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HomeMy WebLinkAboutPermit Plumbing 2013-5-23 • L SPRINGFIELD-� 225 Fifth St • CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 °REGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01048 www.springfieldor.gov permitcentengspringfield-or.gov PROJECT STATUS: Issued ISSUED: 05/23/2013 EXPIRES: 11/18/2013 STATUS DATE: 05/23/2013 APPLIED: 05/23/2013 SITE ADDRESS: 529 W CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703274305805 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Adding a Ice Bin w/Sink OWNER: CENTENNIAL SHOPPING CNTR LLC Phone Number: ADDRESS: 7831 SE STARK ST STE 103 • PORTLAND OR 97215 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor SUSAN JANE ARNOLD CCB 49561 12/16/2014 541-484-3787 • 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.` / 45 -?3 "- / 3 Ow t or Contractor Signature Date • ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- PERMIT IS 0090. You may obtain copies of the rules by C MH` ORIZ D OR-IS S ABAINDONED FOR NOT calling the center. (Note: the telepl- "tri Y 180 DAY PERIOD. number for the Oregon Utility Notification 111 Center is 1-800-332-2344). r Springfield Building Permit 5/23/2013 2:43:21 PM Page 1 of 1 • • SPRINGFIELD CITY OF SPRINGFIELD it `I° Fifth St Fi TRANSACTION RECEIPT 225 225 FifeIQOR97477 OREGON 541-726J753 811-SPR2013-01048 www.springfeld-or.gov 529 W CENTENNIAL BLVD permilcenter@springfield-or.gov RECEIPT NO: 2013001030 RECORD NO:811-SPR2013-01048 DATE:05/23/2013 DESCRIPTION . _`x' ,.,,. !-? . ,i 4 ACCOUNT CODE/TRANS CODE v_.A 4Le' u u ; a Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 38.00 ' Fixture 224-00000-425603 1005 21.00 SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 33.90 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 69.47 SDC:Total Sewer Administration Fee 719-00000-426604 1175 5.17 Sink/basin/lavatory 224-00000-425603 1005 21.00 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: 202.14 PIIPKWENTOWee _ BAYOR casNiea:,iLARSOR= COMMENTS WV TRAIDAMMOVIO Check Benedettis Meat market and Deli 202.14 1683 TOTAL PAID: 202.14 • • • • Plumbing Permit Application DEPARTMENT.USE ONLY `- SCITY-OF S`',PRINGFIELD OREGON] _. Permit no.: F3 ( ad( 3 o (oc(� Kv „y 'u TiginAr iYt.'I S. rrs-`-:1�,eag "amn .,.1`HatThj' �i :%. 1 '� o,' 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: Z 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_P.ROVAL V +i ' ,,, 5= `A:iiii'nigAR F.ELV.S_CI EDULEKA y, i , Zoning approval verified? ❑ Yes ❑No rDeserlptii iS x 7$r45r.s$ `4I $' iCost , }',Total to 617', .. - r�._4: ,v-•3,.` E.c -sue._. qea ,�... cost Sanitation approval verified? ❑ Yes ❑No New residential • ;!CATEGORY ,OF?'CONSTRUCTION 1 bathroom/1 kitchen(includes:first 100 feet of water/sewer lines, hose El Residential ❑Government ©Commercial bibs, ice maker, underfloor low point $262.00 $ s .r, JOBtSITEaINFORMATIION:4AND. LOCATION';:''.';o-fez drains and rain-drain packages) Job site address: 5�" (A7• C. J1e' 3 L_ ]vet 2 bathrooms/1 kitchen - $411.00 $ City: SPet N �tUd State: Q`C– ZIP: 01711-]1 3 bathrooms/1 kitchen $483.00 $ 5 - Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ r t 1 r , ..' -P,'a DESCRIPTIOI COF WORK?^;'n1 is a i` Residential fire sprinklers(includes plan review) I4,s ';a= - —. OF I 1 _6 11`4 0 to 2,000 square feet $80.00 $ Tsr w/sivr/G 2,001 to 3,600 square feet $128.00 $ ,z,,^.a;rl ,{ W1Wy"9'?Ff20PERTYSOWNER}.! e`vr 11M("` ki° 3,601 to 7,200 square feet $192.00 $ � UU 1 7,201 square feet and greater $255.00 $ Name: S()�nSTAW }� Manufactured dwelling or pre-fob(circle one) Address: S.4 ACT- Sl L Connections to building sewer and �// / water supply $80.00 $ - City: �pf(�"L '� State: !)1`� ZIP: 004314 Commercial,industrial,and dwellings other than one-or Phone:' - t- 9c3 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 j $21.00 $ w''^ ,rid.'CONTRACTOR?'INSTALLATION k''{�(�y re Storm water retention/detention facility .$21.00 $ Business name: C\(A wJw 1 -7 l V✓n 1/Y] I�[1_9 Irrigation systems $21.00 $ >C;.') _�/I' Piping or private storm drainage $21.00 $ Address: a�� 7 JcG systems exceeding the first 100 feet City: Y 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.: big(off BCD license no.: Each additional inspection:(1) $80.00 $ w x .,t,e ,i u , i Plumbing license no - P-Medtcal gas plpinve .,s 1,�"# ,. ,' Minimum fee $ .Print name: Enter value of installation and equipment$ . Enter fee based on installation and equipment value: $ Signature: , ! ,trt s a '�,#,`i�@*�^,�tkt'�.� ?` �-�^" rQP_,PLICANTS; USE�,""�; ��'��1��u"*rtnl* ' (A) Enter subtotal of abo ees (Minimum Permit ee$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): $Zo2 /v 440-2500-1(4/1/2013/COM) _