HomeMy WebLinkAboutPermit Plumbing 2013-5-21 •
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SPRINGFIELD , 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01005
www.springfeld-or.gov permitcenter @springfeld-or.gov
PROJECT STATUS: Issued ISSUED: 05/21/2013 EXPIRES: 11/16/2013
STATUS DATE: 05/21/2013 APPLIED: 05/21/2013
SITE ADDRESS: 384 S 48TH ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702324402400 ' TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Install Backflow Preventer
OWNER: BEDDOW NICK R Phone Number:
ADDRESS: 384 S 48TH ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
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INSPECTIONS REQUIRED
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Inspections
3620 Backflow Device Backflow Device: Prior to covering and provide a copy of the test report on site at the
time of inspection.
3999 Final Plumbing Final Plumbing: Wien 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
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��� ATTENTION: Oregon law requires you to
C �'- `off follow rules adopted by the Oregon Utility
o ,r Notification Center. Those rules are set forth
0090.E ou ay sh
oft e9ru ess by
calling the center. (Note: the telepl...n"
• number for the Oregon Utility Notification
NOTICE: Center is 1-500-332-2344).
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED•UNDER THIS PERMIT.IS NOT
COMMENCED OR IS-ABANDONED FOR
Springfield Building aermit80 DAY PERIOD. 5/21/2013 1:33:11PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
i� • ' - - 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
, �'" 541-726-3753
OREGON 811-SPR2013-01005
www.springfield-or.gov 384 S 48TH ST perrnitcenter@springfield-or.gov
RECEIPT NO: 2013000999 RECORD NO: 811SPR2013-01005 DATE:05/21/2013
IPTION _, ACCOUNT'CODELTRANS CODE =•'- 1� AMOUNTrim-a-
Backflow preventer 224-00000-425603 1005 21.00
Balance of Minimum Plumbing Permit Fees - 224-00000-425603 1005 59.00
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
,.h PAYME ITTYPE; : k_PAYOR.-- CasRIeR:��LARSON w_,_,_;, • COMMENTS. a
Credit Card Eric Osborn EO Landscaping 93.60
00828D •
TOTAL PAID: 93.60
MRY-2O-2013 01:59P FROM:OSBORN 5419982966 TO:54172E3E89 P.2'2
Plumbing Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
Permit no.: e' 3
ebli Z10[005
CITY OF SPRINGFIELD, OREGON
225 Fifth Street • Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 mum( Date: 5J/
/Z///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.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? 0 Yes 0 No Description Qty. Co en.st Total cost
Sanitation approval verified? 0 Yes 0 No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first
100 feet of iealer'setver lines,hose $262.00 $
\0 Residential ❑Government I 0 Commercial bills. Ice maker, underfloor Imv-poinl
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: [7, I 1 r hT 2 bathronms/I kitchen $411.00 $
3dr'I CY,
/ - �_ ��//�� ' o ^�^-1 3 bfllhmums/l kitchen $483.00 $
City:C1 n'L�{•(7rva State: 0� ZIP @'7y / / Each additional bathroom(over 3) $104.50 $
Referen e: , J I Taxiot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential Ore sprinklers(Includes plan review)
I(csk-AA1 ► z-Fink) nY4 )_t' 0102,000 square feet $80.00 $
t" 2,001 to 3,600 square feet $128.00 $
PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $
`;l1/
Manufactured square fd dand greater o $255.00 $
Name: N l.X— 444--- Mnmrsquare f e dwelling dab(circle one
Address: 3. e 4-�'p Connections to building sewer and $80.00 $
11 W I Q1i1� water supply
City: el g,4� - State:(fie. Z(P-• 1 t Commercial,industrial,and dwellings other than one-or
Phone"' [-�j 1 S•-tog- Fax: - - two-family
/�r�r �./�� Minimum fee $00.00 $
E-mail' I I , k i/)/. �/ _ • / I I V II t �Ulll Each Fixture $21.00 $
This installation is being made on resident'.I or farm property Miscellaneous fees
owned by me or a member of my immediate family,and is
exempt from licensing requirements under OAR 918-695-0020. 100'storm,sewer,water line $83.50 $
Signature: Each fixture,appurtenance,and piping $21.00 $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $
�%0 /5 J(1n� /� )11 Irrigation systemstbacalr o"1 1 $21.00 $02t
Business name: t`iV '_.lyy l[A�Lr,ry/(/ v�1 Piping or private storm drainage
VDk l J $21.00 S
Address: systems exceeding the first 100 feet
G? Specialty Fixtures $21.00 S
City: IM,��aOO11, StOte� I ZIP. {�Gy ��� Relnspeedon(no,of his,x fee per hr.) $80.00 $
Phone('T(2,Cored Fat9r.Q(-4c,-p- 1ICto Special requested inspections(no.of .$80.00 S
E-mail: ep l r (70 yl hrs.x fee per hr.)
CCH license no.: 11()C4 CD I' ens 0.:
Each additional Inspection:(I) $80.00 $
Plumbing license no.: Medical gns piping Minimum fee $ -
I � Enter value of inslallnlinn and equipment$
Print name: l/(�- 1�,✓y‘ Enter fee based on installation and equipment value. I $
Signature: / .e / APPLICANT USE •
l/// `/`—' (A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00) Citt7—
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+0)) $1 •(PO
(D)Technology Pee(5%of[A]) $
TOTAL fees and surcharges(A through D): .e-°, tJ'
73 — .
440-2500 4(4/1/2013/COM)