HomeMy WebLinkAboutPermit Plumbing 2013-6-4 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
t Phone: 541-726-3753
` OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR201 3-01 1 52
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/04/2013 EXPIRES: 11/30/2013
STATUS DATE: 06/04/2013 APPLIED: 06/04/2013
SITE ADDRESS: 283 19TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703361313600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace sewer line-110ft
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OWNER: HARTSOCK STEVEN DALE&JULIE-MARIE N Phone Number:
ADDRESS: 1125 9TH ST
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SPRINGFIELD OR 97477
L. CONTRACTOR INFORMATION •
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone •
Plumbing Contractor ROBERT D STORRS CCB 76940 11/08/2013 541-689-7574
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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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'0011:13d AH0 OR t ANt/
• 80103N00NV8F/ SI t10 03ON3lNW0O ATTENTION: Oregon law requires you to
ION SI III/1183d SIHl 830Nf1 O3ZI8OH1nV Notification Center. Those rules are set forth
)IHOM 3lil Al 3UIdX3 llt/HS 11Wa3d SIH! in OAR 952-001-0010 through OAR 952-001-
.33110N 0090. You may obtain copies of the rules by
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calling the center. (Note: the teleph rio
number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit 6/4/2013 9:54:31AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
it-
TRANSACTION�‘ 225 Fifth St
RECEIPT Spnngheld,OR97477
OREGON 541-726-3753
811-SPR2013-01152
www.springfeld-or.gov 283 19TH ST pennitcenter @springfeld-ar.gov
RECEIPT NO: 2013001103 RECORD NO:811-SPR2013.01152 DATE:06/04/2013
11 tlAi a:.:4 r .' APIL �y .- ;f � ,:'___' ` ACCOUNT CODE/TRANS CODE"= r °-'y'AMOUNTDUE`iF.
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
kPAYMENTaTVPE .AYOR., CASHIER.CARPENTER COMMENTS.' ... . . _ AMOUNTP.AID '_
Credit Card ROBERT D STORRS 122.27
09069c
TOTAL PAID: 122.27
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Plumbing Permit Application DEPARTMENT USE.ONLY „,•,
SPRINGFIELD a2 -+_}
CIF�SPRINGFIEL�4OREGON Permit no.:S l
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_., ..M 1 "'� . , £0'S'�"�.'3��_Stf., � sqa: _ .--am'' � / C-� I � 3
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: L
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.
,, L:OCAL GOVERNMENT •APPROVAL :K,,: " ' _ 4 `g
, .F„EEq
SCkIEDULE, W4 : rit,:a ,
Zoning approval verified? fi2 Yes ❑No Description” " F 16.-41 :- s)z Qty east,' c stl a
Sanitation approval verified? ,W Yes ❑No New residential
:•CATEGORY,'OF. 'CONSTRUCTION frt: s� , 1 bathroom/1 kitchen(includes:first
Residential ❑ Government ❑ Commercial
100 feet of water/sewer lines, hose $262.00 $
bibs, ice maker, underfloor low-point
yi;'„ 'JOB'SITE 7,'I N I.0 RMATION. AND `LOCATION'', „;vu drains and rain-drain packages)
Job site address: a i,-3 /v 19 r . 2 bathrooms/1 kitchen $411.00 $
City: $ ,,of -t sig— cVL ZIP: `j 7`( 17 3 bathrooms/1 kitchen $483.00 $
} t4 State: Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $
'1. -,,,y v.N 7.:0:1ESCRIPTION'OF;WORK V r Sx',*„` Residential fire sprinklers(includes plan review)
R.tr 14Lt 01 A S-e-wev Li.44 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
, ,nk x :4? "1, P,,ROP ERTY;OWNER 1411 g in ke''i `I IµG 3,601 to 7,200 square feet $192.00 $ '
Name: $%2'w thet)2(-soc4G 7,201 square feet and greater $255.00 $
Manufactured dwelling or pre-fab(circle one)
Address: 1 )_&7/ Ol y wsa,t_ Connections to building sewer and $80.00 $
City: ,S A-e4 / r State: (�y1 ZIP: n y7) water supply
` Commercial,industrial,and dwellings other than one-or
Phone: l - 724,- 7dO Fax: - - two-family
E-mail: V sk . (..6)-k-- w�utt r L(jv yv Minimum fee $80.00 $
2M
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 require ents under OAR 918-695-0020. 100' storm,sewer,water line 7 $83.50 $ VW)
Signature: F-^aT"�f�[i . Each fixture,appurtenance,and piping / $21.00 $ 2 1
rk-.;: '.:+7CONTRACTOR'=INSTALLATION . ' S.:1 t'w' 'c Storm water retention/detention facility $21.00 $
Business name: PL=fL re c0 S VD 11 c eD - Irrigation systems $21.00 $
qq Piping or private storm drainage
Address: 3/ C 6 m.,y L/hVE systems exceeding thedirst 100 feet $21.00 $
City: lit g-t4& State: Uri. ZIP: 97I4 0 y Specialty fixtures $21.00 $
Reinspection(no.of hrs x fee per hr.) $80.00 $
Phone:(-t 1919 7 57 q Fax: - - Special requested inspections(no.of
E-mail: /, hrs.x fee per hr.) $80.00 $
CCB license no.: 7 !G 9 6 BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no Mdicag g r ,4,`i, f ixl Minimum fee $
Print name:
Enter value of installation and equipment$—
Enter fee based on installation and equipment value. $
Signature: 1741V AppLICQNT„OUSEA �?,tfi['`
M
(A) Enter subtotal of above fees
Lae_ /i "w . . (Minimum Permit Fee$80.00) $ /m%
�- {'��'� 2 (B)Investigative fee(equal to[A]) $
;Lit t_ 113 —6 2- 3 7 _ (C)Enter 12%surcharge(.12 x[A+B]) $ /V 3' (D)Technology Fee(5%of[A]) $ ,cz4 .
TOTAL fees and surcharges(A through D): $ )22 2-j—/
1 440-2500-1(4/12013/COM)
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