HomeMy WebLinkAboutPermit Plumbing 2013-6-18 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Oil
Phone: 541-726-3753
" OREGON Building / Commercial Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01259
www.Springfield-or.gov permitcenter @sprin gfield-or.gav
PROJECT STATUS: Issued ISSUED: 06/18/2013 EXPIRES: 12/14/2013
STATUS DATE: 06/18/2013 APPLIED: 06/12/2013
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SITE ADDRESS: 1475 5TH ST,Springfield,OR 97477 SCOPE: Plumbing Only •
ASSESOR'S PARCEL NO: 1703264201201 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Firestation 4 washrack
OWNER: CITY OF SPRINGFIELD Phone Number:
ADDRESS: CITY HALL
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor RYAN THOMAS CONSTRUCTION LLC CCB 188458 10126/2013 541-517-3189
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 re uired inspections are requested at the proper time, that each address is readable from the street,that the
permit card is loc d at the front of the property, and the approved set of plans will remain on the site at all times during
construction.
-r�'-13
Owner or ontractor Signature Date
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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 THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by
calling the center. (Note: the telephat COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
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Springfield Building Permit 6/18/2013 10:58:35AM Page 1 of 1
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' SPRINGFIELD CITY OF SPRINGFIELD
isti
'1 wr.... 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
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sea OItE00N 541-726-3753
811-SPR2013-01259
www.springfield-or.gov 1475 5TH ST. permitcenter @springfield-or.gov
RECEIPT NO: 2013001256 RECORD NO:811-SPR2013-01259 DATE:06/18/2013
!DESCRIPTION__,__- _—____ ____..t... _ _ ___ACCOUNT CODEITRANS_CODE: -_;AMOUNT DUE_
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00
Fixture 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
LPAYMENT TYPE `,PAYOR '=CASHIER ccARPENTER ,• _COMMENTS - -: '. 'm :.,AMOUNT PAID. = - .` ,1
Credit Card RYAN THOMAS CONSTRUCTION LL( ____ 93.60
021984
TOTAL PAID: 93.60
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Plumbing Permit Application DEPARTMENT USE ONLY .-- .
SPRINGFIELD '.*•. ' q- t _
CZz = .OF'SPRi , - FIELfi GREG, , .� n, 3 Permit no.: -1°12 Cct
cit e 4.' xk � L S" *
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: /,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 APPROVAL:] _";, .. -3„4r ifEE'SCHEDULE'{* W l t _tom
Zoning approval verified? ❑ Yes ❑No -Description' 1' ,ter a `"" L+ Qty 42•,:.,4 Cv6.ast's cost) a
Sanitation approval verified? ❑ Yes ❑No New residential
' ' "' CATEGORY' OF. CONSTRUCTION` ' 3- s ,,."=t
1 bathroom/] kitchen(includes:first
❑Residential ❑ Government ❑Commercial 100 feet ofworer/sewer lines, hose $262.00 $
bibs, ice maker, underfloor low-point
1+" JOB`SITE',INFORMATION: AND LOCATION];`; _ r , drains and rain-drain packages)
Job site address: Ic/ 75. J ' Si-..., . 2 bathrooms/1 kitchen $411.00 $
t l n 1 7 • 3 bathrooms/I kitchen $483.00 $
CityS ,Ai i4)0:f State:0 GZ_ ZIP:R P S Each additional bathroom(over 3) $104.50 $
Reference: 170 3 4 a. Taxlot.: C2(t0 l Each additional kitchen(over 1) $104.50 $
IiIII II. *. I7 'DESCRIPTIO OF;WORK?'s" ,,:4 ? ;.v"„ Residential fire sprinklers(includes plan review)
R gt ivt,i( „,f- (4 titmrife/4c,k 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
. r `_ f,P,,ROP,ERTY- OWNERe. 2mi`',e(�fnrar- 3,601 to 7,200 square feet $192.00 $
Na ) r , 7,201 square feet and greater $255.00 $
Name: (] J p.,M
fJ- J 1"-- Manufactured dwelling or pre-fab(circle one)
Address: 7iZ S S4' s - Connections to building sewer and $80.00 $
i' water supply
City: S State: OIL— q� ZIP: / 7k 77 Commercial, industrial,and dwellings other than one-or
Phone: - - Fax: - - two-family ,'O
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 $
°`, � .(?CON//[RACTOR+'INSTALLATION "�'Ir,., 9- ' Storm water retention/detention facility $21.00 $
Business name: j'C: � � £j? A*J3�,l[_L(
Irrigation systems $21.00 $
P Piping or private storm drainage
Address: y'P k 57 Z _ systems exceeding the first 100 feet $21.00 $
City:Sp �1S I State:CA ZIP: 9 7`i 7 7 Specialty fixtures $21.00 $
rr Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone:S`F —SI 7-3 (P9 FaxS-i I 'So,S f'D(
Special requested inspections(no.of $80.00 $
E-mail: ✓yp-L14 el o tAo/ CO cc$tl k 1 ..(Pvtn hrs x fee per hr.)
CCB license no.: 14 yS8 BCD license no.: Each additional inspection:(I) $80.00 $
Plumbing lice[lse n Medicalg s`pipmg4 .t,.0 's ,.,., E Minimum fee $
Print name: 'T-L0,0,..9...__
Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
•Signature: p ar A - s IANTUSE � .1. r„
.S
(A) Enter
subtotal of above fees $ JO
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ v
(D)Technology Fee(5%of[A]) $ 1.-(
TOTAL fees and surcharges(A through D): $ 23 G ed
440-2500-1(4/1/2013/COM)