HomeMy WebLinkAboutPermit Plumbing 2013-6-12 SPRINGFIELD - 225 Fifth St
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CITY OF SPRINGFIELD
Springfield,OR 97477
ACv Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01268
www.springfield-or.gov permitcenter @ springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/12/2013 EXPIRES: 12/08/2013
• STATUS DATE: 06/12/2013 APPLIED: 06/12/2013
SITE ADDRESS: 2290 MAIN ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703364202900 TYPE OF STRUCTURE: Commercial -
PROJECT DESCRIPTION: Sewer Line replacement-All Private Property
OWNER: SHUCK TERRY J&JULIA C Phone Number:
ADDRESS: 4642 ASTER ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION 1
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER . COB 000000 08/01/2025
INSPECTIONS REQUIRED
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Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench 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.
G,.. 44.1A __ 6- 0 -8
Owner or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you ic,
THIS PERMIT SHALL EXPIRE IF THE WORK
follow rules adopted
nte . Toe rules are set forth
Center. Those rules zre set forth
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the
number for the Oregon Utility Notification
Center is.1-800-332-2344).
Spnngtield Building Permit 6/12/2013 3:16:28PM Page 1 of 1
SPRINGFIELD - CITY OF SPRINGFIELD
• �' =rte.:,_„ � 22 Fifth St
OREGON 5 ETON TRANSACTION RECEIPT SFifth SOR97477
541-726-3753
811-SPR2013-01268
www.springfield-or.gov 2290 MAIN ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001219 RECORD NO:811-SPR2013-01268 DATE:06/12/2013
orci ! nom,:' t i . a'-_ rgt2z...I ,T-" ACCOUNT',CODE/TRANS CODE:Ct ' ':I 'AMOUNT DUE"..:4
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
P,AYMENTsTYP.,E - P.A TSI casweR:.dTURSON COMMENTS _ _ AMOUNiteAID
Check SHUCK TERRY J&JULIA C 97.70
1722
TOTAL PAID: 97.70
•
Plumbing Permit Application
A
•I't0iGITYie:OESPRINGFIETAWDREGON,4-3-r: ' •-•cic-
t.,-... -.-..44% Permit no 4 (I 24.2(3 o( -a 6 8
AINfilitikifietIMUJAM4::Thw*:#4,:fri::/7C3:::,: t; *Pg74, S
225 Fifth Street• Springfield,OR 97477 • PH(54I)726-3753 • F4X(541)726-3689 Date: 6 b alf 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.
:1'., ,,,';1,,..,Hiii:LOCA12'1GOVERNMENTiAPPROVALWCiZiiik ?,. ..:1-:.7.Mcrsi:W0f.4=;:n.'1,-IVI,F.EEQSPITIEDUILIER;itUP.10ty,-.,t,441 ,--..>-:
Zoning approval verified? n Yes 9 No ;:.37,incc.-41,,f•cli:tiklezif. k4c4SWA1&/er:Tqkk N I '-," it T.
.4:1141149 ;;;461fIgA:V?;;11 Qq,il ' ?CenK T_P.44.1„,4
!„„ccos,i-i2z4
Sanitation approval verified? 9 Yes 9 No New residential
c.::47PATEGORY..JCIFCONSTRUCTION:::.,tifigt:1A> I bathroom/1 kitchen(includes:first
. — -
100 feet of water/sewer lines,hose
0 Residential E Government It Commercial $262.00 $
bibs, ice maker, underfloor low-point
P1:43:110EnSITEINE013.MATION:?/AND LO,CATIONWal2A drains and rain-drain packages)
Job site address: Aliek 2 bathrooms/1 kitchen $411.00 $
3 bathrooms/1 kitchen $483.00 $
City: i(-:,‘.51,eid State: 0 a ZIP: 710-7
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) ' $104.50 $
irgi.21;lIOMNIDESCRIPTIONTOF.VOR}MA11:4774.:-tt. - Residential fire sprinklers(includes plan review)
gszpo:r Co MI eSeoe Sewer )Si e 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
afrallanItIrlE;PROPERTY4,0WNER7:::4-n1W7044: 3,601 to 7,200 square feet $192.00 $
Name: T (-1 5A,C A' 7,201 square feet and greater $255.00 $
e
Manufactured dwelling or pre-fab(circle one)
Address: t;V°70 m :A. SI■ Connections to building sewer and
City: tr:(1,5 r:e(4 State: 10,(2, ZIP: q 7 Li)1 water supply , $80.00 $
Commercial,industrial,and dwellings other than one-or
Phone:511 /9'cg– / I/I Fax: - - - So-family
E-mail: -(-
. le A CI a,es ;), ,,,, .cork Minimum fee $80.00 $
,4 J ,,,, ()
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 requir;etyts under OAR OAR 918-695-0020. 100' storm,sewer,water line 7 0 . $83.50 $
)
Signature: c."-- --1.-C/ Each fixture,appurtenance,and piping $21.00 $
CONTRA • .0R,z1NSTALLATIONVSt4niA Storm water retention/detention facility $21.00 $
Business name: 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.)
Each additional inspection:(1) $80.00 $ .
CCB license no:: BCD license no.:
Plumbing license no.: !!ligilariaMirtagg.iinictliji% Minimum fee $
Enter value of installation and equipment$ -.
Print name:
Enter fee based on installation and equipment value. $
Signature: cierrz: :;::::14-atiraktetlistowara-sttg
(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 -2_0--
440-2500-1(4/1/2013/COM)