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HomeMy WebLinkAboutPermit Plumbing 2013-6-19 SPRINGFIELD 225 Fifth St A4 CITY OF SPRINGFIELD Springfield,OR 97477 l Phone: 541-726-3753 \OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01326 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/19/2013 EXPIRES: 12/15/2013 STATUS DATE: 06/19/2013 APPLIED: 06/19/2013 SITE ADDRESS: 4076 NORTH ST,Springfield,OR 97478 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1802061100700 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Connect to sanitary sewer • OWNER: VANBEENEN CINDY&LARRY Phone Number: ADDRESS: 4076 NORTH ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION _J - Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor READY ROOTER DRAIN CLEANING 8 REPAIR SERVICE I COB 92524 02/18/2015 541-744-7991 INSPECTIONS REQUIRED - Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 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. 416' • Zat-t e"(---) - k Cl- & Owner or C•• ractor Signature Date ATTENTION: Oregon law requires you to NOTICE: follow rules adopted by the Oregon Utility tth THIS PERMIT SHALL EXPIRE IF THE WORK in Notification OAR 952-001 Cen-0er.010 Those through rules OAR are 952-00set 1- 0090. You may obtain copies of the rule by AUTHORIZED UNDER THIS PERMIT IS NOT s for .b COMMENCED OR IS ABANDONED FOR calling (Note: :.;n ANY 180 DAY PERIOD. number for the the center.Oregon Utility the Notification Center is 1-800-332-2344). Springfield Building Permit 6/19/2013 11:51:48AM Page 1 of 1 • • T-11 i\ Plumbing Permit Application :P , . . R ONLY ATMENT USE O ' F. .... .. • - ' '''. efrictF-;14,&•;E:•741.517,:izTh2:7,KiwjA•24;2143,12.0-.÷:i:i?,:;_::,,Ivam:A4.3.: i", A ,. _ AAA,. 11131=LiGITY1OFSPRINGFIELIVOliteliNffiM- I--1-"*Ptalral Permit no.: 573-/5 2,6 ' ussigtsokteszisp:aMdis=taine:rt:.!--4micizawkw -. -• 4, rat c ii 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 67/9//_.5 , . 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.:Cl.CAL:,.GOVERNMENT.:APPROVAV,411n, 2:,ffilti.5igin:SATEE=3,SCHEDULETVZSzaAlitikei:E" Zoning approval verified? 0 Yes 0 No -vl. ,54,7-itrittsa.4,t-1,xalip5W.!:f.35!-J.!' ";";--sC6sq!.tT6614 31:Yes-tription-,.----: ,,,,Itt4 -,,,, ,-,."4 yty:1_,,,,-,.-,,..-:.4 - ,..-• 4-,i,CAstii:fry; ;.b,... :::,.eP;', r.i.t2i*Mnsirci.n Sanitation approval verified? D Yes D No New residential I''''.lI•ItATEGORr:OF.,:tONSTRUCTIONi!::MirW•Ii; I bathroom/1 kitchen(includes first 100 feet of water/sewer lines, hose Residential 0 Government 0 Commercial $262.00 $ bibs, ice maker, underfloor low-point JOBISITE1-1NFORMATION:AND LOCATION-am,n drains and rain-drain packages) Job site address: 17107 4 A/OPH 5T1tEET" 2 bathrooms/1 kitchen $411.00 $ 3 bathrooms/1 kitchen $483.00 $ City: Sp etitiefristO State: 0 R ZIP: 975/78 Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over I) $104.50 $ Pli:;':.%:4;;, :',;;.eDESCRIPTION':OFi:',WORK*CageKK Residential fire sprinklers(includes plan review) i.:2271/1(e---ir 77) .fitvfm-e_y Sz-,272-- 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ rMili,IntKelt?;:MEIROPERT,W.I.:OWNERYAgmfogxtom 3,601 to 7,200 square feet $192.00 $ 7,201 square feet and greater $255.00 $ Name: ‘,407 t;A,„, 8,,,,.., Manufactured dwelling or pre-fab(circle one) Address: ile,76 Milt-pi Sriesn Connections to building sewer and $80.00 $ CitY:SrZhVer if 4-P I State: OR ZIP: 7 7979 water supply Commercial,industrial,and dwellings other than one-or Phone: .S19-751/- 7 a 8 0 Fax: - - two-family Minimum fee $80.00 $ E-mail: a. blue ick."to a y(.. C..0 MCA Sr• /vex 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 fro licensing reqtme ts under OAR 918-695-0020. 100' storm,sewer,water line / $83.50 - Sianature• /.4)-2 x).2 64 Each fixture,appurtenance,and piping $21.00 $ ''..';CY,:',!.c'.:3TCO N4 CTOR'±INSTALLATION1';'aterdlicp Storm water retention/detention facility $21.00 $ Business name: 00/7.7-f2rp47:44/ AZ')V ,,zin_ Irrigation systems $21.00 $ Piping or private storm drainage Address: 70 73-7 /e7/1...--Ar 7f./.) systems exceeding the first 100 feet $21.00 $ City: 6,-14 C State• ZIP:5 7rey:____ Specialty fixtures $21.00 $ Reinspection(no of hrs x fee per hr) $8000 $ Phone: - - Fax: - - Special requested inspections(no.of $ao.00 $ E-mail: hrs.x fee per hr.) CCB license no.: 925-z ?BCD license no.: Each additional inspection:(1) $80.00 $ Plumbing license no.: trMeilicallas,Ripingro-,:,AsZi4es Minimum fee $ Enter value of installation and equipment$ . Print name: . Enter fee based on installation and equipment value. $ Signature: P.1441:`..5;1Cialgtra=t0AfitAtgEgf ID-4WtMiai (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) 73 TO (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $/0 02. (D)Technology Fee(5%of[A]) - $ 41/S TOTAL fees and surcharges(A through D): $ i? 212- 440-2500-1(4/1/2013/COM) SPRINGFIELD CITY OF SPRINGFIELD !ai - 225 Fifth St 'ff. TRANSACTION RECEIPT Springfield,OR 97477 1`OREGON 541-726-3753 811-SPR2013-01326 www.springfield-or.gov 4076 NORTH ST permitcenter©springfeld-or.gov RECEIPT NO: 2013001270 RECORD NO:811-SPR2013-01326 DATE:06/19/2013 ,� DESCRIPTION -" >; - 2i '�.S„�,=_';i ,'S_a_', ui;,t,ii�iACCOUNTdCODE/TRANS'CODEr 5W,.,,ii AMOUNTDUE:=t? SDC:Administrative Fee-MWMC Regional Wastewater SDC 611-00000-426604 1189 10.00 , SDC: Compliance Cost-MWMC Regional Wastewater SDC 444-00000-426607 1113 E. 22.61 SDC: Improvement Cost- Local Wastewater 443-00000-448025 1184 542.46 SDC: Improvement Cost-MWMC Regional Wastewater SDC 445-00000-448025 1187 1,392.04 SDC: Reimbursement Cost- Local Wastewater 442-00000-448024 1183 1,111.45 SDC: Reimbursement Cost-MWMC Regional Wastewater SDC 444-00000-448024 1186 108.14 SDC:Total MWMC Administration Fee—Local 719-00000-426604 1121 76.64 SDC: Total Sewer Administration Fee 719-00000-426604 1175 82.70 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: 3,443.74 hiE.WiCMENTSI E._ PAILOR* cnsiTeireraPerreR MIENTS AM.UNT3_P./UD. E -=_r; Credit Card VANBEENEN CINDY& LARRY 3,443.74 05066a TOTAL PAID: 3,443.74 •