HomeMy WebLinkAboutPermit Plumbing 2013-5- •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
,"Siy Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00868
www.springfield-or.gov permitcenter @springtield-or.gov
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PROJECT STATUS: Issued ISSUED: 05/01/2013 EXPIRES: 10/28/2013
STATUS DATE: 05/01/2013 APPLIED: 05/01/2013
SITE ADDRESS: 275 17TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703362404500 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Sewer Line Replacement
OWNER: HOWARD VIRGINIA A Phone Number:
ADDRESS: 275 N 17TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone •
Plumbing Contractor READY ROOTER DRAIN CLEANING 8 REPAIR SERVICE I CCB 92524 02/18/2015 541-744-7991
INSPECTIONS REQUIRED III
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.
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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.
SIT/ 3
Owner or C ractor Signature Date •
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility.
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NOTICE: Notification Center. Those rules OAR 952-001-
n OAR 952 001-0010 throug
THIS PERMIT SHALL EXPIRE IF THE WORK 0090. 952 001 obtain copies of the rules by
AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone
COMMENCED OR IS ABANDONED FOR number fortheiOrego0 3 ti 2 4otification
ANY 180 DAY PERIOD.
Springfield Building Permit 5/1/2013 12:24:19PM Page 1 of 1
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SPRINGFIELD--. CITY OF SPRINGFIELD
jilS I TRANSACTION RECEIPT SpnngeldtOR 97477
may,
' '`REGON 541-726-3753
811-SPR2013-00868
www.spnngfieldor.gov 275 17TH ST pennitcenter @spnngfield-or.gov
RECEIPT NO: 2013000856 RECORD NO:811 SPR2013-00868 DATE:05/01/2013
inpuoifid7.- 2r'7 7.:.....L. ,, t 1,-;,AL: -�,
� 1; St e 7 CODELTRANS COD -1:- ' ', AMOUNT DUE;=':
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
EaiP.AYENT TYPE 'P.AY.OR GAMER:JLARSON ___,.___:-__COMMENTS _:pAMDUNT PAID
Credit Card READY ROOTER DRAIN CLEANING! 97.70
025508 REPAIR SERVICE INC
• TOTAL PAID: 97.70
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Plumbing Permit Application DEPARTMENT_USE.ONLY:
.y, ,cc.w SPRINGFIELD"'V `� c
�'. VIsTI? OF'SPI�GF�IELD REG.ON � t.% Permit no oo (( Zo(3 oo868
, f lA % " '' '�4;ter eA; 114: `'
225 Fifth Street♦ Springfield,OR 97477 • PH(541)726-3753 ♦ FAX(541)726-3689 Date: 51�/ / >
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.
z ' ::.LOCAL' GOVERNMENT, AP P.ROVAli.k0+]''�tx.Mr, `-',.i n... IkI 1^FEE ,SCHEDULE,, ', ' , , , " .,::,`1
s w rr '� '" `` ' .,Cost (Total m
Zoning approval verified? ❑ Yes ❑ No Description " i' '�'"ff 4` , Q '
ty. °.'ea cost''
Sanitation approval verified? ❑ Yes ❑ No New residential
''.`'' .(CATEGORY,OF;'CO- NSTRUCTION rF "`'::' I bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
Residential ❑Government ❑ Commercial $262.00 $
bibs, ice maker, underfloor low-point
,%, . JOB''SITE'=INFORMATIONi'ANEl LOCATION drains and rain-drain packages)
Job site address: � S /7' 5-1 2 bathrooms/1 kitchen $411.00 $
City: rj ys n said Stated)2_ ZIP:c1 7 y-1 3 bathrooms/I kitchen $483.00 $
r 7 Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $
^±"'t ' ,r ( DESCRIPTIONi'OF,WORK`` „Etic`'�-a# s Residential fire sprinklers(includes plan review)
/2p,pIGc-cd Se-tn tr Lt {,ow, iw /.0l„t p.c 0 to 2,000 square feet $80.00 $
y/ t 11 ��,(' 5�" 2,001 to 3,600 square feet $128.00 $
i;,?t '] Tr/Ft, ,KOP.ERTY OWNEW'^s[�',�* c$W x " 0 3,601 to 7,200 square feet $192.00 $
y1 7,201 square feet and greater $255.00 $
�
Name: I ryl 1'11ti Pahoul
1- Manufactured dwelling or pre-fab(circle one)
Address: an S 4-7 Connections to building sewer and
City: 5pcil State: on_ ZIP: ti 7/
water supply $80.00 $
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
exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line gt: $83.50 $
Signature: Each fixture,appurtenance,and piping $21.00 $
icir:g1' , ..'.`..I-CONTRACT.OR''1NSTALLATION g, 4?jwtdrr'^1L`' Storm water retention/detention facility $21.00 $
Business name: Irrigation systems $21.00 $
/2,e4,4,.. 02,04`f /� Piping or private storm drainage
Address: ']0.5.5-7 LI h 4t ) .4 . systems exceeding the first 100 feet $21.00 $
City: - State: ZIP: `j iyUy' Specialty fixtures $21.00 $
-- Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone: -59/- ]9f1-'7 `'11 Fax: - - Special requested inspections(no.of
E-mail: '. hrs.x fee per hr.) $80.00 $
CCB license no.: ,2.S BCD license no.: Each additional inspection:(1) $80.00 $
T
L NC
Plumbing license no "Nedlcal gas pipingAi:lpi-:;:,6i;xyllr.4l,W t
Minimum fee $
Print name: ADD J ,J/ter Enter value of installation and equipment$—
Enter fee based on installation and equipment value. $
Signature: ;',--
, ,,' : -"'C' alt,P_PLICANTItUSE Xt,, IN
(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): $ 7 7 7i-,
440-2500-1(4/12013/COM) •