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HomeMy WebLinkAboutPermit Plumbing 2013-4- I -V -/r SPRINGFIELD 225 Fifth St -e`4 CITY OF SPRINGFIELD Springfield,OR 97477 - C�i Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00779 www.springfield-or.goy pennitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 04/17/2013 SITE ADDRESS: 876 BELTLINE RD,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703153000900 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Adding toilet and 2 sinks OWNER: SYCAN B CORP Phone Number: ADDRESS: 840 BELTLINE RD STE 202 SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor RELIABLE PLUMBING&MECHANICAL INC CCB 182964 09/20/2014 541-689-4235 INSPECTIONS REQUIRED Inspections 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 at 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 prerty, and the approved set of plans will remain on the site at all times during construction. ' . �r O er or Contractor SignMe Date ATTENTION: Oregon law requires you to NOTICE: follow rules adopted Those ose the rules are Oregon set Utility THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth 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 4/17/2013 2'.55;34PM Page 1 of 1 Po SPRINGFIELD --- CITY OF SPRINGFIELD 44‘kk 225 Fifth St et? TRANSACTION RECEIPT Springfield.OR 97477 541-726-3753 OREGON 811-SPR2013-00779 www springfield-or gov 876 BELTLINE RD permitcenter©springfield-or gov RECEIPT NO: 2013000770 RECORD NO: 811-SPR2013-00779 DATE:04/17/2013 tolkkjkioli7 Minimum Plumbing Fee(Three or Fewer Fixtures) 224-00000-425603 1057 80.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 p:PAYMEfillitYPE PAYOR nCPSHIEJLARSoN gOMMENtS,j, Credit Card Derek Noble 93.60 0554613 TOTAL PAID: 93.60 • Plumbing Permit Application 'DEPARTMENT USE ONLY. . .,�t SPRINGFIELD ���+��M, �C7` V w. w.1 ( �} Y � 5 �."CIiViitStifth ttlt•�DREGON pg14'4-44 4 Permit no.: S I� —q7°i 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753.• FAX(541)726-3689 Date: `I /( -2 ' /J 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. .. ';'.FEE SCHEDULE, .""..is a , 14 1•l it,;.'n r ;;:LOCAC.�GOVERNMENT APP,ROVAL` ..,.=t� �?° '', ,t.,,. ,r"�§ „i _ , Zoning approval verified? Ell Yes ❑No Descripttion : : I :- Qty{ it]east :.0 cost)„°; Sanitation approval verified? ❑ Yes ❑No New residential "t%it ',5:CATEGORY OF;CONSTRUCTION t 1 bathroom/I kitchen(includes.first 100 feet of water/sewer lines, hose ❑Residential ❑Government ❑ Commercial bibs, ice maker, underfloor low-point $262.00 $ I'+,+,I'JOB SITE;`INFORMATION:LAND, LOCATION ;HI.;;;;Ltif drains and rain-drain packages) Job site address: (0 �Z]-{-Itv.L L.Q 2 bathrooms/I kitchen $411.00 $ 3 bathrooms/1 kitchen $483.00 $ City:�pr(vA el (s State: cif— ZIP:6(79 7 7 jj Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over I) $104.50 $ 3'`, ,t i '',,,;,DESCRIPTION':OF.WORK, t ,-_°, ;.F Residential fire sprinklers(includes plan review) • -(292•'y-11/4:70,s,w c-e?. .‘‘- 1.11.1`--- 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ .71144714h1, .,'iwc °.,PROPERTY`.OWNER` Aht , , -:4 + .[l 3,601 to 7,200 square feet $192.00 $ Name: S ve-L)101/� 7,201 square feet and greater $255.00 $ �� Pv� Manufactured dwelling or pre-fab(circle one) Address: - Connections to building sewer and $80.00 $ \ Q water supply City:sQc N� -•CC3 State:'Dd ZIP: F-ic(> Commercial,industrial,and dwellings other than one-or Phone: 541 —`c1Tt' O6)y Fax: - - two-family � . sS ,Co „1,1 Minimum fee ,,,tnt 5 E-mail: W Ct j SY C r v� 3 0...1"' $80.00 $SC/ This installation is being made on residential or farm property Each fixture tJ $21.00 $ 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 $ '°4:1.4 '1'<,-.CONTRACTOR'INSTALLATION `.0V-. ;i? Storm water retention/detention facility $21.00 $ Business name: \\.W 1 (\--LAJ''c 11 Irrigation systems $21.00 $ Piping or private storm drainage $21.00 $ Address: 't;,.. X- 7 a a.?? 5 systems exceeding the first 100 feet City: 9 e,_ State: (� ZIP: 7 L 0 Specialty fixtures $21.00 $ Phone:5"tj I( -�,�9--v`a.S Fax:5�I ] -s a�S \1 Special requested sled inspections pec i fee per hr.) $80.00 $ A Special requested inspections(no.of $80.00 $ E-mail: g,�/u\ ® -f'(vy v(V.)m_9( , i1w.4". hrs.x fee per hr.)• CCB license no.: (ke),9 (91 BCD license no.: - Each additional inspection:(1) $80.00 $ Plumbing license no.: Medical'g as p I m g )1,-: 5z'� g ti, Minimum fee $ Print name:/ 'ic Wl� k�— Enter value of installation and equipment$ (/ J Enter fee based on Installation and equipment value. $ Signature �� r u,. *AP.PLICAN,T, USE : . :1 ;=: (A) Enter subtotal of above fees (Minimum Permit Fee$80.00) $ 73 (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ qt/0 (D)Technology Fee(5%of[A]) $ Li 00 TOTAL fees and surcharges(A through D): $ 95(d 440-2500-1(4/1/2013/COM) - •.- ..: SPRINGFIELD _... CITY OF SPRINGFIELD kw - - 225 Fiflh Sf `OREGON TRANSACTION RECEIPT SpringfieldOR97477 541-726-3753 811-P W2013-00068 www.springfield-or.gov 876 BELTLINE RD permitcenter@springfield-or.gov RECEIPT NO: 2013000769 RECORD NO: 811-PW2013-00068 DATE:04/17/2013 .. _.at: _ :ACCOUNTCODE/TRANS.CODE '___ '2_,_AMCiUNT_DUELJ SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 542.47 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 311.45 SDC:Total Sewer Administration Fee 719-00000-426604 1175 82.70 TOTAL DUE: 936.62 ' ' ' ' 7 AMOUNT PAID PAYMENT TYPE . '.iPAYOR .�cnswErs:JLnrssoN '.-�- COMMENTS '. - -�= t � - Credit Card Derek Noble 936.62 05546B TOTAL PAID: 936.62 r ' SPRINGFIELD' 1 CITY OF SPRINCFIIiLU r +t,k -coq, 225 Fifth St ` 6OOH TRANSACTION RECEIPT Springfleld,OR97477 541-7264753 811-P W 2013-00068 www.springfield-or.gov 876 BELTLINE RD permitcenter@springfield-or.gov RECEIPT NO: 2013000768 RECORD NO: 811-PW2013-00068 DATE:04/1 712 01 3 (DESCRIPTION ' s-ACCOUNT CODELTRANS CODE ' AMOUNT DUE , SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 800.00 TOTAL DUE: 800.00 ='AMOUNT,PAID ` I_PAYMENT TYPE T PAYORy CASHIER:JLARSON . .,L COMMENTS: - - ' s.; I Credit Card Derek Noble 800.00 086978 TOTAL PAID: 800.00