HomeMy WebLinkAboutPermit Plumbing 2013-4- SPRINGFIELD 225 Fifth St
• CITY OF SPRINGFIELD Springfield,OR 97477
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OREGON Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00737
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/11/2013 EXPIRES: 10/08/2013
STATUS DATE: 04/11/2013 APPLIED: 04/11/2013
SITE ADDRESS: 1121 C ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703351414400 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace 90 Ft.Private Sewer Line
OWNER: DAVIDSON DANIEL Phone Number:
ADDRESS: 37875 UPPER CAMP CREEK RD
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3999 Final Plumbing 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 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.
I lir/ c/4
Owner or Contractor Signature Date
•
•
ATTENTION: Oregon law requires you to NOTICE:
follow rules adopted by the Oregon Utility
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 COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344). •
Springfield Building Permit 4/11/2013 1:38:04PM • Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
6.17Thrt 225 Fifth St
TRANSACTION RECEIPT SpringFleld,OR 97477
OREGON 541-726-3753
811-S PR2013-00737
www.springfield-or.gov 1121 C ST permitcenter@springfield-or.gov
RECEIPT NO: 2013000714 RECORD NO:811-SPR2013-00737 DATE:04/11/2013
'DESCRIPTION f_ _ACCOUNT CODEITRANS CODE _ AMOUNT DUES
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
AMOUNT PAID ..
(_PAYMENT TYPE ? s.. PAYOR =`,cASFiIER:JCARSOR�- _� C OMMENTS � - _ � � -
Check DAVIDSON DANIEL 97.70
302
TOTAL PAID: 97.70
Plumbing Permit Application DEPARTMENT USE ONLY
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CITY ®F SPRINGFIELD;OREGON - Permit no.:S( I Zd t300737
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: L/
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. GQVERNMENT:APP.ROVAL z,',r , TEE 'SCHEDULE
Zoning approval verified? ❑ Yes ❑No Descrl tlon a, 3 , . c4-,C.
ost Total r
9'13'7)1' .`acost'::a
Sanitation approval verified? ❑ Yes ❑No New residential
CATEGORY"OF. 'CONSTRUCT;ION ` ' ' 11 ` 1 bathroom/1 kitchen(includes:first
gf Residential ❑Government ❑Commercial 100 feet of water/sewer lines, hose $262.00 $
bibs, ice maker, underfloor low point
!`JOBASITE'!INFORMATION I;`ANDI LOCATION._g^r -v drains and rain-drain packages)
Job site address: 0,2( t_ Si
2 bathrooms/1 kitchen $411.00 $
City:Syft.O State: QK ZIP: 97Y77 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $
? S pESCRIPTION'i0F )-WO Residential fire sprinklers(includes plan review)
Fee/A-Ctwc- SF& C.tve 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
3,601 to 7,200 square feet $192.00 $
Name: 04,,,v/5 t_ O4V/Ds ^/ 7,201 square feet and greater $255.00 $
Manufactured dwelling or pre-fab(circle one)
Address: '3 75 /Jpfze c4,-np RD Connections to building sewer and
—
water supply $80.00 $
City: S?fGD State: OA ZIP: ?7'V7' Commercial,industrial,and dwellings other than one-or
Phone:5Y/-7yr- OY/2 Fax: - - two-family
E-mail: Minimum fee $80.00 $
This installation is being made on residential or farm property Each fixture $21.00 $
owned by me or a member of my immediate family, and is Miscellaneous fees
exempt from sing .. en . der OAR 918-695-0020. 100' storm,sewer,water line Z $83.50 $ •
Signature: - Each fixture,appurtenance,and piping $21.00 $
ci. CONTRACTOR INSTALLATION ' "'4t, ,> ^z Storncwater retention/detention facility $21.00 $
Business name: Irrigation systems $21.00 $
Piping or private storm drainage $21.00 $
Address: systems exceeding the first 100 feet
City: State: ZIP: Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone: - - Fax: - -
Special requested inspections(no.of $80.00 $
E-mail: hrs.x fee per hr.)
CCB license no.: BCD license no.: Each additional inspection:(I) $80.00 $
Plumbing license no =Medical gas.ptpmg ,; '` k - Minimum fee $
Print name: Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature:
(A) Enter subtotal of above fees, $
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) - $ -
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through D): $77�
440-2500-1(4/1/2013/COM)