Enter subtotal of above fees $ r;r"
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [A]) $
(e) Enter 12% surcharge (.12 x [A+B]) $ 'J '>-.!:L
(D) Technology Fee (5% of[A]) $ >H
TOTAL fees and surcharges (A through D): $ "10"2-
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00589
ISSUED: 05/11/2010
APPLIED: 05/11/2010
EXPIRES: 11/11/2010
VALUE:
1",1
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2048 DONNELLY DR 1"" \0 'Springfield TYPE OF WORK: Plumbing Only
ASSESSOR'S PARCEL NO.: 1703271303500 \}ileS~~\i\i\'f'
\a'l'l leO: le90'fl'i'itt\O~. TYPE OF USE: Alteration
PROJECT DESCRIPTION: Jtlpl~:i;le~ ~&1i19~t;noo~ured dwelling
",~""i\O '~60'i'\e .,.nOse ~ '" O"'~ tuxeS
P',..c: u\~~ (\\6\. \\,\\u(.'i 0' ~.s ~O\~
Owner: GUIL~.Ne 00\0 o~\es \e\e9 ~O(\
Address: 2048 D ~Il oit'" o'O\ai'fl ~O\e" ~~~ ~o\i\iC
SPRIN offi ~~'l,~I. o'fl \)\\\\ '2.z,,,,,,,).
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~u~'Oe\je'fl\al \s I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor " , ' License
EUGENE EXCA V A TlON.& PLUMBING INC 138003
I BUILDING INFORMAT~~_
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1>-'0 .~.~~~ "...'\~P.~ided Building' n/a
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I>-~'\ i'~EVELOPMENTlNFORMATlON I
# of Units:
Pri"1ary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frolltyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
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Notes:
I Valuation DescriPtion I
Description
$ Per Sq'.Ft.', , ' Sqllare Footage
or muli!plier,~)':' .. / 6~rlBid Amount
Type of COllstruction
. "1""~ 1\",:":,
f~:kiT'
Paee 1 of2
Resideutial
Expiration Date
07106/2011
Phone
541-988-0868
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2ud Floor:
Sq Ft Basemellt:
Sq Ft Garage/Carport
Sq Ft Other: '
Occupallt Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspoutsffirains:
Value
Date Calculated
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00589
ISSUED: 05/11/2010
APPLIED: 05/11/2010
EXPIRES: 11/1I/2010
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 ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backflow Device
Miscellaneoos Plumbing
Amount Paid
Date Paid
Receipt Number
$9.244,,:,.,
$3.85};> ore r:;
$19.00' '0"
$58.00C :
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5/11110
5/11110
5/11110
5/11110
1201000000000000432
1201000000000000432
1201000000000000432
1201000000000000432
Total Amount Paid
$90.09
I Plan Reviews ~
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, inspectionsnquested after 7:00 a.m. will be made the following
workday. 0" ,", .
Reouired InsDect~
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Backflow Device: Prior to covering and pro~.id.~ .. copy of tbe test report on site at the time of inspection.
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By signature, I state and agree, that I have carefully.examined the completed application ..nd do hereby certify tbat all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accord..nce witb
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to tbe work described herein, and
th..t NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Bnilding Safety.
I further certify th..t only contractors and employees who are in compliance with ORS 701.005 will be nsed on this project.
I further agree to ensure that all required inspections ..re 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.
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Owner or Contr..cto Sign..ture
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Page 2 of 2
(.;:
225 Fifth Street
S[!ringfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000432
Date: 05/11/2010
2:19:05PM
Job/Journal Number
COM20 I 0-00589
COM20 I 0-00589
COM20 I 0-00589
COM2010-00589
Payments:
Type of Payment
Check
cReceintl
Description
Miscellaneous Plumbing
Backflow Device
+ 12% State Surcharge
+ 5% Technology Fee
Item Total:
Check Number Authorization
Batch Number Number How Received
1102 In Person
Amount Due
58.00
19.00
9.24
3.85
$90.09
Paid By . Re~eived By
EUGENE EXCA V A nON AND cJc
PLUMBING
Amount Paid
$90.09
Payment Total:
$90.09
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