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Permit Plumbing 2013-5-15
• SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 �• ecor4 Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00963 xww.springfield-ar.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/15/2013 EXPIRES: 11/10/2013 STATUS DATE: 05/15/2013 APPLIED: 05/15/2013 SITE ADDRESS: 1024 PLEASANT ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703264104800 • TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Repair Kitchen plumbing OWNER: SHAW CHRISTINA M Phone Number: ADDRESS: 1024 PLEASANT ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type . Lic No Lic Exp Phone Plumbing Contractor DAVIS BROS GENERAL CONTRACTORS INC GCB - 63275 04/06/2014 541-501-0877 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 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. 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 number for the Oregon, t Itillty Notification ANY 180 DAY PERIOD. Center is 1-Sflc-332-2344 Springfield Building Permit 5/15/2013 8:47:02AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD • �. 225 Fifth St ` EGON TRANSACTION RECEIPT 5prngfield,OR97477 541-726-3753• 811-SPR2013-00963 www.springfield-ar.gov 1024 PLEASANT ST permimenter @spdngfield-or.gov RECEIPT NO: 2013000950 RECORD NO:811-SPR2013-00963 DATE:05/15/2013 1.14: -ItACCOUNTmCODFJTRANS 'AMOUNT DUE Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 38.00 Fixture 224-00000-425603 1005 42.00 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 PAYMENT.TYP,E. PAY here IER.-dtn e 'COMMENTS -AMOUNT PAID Check DAVIS BROS GENERAL CONTRACT( 93.60 5557 INC TOTAL PAID: 93.60 Plumbing Permit Application ;DEPARTMENT USE ONLY "-, iiSIIIII1iIWiI'1 �,..�.s, .St l 3 0 9 )-Permit no.: ( � o 5 C//5 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 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 APPROVAL 1 ,4 FEE' SCHEDULE , r,k ^" " h" Zoning approval verified? ❑ Yes ❑No 'Description At Q�„ •,iCost Total.;` Sanitation approval verified? ' ❑ Yes ❑ No New residential ';CATEGORY' OF CONSTRUCTION , r I bathroom/1 kitchen(includes:first ❑Residential ❑Government ❑Commercial 100 feet ofwaler/sewer(roes;hose bibs, ice maker, underfloor low point t $262.00 $ JOB^SITE'tINFQRMATION AND LOCATION „"_a drains and rain-drain packages) Job site address: nay pkci #a - 2 bathrooms/I kitchen $411.00 $ City: lj P(_f State:QR ZIP:S 77 3 bathrooms/1 kitchen $483.00 $ Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ t DESCRIPTION' OF WORK : ,«07n Residential fire sprinklers(includes plan review) 11 i<.c. 166-str nG a K �-0/sit/to 0 to 2,000 square feet $80.00 $ v FN`S 2,001 to 3,600 square feet $128.00 $ aSi tut: ) Q S PW RO PECRTTc Y a;OnWd NUER A H( rt 3,601 to 7,200 square feet $192.00 $ Name: / ,�....// 7,201 square feet and greater $255.00 $ �h f 9 hewn - Qi w Manufactured dwelling or pre-fab(circle one) Address: 0 24 /"/e n-7" Connections to building sewer and City: '5 / State: (+)! ZIP: 9/11.77 water supply than $ -N 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 -$83.50 $ Signature: Each fixture,appurtenance,and piping Z. $21.00 $ `'` :t' ,.,. =. iCONTRACTOR°'INSTALLATION 1L'45 Storm water retention/detention facility $21.00 $ Business name: —� /J Irrigation systems $21.00 -$ PO�8in S Pe f(t sr 0 A (A F'l In i:Ai ) Piping or private storm drainage Address: /'O f3,�>C- 700 3 z-. -' systems exceeding the first 100 feet $21.00 $ City: f g7�7 State: ZIP: Specialty fixtures $21.00 $ Phone: Fax: - - Reinspection(no.of hrs.x fee per hr.) $80.00 $ �y�'�S�- f©10 Special requested inspections(no.of E-mail: hrs.x fee per hr.) $80.00 $ CCB license no.:Az.Z'S BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no.: .Medical gas piping., . 2a " ,,``^ Minimum fee $ Print name: _ _ Enter value of installation and equipment$_, Enter fee based on installation and equipment value. $ Signature: �, j/ - -,� ,- u ti )� I .,.4 yr;APPLICANTroUSE,. . 'ru . + ? (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 3 6= 440-2500 4(4/1/2013/COM)