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HomeMy WebLinkAboutPermit Plumbing 2013-5-17 SPRINGFIELD _. 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 ter Phone:Phone 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00989 www.springfieldor.gov permitcenter @spdngfleld-or.gov PROJECT STATUS: Issued ISSUED: 05/17/2013 EXPIRES: 11/12/2013 STATUS DATE: 05/17/2013 APPLIED: 05/17/2013 SITE ADDRESS: 1034 4TH ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703352104000 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace water line OWNER: STERUP CHRISTOPHER&POPPIE Phone Number: • ADDRESS: 1034 4TH ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name • Lic Type Lic No Lic Exp Phone . OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED II Inspections 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. _5 -3773 • Owner or Contractor Sign- re Date • • ATTENTION: Oregon law requires you to • follow rules adopted by the Oregon Utility ''I®TICE: • Notification Center. Those rules are set forth 1-11S PERMIT SHALL EXPIRE IF THE WORK • In OAR 952-001-0010 through OAR 952-001- J?h'ORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by )Mfv1ENCED OR IS ABANDONED FOR calling the center. (Note: the teleph number for the Oregon Utility Notification Y 180 DAY PERIOD. • Center is 1-800-332-2344). • • Springfield Building Permit 5/17/2013 1:17:56PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 541-726-3753 OREGON 811-SPR2013-00989 www.spnngfield-or.gov 1034 4TH ST permitcenter©spnngfeld-or.gov RECEIPT NO: 2013000977 RECORD NO:811-SPR2013-00989 DATE:05/17/2013 •DESCRIPTION , .4u'W" k W 4` ,'' I'Pu,..J°j ;•45. iii.' `:ACCOUNT CODE/TRANS CODE _; ,1,4.t1WAMOUNT.DUE.,: .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 Water Line 224-00000-425603 1005 83.50 I.� TOTAL DUE: 97.70 PAYMENTi.-TYP,E - PAYOR' etatiiER.T,ccARRENTER ,COMMENTS t . AMOUMAID';i.. Credit Card Darden resturants 97.70 804535 TOTAL PAID: 97.70 Plumbing Permit Application DEPARTMENT.USE ONLY CI ,iWOFSSI GFIEL-IS4QREGON Permit no.: .S/ ? ' Y? a.1"-kagaMICARN:t4ZOIRMII411iKe4'451fEW1rti- 10',:"-T arg 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: (7// 7/7I 3 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. ,i'LOCACGOVERNMENT APPROVAL z „ . " tii.-g F EEiISCHEDULEI-ij a q Zoning approval verified? E Yes ❑No ` µre } fir , Cost , : Description } hm s _:-.. Q?y, }" ,ea ; costlb Sanitation approval verified? ❑ Yes ❑No New residential ;CATEGORY,OF;;CONSTRUCTION M;; 1 bathroom/1 kitchen(includes:first } 100 feet of water/sewer lines, hose IQ Residential ❑ Government El Commercial bibs, ice maker, underfloor low-point $262.00 - $ tr1 ,''. ''JOB".'SITE,INFORMATILLON: AND, LOCATION r ' drains and rain-drain packages) • Job site address: /O3 y t/ ciree)- 2 bathrooms/1 kitchen $411.00 $ City: 5p ti yv9.F1E id State:Q R ZIP:9707 3 bathrooms/1 kitchen $483.00 $ / Each additional bathroom(over 3) $104"50 $ Reference: /703 55-D Taxlot c%/a';O Each additional kitchen(over 1 ,, ,,n';` ''=',DESCRIPTION 'CIE>VVORKM: ..tginn Residential fire sprinklers(includes plan review) refi&ce nlcf 14 Wafer Ilse 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ ;M_,..(I,yW(7 r r r,aes, 4 3,601 to 7,200 square"feet $192.00 $ , , ;.1 �•P,,ROPERTY;=OWNER. .t,:s� r���f+t�?.r;, Name: Chi) s S'+'ery)� 7,201 square feet and greater $2$5"00 $ . . ,I �[� "�( Manufactured dwelling or pre-fab(circle one) Address: /O31' 7" S#ttef Connections to building sewer and I ///1 water supply $80.00 $ City: S rl'1�q';t3/t( State: Of ZIP:9707 // Commercial,industrial,and dwellings other than one-or Phone:7rp-5y) - 3y4y / L Fax: - - two-family /'J E-mail: a5leiU 6 07 n1''co irk Minimum fee $80.00 $ This installation is liking 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 r quirem-. i.er OAR 918-695-0020. 100' storm,sewer,water line ! -$83.50 $ V3 Signature Each fixture,appurtenance,and piping ( $21.00 $ ' kCON CT,OR`..:I " ALIATIONfi-e941.10 Mil Storm water retention/detention facility $21.00 $ Business name: ! /' " CI ` Irrigation systems $21.00 $ Piping or private storm drainage $21.00 $ Address: systems exceeding the first 100 feet City: State: ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of E-mail: - hrs.x fee per hr.) $80.00 $ CCB license no.: BCD license no.: . Each additional inspection:(1) $80.00 $ Plumbing license no 1Medical gas,pipmg, „"1, ,tit , , Minimum fee $ Print name: Enter value of installation and equipment$ Enter fee based on installation and equipment value. $ Signature: ,..; �,. .. _... *_ r`,e,.:ret APPLICANISLISE � ,` . (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]) $ /0.7.-°-4: (D)Technology Fee(5%of[A]) - $y/ I TOTAL fees and surcharges(A through D): $ 97 7J 440-2500-1(4/12013/COM) • • Property Owner Statement • Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: FI own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. �/ Or • - I will be performing work on property I own, a residence that I reside in, or a residence that I will ///`����`� reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 64/- IS Weli Print Name of Pe . Applicant • • Signature of Pe I Applicant Date Permit#: S/3 - 91 . / / /D3 1-7 ,„,: , \e . Address: v r sva lO S,iah-/) �- y 74 77 cl y" . Issued by: c 1 t Date: 7/7//.3 59 • This Copy for Permit Offices