HomeMy WebLinkAboutPermit Plumbing 2013-6-10 SPRINGFIELD- 225 Fifth St
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`` CITY OF SPRINGFIELD Springfield,OR 97477
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Phone:541-726-3753
ORES°" Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR201 3-01 21 4
www.springfeldor.gov - permitcenter @springfield-ocgov
PROJECT STATUS: Issued ISSUED: 06/10/2013 EXPIRES: 12/06/2013
STATUS DATE: 06/10/2013 APPLIED: 06/10/2013
SITE ADDRESS: 5599 B ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702334202901 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: extending line to new meters both units 5597 and 5599 B.
OWNER: PARKER CLAY D II&KATIE DONALEE Phone Number:
ADDRESS: 422 S 37TH ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION 1
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor JENCOURT ENVIRONMENTAL SERVICES LLC . CCB 182531 06/11/2014 541-689-1711
INSPECTIONS REQUIRED II
Inspections
3315 Water Line
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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
construcioon.
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to rl{CTICE:
follow rules adopted by the Oregon Utility ;HIS PERMIT SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- .UTFIORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the teleph:.i i ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 6/10/2013 1:34:04PM Page 1 of 1
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SPRINGFIELD
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` . TRANSACTION RECEIPT CITY OF SPRINGFIELD
225 Fifth St
Springfeld,OR 97477
OREGON 541-726-3753
811-SPR2013-01214
wvnv.springfieldor.gov 5599 B ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001177 RECORD NO:811 SPR2013.01214 DATE:06/10/2013
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Ie1X.Yo1-71�hi[o]'�... ,i<' #r�v_�_ ""(`�--4 �..L�:. I :+�{.."���oio�ol�l'btCODE/TRANSCODE�..:.�fxw. '��.a.',. . OUNT DUE :.I
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
Water Line 224-00000-425603 1005 83.50
TOTAL DUE: 97.70
PAA!!EN111WE P.AYOR CASNIER:.JL'ARSON COMMENTS 'AMO_UNTON
Check JENCOURT ENVIRONMENTAL 97.70
1168 SERVICES LLC
TOTAL PAID: 97.70
Plumbing Permit Application DEPARTMENT USE ONLY
5; �„ tom. SPRINGFIELD '`
= CIT OcSPRING IEWDRE60 Permit no �/l 2c 13 Ol Z 11
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: •/ 0 ' ,20 _ ?
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 APPROVALF- )'f RE fy,±W `1, ;'FEE;IS_CHEDULIE '; , ".
Zoning approval verified? ❑ Yes ❑No . i ' -' ;..4. a Qy _ C ost ('Toal 'Descrption 1 fr t ' .
w w a alrsz.,".., I Z , _ . ;'2 ea . fe45t a
Sanitation approval verified? ❑ Yes ❑No New residential
'TttATEGORY OF.'=CONSTRUCTION >i'* r r.:+
I bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
residential ❑ Government ❑ Commercial $262.00 $
bibs, ice maker, underfloor low point
fi', "JOB`SITE INFORMATION:,AND, LOCATION?'r4 �,` drains and rain-drain packages)
/6-5.-2,9" 2 bathrooms/1 kitchen $411.00 $
Job site address: �$.5�/� �3
Ci State:/IJ ZIP: /1 3 bathrooms/1 kitchen $483.00 $
Ty 57fl `-"" ��7�fl Each additional bathroom(over 3) $104.50 $
Reference: - Taxlot.: Each additional kitchen(over 1) $104.50 $
r4 '- ` ''':'''DESCRIPTION "OF WORK`'a'4' n `:?S. t Residential fire sprinklers(includes plan review)
(
Zvi/ter /J ageace 0 to 2,000 square feet $80.00 $
i7l_itc) � -a 2,001 to 3,600 square feet $128.00 $
<x : \t19.1,ROPERTY.=OWNER `r[�t. ti .r�I ' "- 3,601 to 7,200 square feet $192.00 $
Name: �ark«- G L/r `r /, f ( L 7,201 square feet and greater $255.00 $
/ -5 ,�-/ ( / • Manufactured dwelling or pre-fab(circle one)
Address: 22 S. :- 7 Connections to building sewer and
water supply $80.00 $
City: 5 or Li) State: ZIP: Commercial,industrial,and dwellings other than one-or
Phone: - - I 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 $21:00 $
?i . 1,CONTRACT.ORt'INSTALLATION+ .i'f,,r ai` ;z fm Storm water retention/detention facility $21.00 $ -
Business name: j///Cco fG I 6y/1//I� J��
Irrigation systems $21.00 $
- y�� Piping or private storm drainage
Address: • 0.55' 7 systems exceeding the first 100 feet $21.00 $
City: G u4t c I State: I �ZIP:9)gi.".9 Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phongt /2/f I Fax: Special requested inspections(no.of
E-mail: - h x fee per hr.) $80.00 $
hit
CCB license no.:/g2 G3/ I BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no.: y6'Acc-C P Medicalgas plpmg , 7 a V.9 Minimum fee $
_ Enter value of installation and equipment$ .
Print name:
��L / O,bej,U,/ Enter fee based on installation and equipment value. $
Signature: // P g,L '§r " 3 ` APPLICANTINOWE , : -t—ta--
`�U/ (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): sq 732--
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440-2500-1(4/12013/COM)