HomeMy WebLinkAboutPermit Plumbing 2013-4- SPRINGFIELD- 225 Fifth St
'' CITY OF SPRINGFIELD Springfield,OR 97477
�` Phone: 541-726-3753
-OREGON Building / Residential Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00736
www.springfield-ar.gov permitcenter @springfield-ar.gov
PROJECT STATUS: Issued ISSUED: 04/11/2013 EXPIRES: 10/08/2013
STATUS DATE: 04/11/2013 APPLIED: 04/11/2013
SITE ADDRESS: 649 WATER ST,Springfield,OR 97477 SCOPE:. Plumbing Only
ASSESOR'S PARCEL NO: 1703352301100 TYPE OF STRUCTURE: Residential
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PROJECT DESCRIPTION: Replace 85'Ft of Private Sewer
OWNER: SHERWOOD ANANDA Phone Number:
ADDRESS: 649 WATER ST
SPRINGFIELD OR 97477
_ CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor HARTSELL ENTERPRISES INC CCB 164730 06/03/2013 541-689-4610
INSPECTIONS REQUIRED
Inspections
5c.„ra-y c-r•t r cov4 F,,,m-t
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 or 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 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.
. lW7 r-1/— ''i3
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Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
• follow rules adopted by the Oregon Utility
NOTICE: Notification Center. Those rules are set forth
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
calling number the the Oregon(Note: the telephone
COMMENCED OR IS ABANDONED FOR '
number for the Oregon Utility Notification
ANY 180 DAY PERIOD. • Center is 1-800-332-2344).
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Springfield Building Permit 4/11/2013 1:15:39PM Page 1 of 1
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` SPRINGFIELD
CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
rOREGON 611=SPR2013-00736
www.sprint-midor.gov 649 WATER ST permitcenter @springfieid-or.gov
RECEIPT NO: 2013000712 RECORD NO:811SPR2013-00736 - DATE:04/11/2013
• • ` P Y" " 43. ;ACCOUNT,CODEITRANS'CODE a 'T " AnnouNTLMA
Sanitary sewer 224-00000-425603 1005 83.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.02
Technology fee(5%of permit total) - 100-00000-425605 2099 4.18
TOTAL DUE: 97.70
may- e7ieltgliMlEngir �xaeR
P.AYMENSaTYPE P.AYOR CASHIER:,JhARSON t{}COMMENTSIYep�"— MOUN,TyIPAID_
Check HARTSELL ENTERPRISES INC 97.70
3979
TOTAL PAID: 97.70
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Plumbing Permit Application ,)„‘:. -',DEPARTMENT USEONLY •' ,
231,4,2ii-411.35::-tcreff :11. .i:7:::ii,"1%7•VIF,V{:f7:;--::t.::.rt?p,:-.4t1i-- -?.., t .4 ,
Ir;r1,..C-IT,P3FiSER,INGRELD14.),RtiGONItta:.: J... - ' ',,,,-uct"af Permit no.:g7/z_al 3 of:,73,6
:dV:,,:t-Ii,...14'-:i.::.iiiii.z,;E.Tr:t::::c:-.3::5_7i::?..lt;.?,1:;;;Y:riielle?,:cf: I: .!'":43'S.?-. ca, .
225 Fifth Street• Springfield,OR 97477 • PI-R541)726-3753 • FAX(541)726-3689 Date: L/7/// 5
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.
LOCAL GOVERNMENT APPROVAIS-=',,:t: Y.W.:. 5)..fr;:;qii:!;4(.:1irl:7;:k1,.:1;:::',,FEE SCHEDUL:Et,:;,:':.'',',?.1:-Y':i;.;-.'51,:i,
Zoning approval verified? 0 Yes 0 No ,Descriptionf4;- -,'-•-;,:47--PL: .' -,:-.': Qty Cost 'rotal
C.'4■ P"--Z,V Ar,..--4,1-A rg•e- -.7k,- ‘.-'';' , - .,••4 ea: F:.', -,.?-teost
Sanitation approval verified? 0 Yes D No New residential
CATEGO-RY. OF.(CONSTRUCTION-. ?:4:1=, 1.1/71,••1 I bathroom/1 kitchen(includes.first
100 feet of water/sewer lines, hose
Residential 111.Government 0 Commercial $262.00 $
bibs, is maker, underfoot-low-point
TW'JOB t SITE"-:INFORMATION,;.AN D:O LOCATION-'-:,';.::-;'.0 drains and rain-drain packages)
Job site address: G ei ci tthqr6 A_ ri- 2 bathrooms/1 kitchen .$411.00 $ 1
3 bathrooms/1 kitchen $483.00 $
City:5e,f2146,c-ig i.„ 6 State: OR, ZIP:19-00C)
Each additional bathroom(over 3) $104.50 $
Reference: /7-a 3 -.3£-23-Taxlot.:of 1 o c) Each additional kitchen(over I) $104.50 $
■;..1;4:,..;S,..:‘,.-:L.',a:DESCRIPTION '0 EiM0 RiCi::'':.:- .'4'',4:Z.°1-41.°. Residential fire sprinklers(includes plan review)
P2—e5atjetig— FSS' obt- ega......3G.. 52,.,,.s V, ; 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
24:1',.:.;,11tW17,::1,:t,1.- 1?,R01:1.ERTY:-LOWNE nit'l+kii:Cng,' 3,601 to 7,200 squaie feet $192.00 $
Name: A MA M CIA Sive(2, (A) Op& 7,201 square feet and greater $255.00 $
Manufactured dwelling or pre-fab(circle one)
Address: 6 4/9. La treca, -5-1- Connections to building sewer and
$80.00 $
water supply
City:,,SpRiabC s'e..1.-() State:SR-- ZIP:
Commercial,industrial,and dwellings other than one-or
Phone:54i/ -577--76.21 Fax: - - two-family
E-mail: Minimum fee $80.00 $
Each fixture $21.00 $
This installation is being made on residential or farm property
owned by me or a member of my immediate family, and is Miscellaneous fees
exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line / $83.50 $
Signature: Each fixture,appurtenance,and piping $21.00 $
(ic ON TRACTORY INSTAL EAT IO N It!z. :,:;. :1,;:;Tl Storm water retention/detention facility $21.00 $
Business name: Piki23-5 V.-11 eta.)s r Irrigation systems $21.00 $
Piping or private storm drainage .
Address:9 / et C,7 .6 CS EN I-I NI RU systems exceeding the first 100 feet $21.00 $
Specialty fixtures $21.00 $
City:rckeri 4 t4 Ct t y State:OR, ZIP:97'14'Y
Reinspection(no of hrs.x fee per hr.) $80.00 $
Phone:554'-“s el 7 n l D Fax: 511/-4/6/- ?wet 7 q Special requested inspections(no. of
E-mail: . hrs.x fee per hr.) $80.00 $
CCB license no./4 si 7 30 BCD license no.: Each additional inspection:(1) $80.00 $ .
Plumbing license"no.: 31.75/3 -iiiigdic4nis i3iiiiira.:75kfrIrcl-j!i4N•;.3.'.11;z! Minimum fee $
Print name: ST6 VS g ..t . 1-IA ft-t5 Q-(/ Enter value of installation and'equipment$
, Enter fee based on installation and equipment value. $
Signature:..)L09..4.2....,....-*-.. ,r) ' 1 fyi!lt?$!`ift.:1Z.:0:2J,N11.5APPLicAtircusEilWA*A6:J:!R
(A) Enter subtotal of above fees . $
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+131) $
(D)Technology Fee(5%of[A]) • $
TOTAL fees and surcharges(A through D): $`I 7 2'-
. ..
a.
440-2500-1(4/1/2013/COM)
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