HomeMy WebLinkAboutPermit Plumbing 2010-6-28
P~umbing Permit Application
~...,... ,!'i;'l~,., ;.'.,..~.~"_':'-, ->D--"'-{ 4<',,'-....-'-.)'1,. "-".: '. ~_." ,-. ''''''''''"';~,'-.~t:l.i ;fC;li
'~'~"DEPARTMENT ,USEONtY;,'!'~'i~
. .0','. .:'.' . . .' _' " . ... "....~~
Pennit no.: cro , 0 () 2? ? L!
Date: b ~zg - ( 0
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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.
.t'\:::t~!,ii!,f{'~'IlC)CAtt'~0VERNMENT,fApRROVA&qn0~Wt',,!:iii5iij
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEGORY' OF, CONSTRUCTION" . .'
Residential
;",c:,'Z~;;'JOB!,SHE
o Government 0 Commercial
,INFC)RMAfIONitANO~EOCA1"10N~1Wr':";j
:b
Address:
City:
Phone:
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,
ZIP:
Signature:
CONTRAcrOR"INSTAttA TION.
Business name: (;,6- f J. ,k
Address: qOIOO
City:
Phone.
!..."'~,,,':_J;. . d
Print name:
Signature:
~~
A..... '>..0'
~v
~.\~
~
440-2500-J (11/08/COM)
"'i~,!i:i;';~!~olliil.Bii~rEPr!'~\\f~'m~\Wr;%~!:"iWl~;);\
r'Co J1 ({",I,.:' ~'Toial;~'
~h!...!~& ~i:~r: co_st;;i~;
New residential
] bathroomll kitchen (includes: first
100 feer of water/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms!] kitchen $374.00 $
3 bathrooms!] kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over 1) $95.00 $
Residential fire sprinklers (includes plan review)
o to 2,000 square feet $58.00 $
2,00] 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 dwellings other than one- or
two-family
Minimum fee 1 $58.00 $
Each fixture 31 $19.00 1 $ c:: '7
Miscellaneous fees
100' storm, sewyr;water line ) I $76.00 $ 7b
Each fi~ture, llPPm:tenanee;and piping $19.00 $
Storm water retention!detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
systems exceedinp 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 $
,~ Mi.nimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value. 1 $
-"~""~~,\,,"!"'''~~1ii~.-...n'ii1~'' -~'1,."~"'~'
!.!t~;!\?tiE". ",~il,i!Wj.~;hi:O;l?eL::ICANiT~,USEt!iilit-",.'. _,U'. ".,,?,
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $
(B) Investigative fee (equal to [A]) $
(C) Enter] 2% surcharge (.] 2 x [A+B]) $
(D) Technology Fee (5% of [A]) , $ ,
TOTAL rees and surcharges (A through D): $I<:'\'....--
I/~
)~:i"
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00834
ISSUED: 06/28/2010
APPLIED: 06/28/2010
EXPIRES: 12/2812010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1021 7TH ST
ASSESSOR'S PARCEL NO.: 1703351201100
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace water line and supply for fixtures
Owner: REBEIZ SAMY H
Address: 1021 7TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor License
EUGENE EXCAVATION ~PLUM.BING INC 138003
..' W' -..,'~.. ~~_. ."
'I BUILDING INFORMATION I
Expiration Date
07/06/2011
Phone
541-988-0868
# of Units: # of Stories:
Primary Occupancy Group: ' R-3 ~ight of Structure
Secondary Occupancy Group: ff.> "~~~Of Heat:
Primary Construction Type VBe\lIuXI O~ ii-Type:
Secondary Construction Type: ~'II \ & O\~\0 <;; ~<g'b~ype:
# of Bedrooms: ~ '0'1 ~ ~e~~~5!1 l; Path:
'~,' lit. lIl~o~u~~ o\':t'~:I.\lsd Building: nla
~ ~~,~~; ~ .MENT INFORMATION
Frontyard Setba@~~~~~~~~:overlaY Disf:
Side I Setback: ~~, \6~e\ ~ # Street Trees Rqd:
Side 2 Setback: ~~ C~ Paved Drive Rqd:
Rearyard Set hack: ~ ,,% of Lot Coverage:
Solar Setbacks:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS_
~:.f.,;~\;f.:::'\:';-:.~ "
,""'" " -..
~ ...,..;~Ji~~~" ~~ 7,.,
Sidewalk Type:,""" ~ ~~~'\ ~:.
Downspouts/.lk:llf,tl"t \~ .~:" :
\. ~"\~Vt.~~~ ~t;j'" :c;:': ~ .
C~. ~~~~ '\~\';) ~'V~\. ".: .
~()....'\ ,,'i:.\l-*,~~ \)~~\~ ~~~~
Valuation Descri ti\)~~'i:.~"~~ fi'i:.'?'
K .... COIJ
Squar<\~otage
or Bid Amount,
. ,.~\,'; 1 ,L' \;~;L' '.
.t',-~-:r..'~:~::-e-~;-;,;' , .
TL[i~ '-."'l\':
.is,,,,~"h<',,,''...x.l.!iJ,,,,
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
$ Pe.. Sq Ft
or multiplier
Value
Date Calculated
, Ii
JJ;....,.' ,:11
Pa2e I 01'2
I"...;",; ,
"
{.,'.
. ."'~"'''''.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
,'I.'!1', ! , :', I,'}. ~_;'~ " ,
'.:l?~:t 'ii.~:l'" :!,r ,;..'.-
'I.!'.
....,J<k:t!;,/~
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00834
ISSUED: 06/28/2010
APPLIED: 06/28/2010
EXPIRES: 12/28/2010
VALUE:
Status
Issued
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Water Line - 1st 100.'
Amount Paid
Date Paid
Receipt Number
$15.96
$6.65
$57.,0.0...
$76.0.0." ,
,6/28/10.
.. "J, 6/28/10.
6/28/10.
6/28/1 0.
120.10.0.0.0.0.0.0.0.0.0.0.0.764
120.10.0.0.0.0.0.0.0.0.0.0.0.764
120.10.0.0.0.0.0.0.0.0.0.0.0.764
120.10.0.0.0.0.0.0.0.0.0.0.0.764
Total Amount Paid
$155.61
I Plan Reviews ,
To Request an inspection call the 24 hour re~~rdi~g;'at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, ins'pectionsrequested after 7:00 a.m. will be made the following
work day.'-'"
I Reouired Insoections I
Water Line: Prior to filling trench and including required testing.
Rough Plumbing: Prior to cover and including required testing;
Final Plumbing: When all plumbing work is complete.
"
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 La";s 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.
I further certify that only contractors and employees who are in compliance with ORS 70.1.0.0.5 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 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.
'::;"'::'.. ":,;:~;:~.r,~'1 ~" ,. :,:, .
~"'-'.r' ''OJ' I
,.iSj;;J2i ~ I 'ji',i., '
"" "7 d.--r-
~ ~ ,y--o ---; -'2V/ D
.
Owner or
Date
Page 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000764
11 :00:52AM
Date: 06/28/2010
Job/Journal Number
COM20 1 0-00834
COM20 I 0-00834
COM20 1 0-00834
COM20 I 0-00834
Payments:
Type of Payment
Check
cReceintl
Description
Water Line - 1st 100'
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Paid By
EUGENE EXCAVATION AND
PLUMBING INC
. .
: ~tlj ::1, .~' ',~
Amount Due
76.00
15.96
6.65
57.00
$155.61
........ )~. _ i,l.;.
Ii' ./
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
$155.61
4063
In Person
Payment Total:
$155.61
.1
.?
'~~~lf. . r3.r ';~ '"" '
, -"~'
~: I
;.!,".':
;;~ .~.J;<
t:!
Page 1 of 1 .
6/28/20 I 0