HomeMy WebLinkAboutPermit Plumbing 2013-6-17 SPRINGFIELD 225 Fifth Si
....sattaii
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-SPR2013-01299
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/17/2013 EXPIRES: 12/13/2013
STATUS DATE: 06/17/2013 APPLIED: 06/17/2013
SITE ADDRESS: 1436 SEQUOIA AVE,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703273309100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Adding Shower on Septic
OWNER: MYERS TERESA L Phone Number: .
ADDRESS: 1342 CENTENNIAL BLVD
SPRINGFIELD OR 97477 '
. CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor SCHIRMER ENTERPRISES INC CCB 169413 03/30/2014 541-485-1949
INSPECTIONS REQUIRED
Inspections •
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.
�_ 0 //,3
Owner or Contractor Signature Date •
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE:
•
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF NEWORK
in OAR 952-001-0010 through OAR 952 001- AUTHORIZED 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 +_�=.
number tor the Oregon Utility Notification ANY 180 DAY PERIOD.
c,_,r.t:?,r is 1-a0+;-s•.,2-Nona).
Springfield Building Permit 6/17/2013 10:55:02AM Page 1 of 1
•
SPRINGFIELD -- - CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spdngfield,OR 97477
r t 541-726-3753
OREGON 811-SPR2013-01299
www.spdngfieldor.gov 1436 SEQUOIA AVE perrnitcenter @springfield-ar.gov
RECEIPT NO: 2013001248 RECORD NO: 811-SPR2013.01299 DATE:06/17/2013
DESCRIPTION a "L`i : x'f5__ £` f7`t _ 'ACCOUNT CODEITRANS CODE s. AMOUNTIDUE K
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00
Shower/Shower pan 224-00000-425603 1005 21.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
PAYIIAENTTYP.E PAYOR' casrlleR:.luRSON° OINMENn 4049UNTOPAIDSM . - '°
Credit Card Teresa Myers 93.60
561747
•
TOTAL PAID: 93.60
•
•
•
Plumbing Permit Application r DEPARTMENT.USE ONLY=?
HPRWJOFIELO '+-
`` C' TY OF SPRINGFIELD OREGON;� Permit 13/(10/3 0 (act
*
225 Fifth Street• Springfield,OR 97477•PH(541)726-3753 •FAX(541)726-3689 Date: G /( // 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.
Aila , .-. LOCAL,;GOVERNMENT_APPROVAL, ,, ';',",,MA -:-. 4". ,=::,,,:,9 ,,R,1FEE=SCHEDULE S: .•-e, .. . � .;_;,
Zoning approval verified? ❑Yes ❑No :Description ` r Qty. Cost" Total,• 'ea: cost,
Sanitation approval verified? ❑Yes ❑No New residential
CATEGORY'OF-CONSTRUCTION, , , . , . I bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
*Residential ❑Government ❑Commercial bibs, ice maker, underfloor low-point
$238.00 $
JOB SITE INFORMATION AND:LOCATION' drains and rain-drain packages)
Job site address: / L3(0 6 E1 U U/A AVE 2 bathrooms/1 kitchen _ $374.00 $
City: Gegi,1 L� q bathrooms/l kitchen $439.00 $
Ci AI Stale: ZIP: /�� Each additional bathroom(over 3) $95.00 $
Reference: Taxlot.: Each additional kitchen(over I) $95.00 $
DESCRIPTION OF WORK "-)��:�� Residential fire sprinklers(includes plan review)
4;'I�. l a �„ - In e. i 5*(q YZ Poi i 0 to 2,000 square feet $58.00 $
I n Fci ine i / 2,001 to 3,600 square feet $116.00 $
--24-- I 'It;I P/R�OPERvT/Y YEAS _ 3,601 to 7,200 square feet $174.00 $
Name: _r.-ZESA M 1 EAS 7,201 square feet and greater $232.00 $
AVE Manufactured dwelling or pre-fah(circle one)
Address:(/4342 SEQUOIA Y 1 A Connections to building sewer and $58.00 $
City: ScI-DI Nb Piew igg74- water supply
Ci F t` State: ZIP: Commercial,industrial,and dwellings other than one-or
Phone:;lit-eil`A 3100 0 Faxx: - /!- two-family
E-mail: LMSMYERS 0 GI J E_ COMVl Minimum fee $58.00 $
This installation is being made on residential or farm property Each fixture $19.00 $
owned by me or a member of my immediate family,and is Miscellaneous fees
exempt fro/ u menty der OAR 918-695-0020. 100'storm,sewer,water line $76.00 $
Signature:Z-'— /7/7]�-- Each fixture,appurtenance,and piping $19.00 $
CONTRACTOR INSTALLATION _ :. Storm water retention/detention facility $19.00 $
The, Plumbing �b r F-1S Irrigation systems $19.00 $
Business name: J Piping or private storm drainage
i71j f r . 1, (- $19.00 $
Address: t 1 U`f Vll tc systems exceeding the first 100 feet
City: ELA W� State: Z ZIP:q 4O Specialty fixtures $19.00 $
�V 4g — /O / 1/ 4185 A,, Rcinspection(no.of hrs.x fee per hr.) $58.00 $
Phone: Fax: ✓ (JCf Special requested inspections(no.of
E-mail: IC/(ACK-Fa (D£ on'ca.s''f, net- hrs.x fcc per hr.) $"5�8�.00� $
Each additional inspection:(1) _5500 $ jf
CCB license no.: ����� BCD license no.: '— /' �'� (�
Plumbing license no.: /6,1 4/3 ;Medical gas piping , , Minimum fee $
Print name: �u a ar)i i Kmeg Enter value of installation and equipment$
J Enter fee based on installation and equipment value. $
Signature: -
d' ty�_.,"""a � �..fl,APPLICANT��USEQxr x'ar '=al, & ...`
(A) Enter subtotal of above fees '1
. (Minimum Permit Fee$58.00) $7j U----
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ 7°
(D)Technology Fee(5%of[A]) $ /I 00
TOTAL fees and surcharges(A through D): $ f 364
440-2500-3(11/08/COM)