HomeMy WebLinkAboutPermit Plumbing 2013-5-8 •
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SPRINGFIELD- - 225 Fifth St
1 c CITY OF SPRINGFIELD Springfield,OR 97477
-2o ecoN Phone: 541-726-3753
Building / Commercial Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00907
www.springfieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/08/2013 EXPIRES: 11/03/2013
STATUS DATE: 05/08/2013 APPLIED: 05/08/2013
SITE ADDRESS: 205 DORRIS ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1803020000802 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION: Sewer ling to septic tank
OWNER: - WILLAMALANE PARK&REC DIST Phone Number:
ADDRESS: 250 S 32ND ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor CASEY JONES WELL DRILLING CO INC CCB 114437 06/07/2014 541-747-2806
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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`S.rusk ._ _. � 6672 -3
Owne or Contractor Signature Date
ATTENTION: Oregon law requires you to
Utility
NOTICE:
Notifi at oln Centerr Those the
ruble
ages t forth
THIS PERMIT SHALL EXPIRE IF THE WORK . in OAR 952-001-00.10 through OAR 952-oot-
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
COh FENDED OR IS ABANDONED FOR calling the center. (Note: the telephone
ANY 1 SD DAY PERIOD. number for the Oregon Utility Notification
Center is 1-800-332-2344),
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Springfield Building Permit 5/8/2013 8:55:59AM Page 1 of 1
SPRINGFIELD-- CITY OF SPRINGFIELD
.I TRANSACTION RECEIPT Sp5 ngfielaoR9477
` �.
OREGON 541-726-3753
811-SPR2013-00907
viww 205 DORRIS ST
spring(eldar.gov permitcenter @spdngfield-or.gov
RECEIPT NO: 2013000899 RECORD NO: 811SPR2013-00907 DATE:05/08/2013
do73�'M:71 a1 4 1_ 1__ t z. ACCOUNT CODEFF-;NS:CODE 'actli.AMOUNT DUE.
Sanitary sewer 224-00000-425603 1005 83.50
Sanitary sewer-each additional 100 feet or portion of 224-00000-425603 1005 21.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 12.54
Technology fee(5%of permit total) 100-00000-425605 2099 5.23
TOTAL DUE: 122.27
.P,AYMENT.97YPE P.AYOR. . cgsNiER:.ccnRPEnreR -;2 COMMENTS. AMOUNTIOID ,
Credit Card Jacob Risley 122.27
055694
TOTAL PAID: 122.27
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- 'Plumbing Permit Application DEPARTMENT USE ONLY
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ITITY OFdSPRINGF+IELE�}REGON t r Pemut no Si
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: S O/((
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.PROVAL4 ):7Aia >if '
. ' +c.#.r -Cilli;; ;V:V€TheitFEEcISPFIEDLILERWIWI4Ma
Zoning approval verified? ❑ Yes ❑No D'escrlption11-1, §'n4,"^ ° Qty` 7,4--tCosty� : Total
Sanitation approval verified? ❑ Yes ❑No " �` .`itr``I7it. '� _t'•"t 457 f"' :“.5,./:‘`•- a , ,cost.,
New residential
CATEGORY,OF"CONSTRUCTION y at =: I bathroom/1 kitchen(includes:first
❑Residential ❑Government ❑ Commercial 100 feet of water/sewer lines,hose
bibs, ice maker, underfloor low point $262.00 $
:1OB''SITE:INFORMATION;'AND LOCATIONS w x drains and rain-drain packages)
Job site address: 2,0c 00/4-4,5 -(. . 2 bathrooms/1 kitchen $411.00 $
City:C \- flcta.YO State: Ol'Z ZIP: �- 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference:'T) g.z c-, 12.gNU.1` Taxlot.: e502—2 Each additional kitchen(over 1) _ $104.50 $
5z- ,.Y -.0:;i' DESCRIPTION 'OF WORK:'' '-, bw Kr."": Residential fire sprinklers(includes plan review)
ZNSt&t L_, (50 op HP, In/ct2 to n'r to 0 to 2,000 square feet $80.00 $
�, WW1 To S e.-P1 IL TA_N� 2,001 to 3,600 square feet $128.00 $
r :',79 ewi{.!, ^ 'PROP.ERTW'OWNER'.':[ s ; ef[f`+,7 fi 3,601 to 7,200 square feet $192.00 $
Name' AYE 'gtci-r-v /wl wiiv ,, - fv�
7,201 square feet and greater $255.00 $
I6 Manufactured dwelling or pre-fab(circle one)
Address: ..2q) S. - Connections to building sewer and
water supply $80.00 $
City:'21,ct, Ft.10 State: de_ I ziRci4sitt ZIP:
Commercial,industrial,and dwellings other than one-or
Phone941-1-75 _ 401.1-ct I Fax: - - two-family
E-mail. RI` WI tkan toadovc, oat, 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 I exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line I $83.50 se?'Lb
Signature: Each fixture, appurtenance,and piping r $21.00 $ 24
.`'.' `.'rICONTRACT,ORt`.1INSTALLATION V ii Storm water retention/detention facility $21.00 $
fj
Business name: C,5- r M �l Irrigation systems $21.00 $
L Piping or private storm drainage $21.00 $
Address: 'p,0, &jam, gi I q_ systems exceeding,the first 100 feet
City: re ,g« State: OE- ZIP:ci1tksc Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone..jli 19-1- — 29t20 Fax: - - Special requested inspections(no,of
E-mail: hrs.x fee per hr.) $80.00 $
CCB license no.:O[442lr BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no.: _FPMedical gas,prpmg r fifitg 4 - s Minimum fee $
Print name: - Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature: ;.. 3 ITIOIINA' LICANUUSEytiata y n ' ,`4!
' (A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $//07``
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ f2 5`-/
(D)Technology Fee(5%of[A]) $ /S=5
TOTAL fees and surcharges(A through D): $/2-Z
440-2500-1(4/1/2013/COM)