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HomeMy WebLinkAboutPermit Plumbing 2013-6-14 SPRINGFIELD 1 225 Fifth St ' `hCITY OF SPRINGFIELD Springfield,OR 97477• i Phone: 541-726-3753 1` OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01275 www.springfield-or.gov permitce nter©springtield-or.gov PROJECT STATUS: Issued ISSUED: 06/14/2013 EXPIRES: 12/10/2013 STATUS DATE: 06/14/2013 APPLIED: 06/13/2013 SITE ADDRESS: 1290 W CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703273402919 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Dental office remodel OWNER: CENTENNIAL DENTAL BUILDING LLC Phone Number: ADDRESS: 2245 CHARNELTON ST EUGENE OR 97405 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone . Plumbing Contractor HARVEY 8 PRICE CO CCB 77 10/31/2014 541-746-1621 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. �� \ ).Q \_.Arv2 (o — \ y— 13 Owner or Contractor Signature Date • ATTENTION: Oregon law requires you to NOTICE: - follow rules adopted by the Oregon Utility 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 COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephu^:: - ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 6/14/2013 991:35AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD ' .'4•S :.Ym+.. 225 Fifth St 4.`f OREGON TRANSACTION RECEIPT S 9feld.O 97477 811-SPR2013-01275 www.springfield-or gav 1290 W CENTENNIAL BLVD permitcenter @springfield-or.gov RECEIPT NO: 2013001240 RECORD NO:811-SPR2013-01275 DATE:06/14/2013 IDESCRIPTION ;" _c ACCOUNT.CODE/TRANS-CODE' :.' ' AMO,UNLDUE. Fixture 224-00000-425603 1005 105.00 Medical Gas Permit fee(based on value of work) 224-00000-425603 1005 80.00 SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 417.83 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 856.09 SDC: Total Sewer Administration Fee 719-00000-426604 1175 63.70 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 22.20 Technology fee(5%of permit total) 100-00000-425605 2099 9.25 TOTAL DUE: 1,554.07 L.-.PAYMENT TYPE ;,PAYOR,_ CASHIER CCARPENTER,: ` :-:COMMENTS -AMOUNT PAID Check HARVEY& PRICE CO 1,554.07 032122 TOTAL PAID: 1,554.07 Plumbing Permit Application DEPARTMENT USE ONLY SPRINGFIELD CITY OF SPRINGFIELD, OREGON Permit no.: 5/3 - b I Z7.5 g 225 Filth Street • Springfield,OR 97477 • P11(541)726-3753 •FAX(541)726-3689 OREGON Date: I`t 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 FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Description Qty. Cost Total ea. cost Sanitation approval verified? ❑ Yes ❑ No New residential , CATEGORY OF CONSTRUCTION I bathrootrt/I kitchen(includes:first ❑ Residential ❑ Government 113"l..ommercial bibs, ice pinke e,;?se,rer linen.base $262.00 $of bibs, icemaker, unde,floor low-point JOB SITE INFORMATION n AND LOCATION drains and rain-drain packages) Job site address: )2l l�.YadW r l ru pJL 2 bathrooms/I kitchen $411.00 $ 5 /? zr 3 bathrooms/I kitchen $483.00 $ City: State: ZIP:1- �7�'t Each additional bathroom(over 3) _ $104.50 $ Reference: 1 3 C_ ( 3 Cf Taxlot.: OZ 9/5 Each additional kitchen(over I) $104.50 $ i DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) I —De-,, 44.1 o�fce 40_-6 de I 0 to 2,000 square feet $80.00 $ 2.001 to 3.600 square feet $128.00 $ PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $ Name: 7.201 square feet and greater $255.00 $ r �PGL.YSQ1/\ )/� Manufactured dwelling or pre-fah(circle one) Address: 1.230 I�__�P�n ¢�'1.n-t,a/"' Connections to building sewer and $80.00 $ W tp, p +-7 water supply City: - )V I v� lo 01A I State ZIP:,'7�,( ''7 iJ r ! 7/ Commercial,industrial,and dwellings other than one-on Phone: Fax: two-family E-mail: Minimum fee $80.00 $ This installation is being made on residential or farm properly Each fixture _j $21.00 $ D�• 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 $ CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $ Business name: ( Irrigation systems $21.00 S �'�'- Piping or private storm drainage Address: 20/ f5 A / et. systems exceeding the tint 100 feet $21'00 $ r Specialty fixtures $21.00 $ City: !mot late: 0-7.,-- ZIP: 973/4 i - Reinspection(no.of hrs.s Ice per hr.) $80.00 $ Phone: _7/� - Fax: �/ p7 _�' �L�a✓ •,t��ll�'/ 9�b Z Special requested inspections(no.of $80.00 $ E-mail: SC to ll9 k & ha v'c 4 A-nd r)fl ce coin_ his.x ice per hr.) CCB license no.: -J#' 77 1 BCD/license no.: Each additional inspection:(I) $80.00 $ X Plumbing license no.: o — 5677 Medical gas piping . M ininnun fee $ e Print name: �� Enter value e b se of installation on installation and equipment$�. . V , Enter fee based on insmllation and equipment value. $ Signature: CCM • APPLICANT USE (A) Enter subtotal of above fees / ■ (Minimum Permit Fee$80.00) $ IS,S l (B)Investigative fee(equal to[AD $ yDO (C)Enter 12%surcharge(.12 x[A+13J) $ �!/� (D)'technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through D): $ Zi6 N� f 440-2500-J(4112013/COM)