HomeMy WebLinkAboutPermit Plumbing 2010-6-25
Plumbing Permit Application
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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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 180 days.
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Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEG:OR'( - OF, CONSTRUC:T10N' ,
Commercial
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- Name: S PR.b (9
Address: 5"';). ~
ZIP: 4'1 f../'I
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020,
Signature:
City,
Phone:
E-mail:
CCB license no.: 440?'
ZIP, Q')4a
BCD license no.:
Plumbing license no.:
Print name:
Signature:
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440.2500-) (I 11081COM)
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New residential
I bathroomll kitchen (includes: first
100feel afwater/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathroomslI kitchen $374.00 $
3 bathroomslI 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 $
2,001 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-Cab (circle one)
Connections to building-sewer and $58.00 $
water supply
Commercial, industdal, and dwellings other than one- or
two-family
Minimum fee $58.00 I $
Each fixture I $19.00 I $
Miscellaneous fees
]00' storm, sewer, water line I $76.00 $ fJ~
Each fixture, 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 $58.00 $
hrs. x fee per hr.)
Each additional inspection: (I) $58.00 $
~< '."j ':~'~.~XC:;"V:~I::%<~P'i":/;>'. ':qu".q;;?;'i!"~'.: ,,""1''; .,~., !l.":-;"~:,,",,~~.1 Minimum fee $
JMedlcal:gas:plplJlg?Jt;~~;iBMf}t~~N~~if~
Enter value of installation and equipment $
Enter fee based On installation and equipment value. $
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(A) Enter subtotal of above fees $ '7,,-
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [A]) $
(C) Enter' 12% surcharge (.12 x [MB]) $ 'j~
(D) Technology Fee (5% of [A]) $ 1~
TOTAL fees and surcharges (A through D): $ ~l1-
Status
Issued
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00824
ISSUED: 06/25/2010
APPLIED: 06/25/2010
EXPIRES: 12/25/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
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SITE ADDRESS: 7345 THURSTON RD
ASSESSOR'S PARCEL NO.: 1702350002600
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Alteration
Public
PROJECT DESCRIPTION: 100' storm line - upsizing from 12" to 15"
Owner: SPRINGFIELD SCHOOL DISTRICT 19
Address: 525 MILL ST '
SPRINGF'IELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
General
Contractor License
HYLAND CONSTRUCTION
BUILDING I~FORMA TION I
Expiration Date Phone
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
. Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
"..........
REQUIRED PARKING
Overhiy Dist:.....". Total:
# Street Trees Rqd: Handicapped:
'Paved Drive:Rqd: . ComB&~
% of Lot Coverage: n \a'/'J lequlleS Y \J\i\iW
,t\TTEN110l't ~~~{~d bY ~",~, ~~e~~nse\ 101\n
PUBLIC IMPROVE . T~-)n C~~:~~1 b\~;~LJg~ ~~~e rules by
Street Improvements: in all.. ~2-0 ltl}dll*lllll. ~r:\"e \e\ep\'1One
0090. '(ou m ~en\el. -\~~. ,;, iN No\ilica\IOn
Storm Sewer Available: .',~; . , "calling \\'18 ~~.r'efiJ1,(1JlfSfl:jr,~~~~44).
Special Instruction: ',~},:J1,',,);:,;.:~!t,~,,:.: ,l\U[11beld~~\el is 1_800-33"
.WTlCE: ORK'-
Notes:~~,~ .~ER~\T S~A~L ;XP~RE I~~~TE\~ Noi/::, ,',t.',;
nu'" "C~ED OR IS ABANDONED flu,
COMMEN Valuation Descri tion
ANY 180 DAY PERIOD.
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
:)'
Paee 1 of2
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00824
ISSUED: 06/25/2010
APPLIED: 06/25/2010
EXPIRES: 12/25/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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,;Total Value of Project
L Fees Paid .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Storm Sewer - 1st 100'
Amount Paid
Date Paid
Receipt Number
$9.12
$3.80
$76.00
6/2511 0
,6/2511 0
6/25/10
1201000000000000759
1201000000000000759'
1201000000000000759
Total Amount Paid
$88.92, '
.'
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, insp~ctions requested after 7:00 a.m. will be made the following
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L Reuuired hisDect~
Storm Sewer Line: Prior to filling trench.
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 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 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 further agree to ensure that all required inspections a~e requested at the proper time, that each address is readable from the
street, that the permit card is located at the fr6iWOf.,ilie property, and the approved set of plans will remain on the site at all
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Owner or Contractors Signature
Date
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Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000759
Date: 06/25/2010
I :46: II PM
Job/Journal Number
COM20 10-00824
COM20 1 0-00824
COM20 1 0-00824
Payments:
Type of Payment
CreditCard
cReceintl
Description
Storm Sewer - 1 st 100'
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
JOHN HYLAND
CONSTRUCTION
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Amount Due
76.00
9.12
3.80
$88.92
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Item Total:
Check Number Authorization
Receiyed By Batch Number Number How Received
NJM 025617 In Person
Amount Paid
$88.92
Payment Total:
$88.92
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6/25/2010