HomeMy WebLinkAboutPermit Plumbing 2012-04-24 Plumbing Permit Application -4,k DEPARTMENT USE'ONLY.
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: _ y/t gAZ
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,`AP.P.ROVAL ..i71 , ,, u,a ,f. ""-cs.;,:FEE"SCHEDULE. -."` '+ t..> ', `.
Zoning approval verified? ❑ Yes ❑No ,Description, x ' Qty t _Cost TotaP'il
..-r ', cost•N.8
Sanitation approval verified? ❑ Yes ❑No New residential
F L',- ‘,,-.M.CATEGORY OF!CONSTRUCTION :x` t I bathroom/I kitchen(includes first
`` // 100 feet of water/sewer lines, hose
[lResidential ❑Government ❑Commercial $262.00 $
`` bibs, ice maker, underfloor low-point
rr,tJOB<SITE INFORMATION,ANDI,LOCATION . ,,.if'_iI drains and rain-drain packages)
Job site address: 14 -IZ 0 �, 2 bathrooms/I kitchen $411.00 $
City: :VW-
- 'f ick/ ¶ State: (9,/ ZIP: T4'�� 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference: /703 Z 6(4'3 Taxlot.:0 S20 d Each additional kitchen(over 1) $104.50 $
`4 ' ' DESCRIPTION'OF. WORK': "-1-
-,� .. Residential fire sprinklers(includes plan review)
4b/C.4CE /1042-07° 70 LF- _Set rC- . 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
."1_ l„, ," „ ^PROP.ERTY.:;OWNER 11'4sue* t- ??' 3,601 to 7,200 square feet $192.00 $
7,201 square feet and greater $255.00 $
Name: p t
Address: —7/ TO tQ Manufactured dwelling or pre-fob(circle one)
Connections to building sewer and $80.00 $
City: S fea State ZIP: 77/75- water supply
Commercial,industrial,and dwellings other than one-or
Phone: - - 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 - E0
exempt from licensing requirements under OAR 918-695-0020. 100' storrtrrsewe ter line / $83.50 /SD)
Signature: - Each fixture,appurtenance,and piping $21.00 $
'isx „';.,"CONTRACTOR,;INSTALLATIONI „'y, ,' , Storm water retention/detention facility $2100 $
Business name: tin LbeWtst Lai. ( Irrigation systems $21.00- $
Piping or private storm drainage
Address: I T (,mot systems exceeding the first 100 feet $21.00 $
City (�t�hel&,4 State: (f' ZIPf 1y�7 Specialty fixtures . $21.00 $
yr ; Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone:CM cIP r(4i I Fax. - ffib c(cgS Special requested inspections(no.of
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E-mail: hrs.x fee per hr.) $80.00 $
BCD license no.: Each additional inspection:(I) $80.00 $
CCB license no.: (
Plumbing license no -,Medical gas piping - 1 t .i',, Minimum fee $
r Enter value of installation and equipment$—
Print name: t,td 1l[t
ft - Enter fee based on installation and equipment value. $
Signature: Attie ti s.} t*3;, ,J;?A-0PLICANT 3LIS.E h' „ r ,,, '4
(A) Enter subtotal of above fees . �. ?r°
(Minimum Permit Fee$80.00) S I
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $l0 CZ
' (D)Technology Fee(5%of[A]) $ (-It G
TOTAL fees and surcharges(A through D): $Q 770
440-2500-i(4/1/2013/COM)
SPRINGFIELD 225 Fifth St
''' CITY OF SPRINGFIELD Springfield,OR 97477
ta Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00828
www.springfield-cr.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/24/2013 EXPIRES: 10/21/2013
STATUS DATE: 04/24/2013 APPLIED: 04/24/2013
SITE ADDRESS: 1492 10TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703264305200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace sanitary sewer approx 701f
OWNER: PHILLIPS COLBY J Phone Number:
ADDRESS: PO BOX 71306
SPRINGFIELD OR 97475
CONTRACTOR INFORMATION
-
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor LAWRENCE W PHILLIPS CCB 35806 06/29/2013 541-746-9680
INSPECTIONS REQUIRED
Inspections .
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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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.
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Owner or Contractor Signature /et), \i'600) Date
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Springfield Building Permit 4/24/2013 8:37:06AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
OREGON TRANSACTION RECEIPT Spnngfeld,OR97477
541-726-3753
811-SPR2013-00828
wvnv.spnngfieldocgav 1492 10TH ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013000817 RECORD NO:811SPR2013.00828 DATE:04/24/2013
le]4YN:71a a; "2121±1::;1-4 Jr--..724-1.1: -, "'ACCOUNT CODE/TRANS-CODE _,_ -'AMOUNT DUE.t
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
N9PAYMENTAWPEAYOWlarriaThaTagalIMMENTOCIIMEAMKOMOMPUNTEREatifffigai
Credit Card lawrence phillips 97.70
364111
TOTAL PAID: 97.70
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