HomeMy WebLinkAboutPermit Plumbing 2013-6-6 -
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-SPR2013-01177
www.springfield-or.gov permitcenterarspringfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/06/2013 EXPIRES: 12/02/2013
STATUS DATE: 06/06/2013 APPLIED: 06/06/2013
SITE ADDRESS: 477 FAIRVIEW DR,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274100101 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: 35 feet of sewer line on private property
OWNER: HOUSING AUTHORITY 8 URBAN Phone Number
ADDRESS: 177 DAY ISLAND RD
EUGENE OR 97401
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CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor EMERALD EXCAVATING INC CCB 14173 07/14/2014 541-345-1505
L INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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.
` Kete. ., L.47/3
Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to NOTICE.
follow rules adopted by the Oregon Utility • THIS PERMIT
Notification Center. Those rules are set forth AUTHORIZED SHALL EXPIRE IF THE WORK •
in OAR 952-001-0010 through OAR 952-001- COMME UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by NCFD OR IS ABANDONED FOR
calling the center. (Note: the teleph;:-3 ANY 18Q DAYPER10D.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit • 6/6/2013 10:18:11AM Page 1 of 1
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• SPRINGFIELD" -- CITY OF SPRINGFIELD
225 Fifth St
' tORE GON TRANSACTION RECEIPT Spnngfield,OR 97477
541-726-3753
811-SPR2013-01177
www.spnngfield-or.gov 477 FAIRVIEW DR permitcenter @springfield-or.gov
RECEIPT NO: 2013001137 RECORD NO:811-SPR2013-01177 DATE:06/06/2013
1o] Ya llallaolif t tp;m•'a a F !P'tt, .1,; 11 t tai!;'w' $ ; ACCOUNT CODE/TRANS CODE :_: aC t-i',teAMOUNT 111
Sanitary sewer 224-00000-425603 1005 83.50
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
TOTAL DUE: 97.70
WAYmENtWOE PAY.OR scaswrR7Par OH�a�. COMMENTS ,_ 4M_OUNTRAID�
Credit Card Emerald Excavation 97.70
216002
TOTAL PAID: 97.70
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,.,,,...„. . _, . ... .,
Plumbing Permit Application :3-..:.;•=-OE P.ARTM ENT USE ON LrlY
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lEGITY1,0PSPRINGFIEti-M_GREGONW "t- -- ----ta, Permit no.: fitI2c,1- ei°a 7
. :103311taZaIlarg*Q.:Ae4Wilfc:iii4,,ti:Marzn,,45:44 It:1:.4.:;`: . * ''t..
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: G /C?//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.
H: .:',,S'?:`-. ILOCACOOVERNMESIT.,SARP ROVALWriajaa itlf:VIgigt:IiCn±t.F.i.C$ItTEE!1,1SCITIEDULEffilikV:W:gPigk: MI
Zoning approval verified? El Yes n No Q@, ,.
cw..070
974gti r /1
ea -gl!costn
Sanitation approval verified? 0 Yes 0 No New residential i
CATEGORY OF'CONSTRUCTION - 1 bathroom/I kitchen(includes.first
100 feet of water/sewer lines, hosei
'Residential El Government El Commercial bibs, ice maker, underfloor low-point $262.00 $
:."i1C)BYSITE)INFORMATIO N,-AND. LOCATION 4f;'-`*!"0"; drains and rain-drain packages)
Job site address: 411 FA i(?...Ai)tenj TA- • 2 bathrooms/I kitchen \ $411.00 $
3 bathrooms/I kitchen $483.00 $
City: 5pfa iv.-i&-Fie..7.42) State: 0A,, ZIP: 1190-
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) : $104.50 $
:%:-?:7*i:!:.11.01-5,:',tRfiDESCRIPTION,.'0F:::-INORK4Mr^.$1;;MW,St Residential fire sprinklers(includes plan review)
Snw./:7,9a.c/ c.rwci2, Rick 4,ce nic-----,7 i 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
:.?',f:-“ITIWt!Ilt!!V5/.`PROPERTY4OVVNEW:.::;:e.VgAirweel 3,601 to 7,200 square feet $192.00 $
7,201 square feet and greater $255.00 $
Name: EICUsgrio- *JO CO wtonv u,■rl <calf!cEq 4
Manufactured dwelling or pre-fab(circle one)
Address: --7 cc Fa,D-JA e---) ripit. ' Connections to building sewer and
$80.00 $
City: 5.(3/2,,e.—q,-F teal) State: 0/2. , ZIP: water supply
Commercial,industrial,and dwellings other than one-or
Phone6211(-az_ 6:43 , Fax: - - two-family
Minimum fee $80.00 $
E-mail: :
Each fixture , $21.00 $
This installation is being made on residential or farm property
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 1 $83.50 $
Signature: Each fixture, appurtenance,and piping $21.00 $
CONTRACTOR';INSTALLATI ON c:;'°,10•40Ciar Storm water retention/detention facility $21.00 $
---
Irrigation systems $21.00 $
Business name: p....e.QA-g--b acA tiel-ruie,- 7,....36 .
Piping or private storm drainage '
Address: 4260 W. 4 I'Ll kat , systems exceeding the first 100 feet $21.00 $
Specialty fixtures 1 $21.00 $
City: Etertrn/a State:CA, , ZIP: c 7y02_ , tu
Reinspection(no.of hrs x fee per hr.) $80.00 $
Phone411I-PC- /ft 5" Fax ig19 ` Special requested inspections(no.of
$80.00 $
E-mail: 70 cig C re Ent e re-, /a/ eAC ,c0-1,-,4 , hrs.x fee per hr.)
CCB license no.: P-1/7 3 , BCD license no.: Each additional inspection:(1) $80.00 $
. . .-2-a:/ ,,,4A • •
Plumbing license no.: .iMedicalgas piping&,;,4:ii:/Aac.itti+iiiv Minimum fee $
Enter value of installation and equipment$
Print name: A oz.,er L.. k,te be/ ,
. Enter fee based on installation and equipment value. $
Signature: 45/ervi ,. e. twt....4.(2 \ - i itsTr7;f.j...:twit.7-4Talkti 0 4Stillig Eirear.'.:': -.1.
(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]) $
(D)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through D): $ 77 7-2-
440-25004(4/1/2013/COM) '