HomeMy WebLinkAboutPermit Plumbing 2013-6-10 SPRINGFIELD... 225 Fifth St
14.1 - CITY OF SPRINGFIELD Springfield,OR 97477
s t Phone: 541-726-3753
OREGON Building / Residential Permit - Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 81 1-SPR201 3-01 21 6
www.springfield-or.gov pe rmitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/10/2013 EXPIRES: 12/06/2013
STATUS DATE: 06/10/2013 APPLIED: 06/10/2013
•
SITE ADDRESS: 3781 JASPER RD,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1802061309703 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New water line
OWNER: RIEL RODNEY GEROGE 8 H H Phone Number:
ADDRESS: 3910 RICHLAND
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
3315 Water Line
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.
/Silt 4 4 G — 0 l 3
Owner or Contractor Si. ature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility U �IOE
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUl HORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the teleph::s
number for the Oregon Utility Notification C0R4MENCEp OR IS ABANDONED FOR
Center is 1-800-332-2344).
ANY 180 DAY PERIOD.
•Springfield Building Permit 6/10/2013 2:07:33PM Page 1 of 1
SPRINGFIELD crry OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield.OR 97477
etig 541-726-3753
OREGON 811-SPR2013-01216
www springfielchor gov 3781 JASPER RD permitcentergspringtield-or gov
RECEIPT NO: 2013001179 RECORD NO: 811-SPR2013-01216 DATE:06/10/2013
tDESQMPTION:: Adobbi■ifcctbiANt_croptiz ",4;!fli5)Aividiistbi,E:11.
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
LPAiiMENT TYPE„ ::::—.:EPA-Seok/-eASHI612156-ARFE'NTEW,::>±:q; COMMENTS irlk,7j7,A',..;AMPUNTPAIDIC? Y-1.1
Credit Card RIEL RODNEY GEORGE&M H 97.70
018876
Credit Card RIEL RODNEY GEORGE&M H 122.27
018876
TOTAL PAID: 219.97
, Plumbing Permit Application i.c:--*CIEPARTMENT USE ONLY1-'t
' !"*:!'etIF-VOESPRINGFIELIraiREGON:a1. :k-:,11--"Patan-4% Permit no I3 —
. aNstVid:i4V.Ikagtit;IiiiNft4.1cOat.Wfa4';;;;?; `.]::4: •3/4,. Mi Ni
. ' 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 67.704 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.
LOCAL:GOVERNMENT:APPROVAILOP %,:liA957iig,lgWOMFEE.?),SCHEDUEIEIti.XV;kr,,MWteit
-.4t .4-4:, f-,ei:ft!:' ,:k' :1 ''-',' ,7,1-6 4
Zoning approval verified? EI Yes E No '21/eSeititiOn• ,,",-.'l'ilt? 1',:11(t.t.."7.,4 Qty:A ccc..t,±-,,, ,.„ 9, I
',1A,+ ■t,tli,519i);4::::''' '');TI-i:4:az:::;.': .1:Ti,:tte::,b,..f:i.::/;':.eA:-..;:=-. ').',costi.:1
Sanitation approval verified? Ill Yes El No New residential _
CATEGORY OF;ttiNSTRUCTION .i.4%ItWs: I bathroom/1 kitchen(includes-first
100 feet of water/sewer lines, hose
Residential 0 Government 0 Commercial bib s. ice maker, underfloor low-point $262.00 $
X:Ci)24OBSITEllNEORMATION..AND. LOCATIOt■ ak drains and rain-drain packages)
r c--- .
Job site address: K?cf9 I j se Per kd 2 bathrooms/1 kitchen $411.00 $
3 bathrooms/1 kitchen $483.00 $
City: coy- ,..,9 #c(J Statitir r I ZIP:677 V 7G
Each additional bathroom(over 3) $104.30 $
Reference: t Taxlot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION 0.F.,WORKAV."A:.-;fit;gMk Residential fire sprinklers(includes plan review)
/AAA) 1AT ci k v 1._ $ vl. e 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
iE-1:50:21::;tzc‘,1*-1.OROR ERTY4OWNEW:.::MVECaftW5 3,601 to 7,200 square feet $192.00 $
Name 7(0 d R ‘f 7,201 square feet and greater $255.00 $
,--' ", Manufactured dwelling or pre-fab(circle one)
Address: 7 78,4 ,1 7 ye K- k d Connections to building sewer and
$80.00 $
in water supply
City: i"-, .,,i q re 0 SiateOr ZIP: 97 V7Wii
Commercial, industrial,and dwellings other than one-or
Phone: Scri-P)0,76-/70 V Fax: - - two-family
E-mail: rl e I e co rn ra sTfrie I" Minimum fee $80.00 $
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 's Miscellaneous fees
exempt from licensing re.uirements under 0 •-• 9 :-.9 -0020. 100' storm,sewer,water line / $83.50 $
Signature:
V Each fixture,appurtenance,and piping $21.00 $
t.f:•lif . ".: ''.'lll IN MIA- 'ION catafrt, , Storm water retention/detention facility $21.00 $
Business name: 0 cit/leu24/- Irrigation systems $21.00 $
Piping or private storm drainage
Address: systems exceeding the first 100 feet $21.00 $
City: State: ZIP: Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone: - - Fax: - -
Special requested inspections(no. of
$80.00 $
E-mail: hrs.x fee per hr.)
CCB license no.: BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no T,Methca1gasiptpIng,ts,,Atimr;:b3411n;4 Minimum fee $
Print name Enter value of installation and equipment$ .
:
Enter fee based on installation and equipment value. $
Signature:
nrarairwwAo:PEleafiriffgENNAMTVAI
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $a-3 5.-42
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $02-2-
(D)Technology Fee(5%of[A]) $ 4//b
TOTAL fees and surcharges(A through D): $ 7 t_
440-2500-I(4/1/2013/COM)