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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 • OWNER: HARTSOCK STEVEN DALE&JULIE-MARIE N Phone Number: ADDRESS: 1125 9TH ST • 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 • '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 • calling the center. (Note: the teleph rio number for the Oregon Utility Notification Center is 1-800-332-2344). • 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 • Plumbing Permit Application DEPARTMENT USE.ONLY „,•, SPRINGFIELD a2 -+_} CIF�SPRINGFIEL�4OREGON Permit no.:S l — _., ..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) __