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HomeMy WebLinkAboutPermit Plumbing 2013-6-19 • SPRINGFIELD 225 Fifth St 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-SPR2013-01318 www.springfield-cr.gov permilcenter @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: 504 S 3RD ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703353302800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Pipe stormwater to curb OWNER: CHAMBERLAIN WESLEY J Phone Number: ADDRESS: 504 SO 3RD SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER COB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 3400 Storm Sewer Storm Sewer Line: Prior to filling trench. 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. / / 6/1? a6 f-'J / �4 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 IFTHE WORK in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You g the centeral (Note1ethefteleph_-�rby COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification ANY 180 DAY PERIOD. Center is 1-800-332-2344). • • Springfield Building Permit 8/19/2013 8.42:25AM Page 1 of 1 SPRINGFIELD"-- CITY OF SPRINGFIELD 225 Fifth St IIJ E oN TRANSACTION RECEIPT Spnngfeld,OR 97477 541-726-3753 811-SPR2013-01318 www.spnngfield-or.gov 504 S 3RD ST permitcenter©spnngneld-or.gov RECEIPT NO: 2013001263 RECORD NO:811-SPR2013-01318 DATE:06/19/2013 {o7�Yg•71:.VA[ol`I � 4s' ti _._ � 'T n'ACCOUNTcCODFJTRANS e e .__{:i.. ,r `AMOUNT DUE k=1 Rainwater harvesting system 224-00000-425603 1005 83.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20.04 Storm Sewer 224-00000-425603 1005 83.50 Technology fee(5%of permit total) 100-00000-425605 2099 8.35 TOTAL DUE: 195.39 PAYMEIORY Era.'iSNPAYOl rdrATAIERrCCArtril ER° ,' . w60MMENTSflttatignag`AMOUN4TPAIO't:1'ut `ii Credit Card CHAMBERLAIN WESLEY J 195.39 084539 TOTAL PAID: 195.39 Plumbing Permit Application .,: pEPARtMENT.USE ONLY"."1,‘r SPRINGFIELD •t *_. MIS,•CITYGPSPRINGFIELIK, - N;,-,-:47:: „,,,, -:r 1. Permit no.: <7 ? — /7/ f ,y,,itot.,1,14tilnit.,;:112,,5,extrigitigitt,:isis-„,.,:z.-:„rafrIcH,,,,st,,,,tiattqwpS7-4 ..-31:11. 'Of ':. 225 Fifth Street• Springfield,OR 97477 • PH(54I)726-3753 • FAX(54l)726-3689 Date: 01// V/ 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. T , .;!:':!;, •.. :,•LOCAL'LGOVERNMENT •APPROVAL 1.4.igt.V.• TCV:6-:...-21 , :C..rit.:;12,FEE:,..5PHEIDUCE r.0S54l'4: 4,44-;;;:e_tin Zoning approval verified? D Yes 0 No .&1'n'':gi'Vg-t;1"- -i,' -•-`2444-14:: -k- 311 •;JiCiSs1W, fizT66110 1Descraption4''''':e,,f1L- -t,::' ..-,:K52,--=-f Qty:i ,:a.;0,it,4,rf -,-,,.,t kr:::?i,a`,!:,V.#.:4t;:n ',:- .“.,:,."4:4;,‘`",,C,2?-.43,,:opn., Sanitation approval verified? 0 Yes 0 No New residential ;%:72t:::•4ATEGORY:2 0F.A.:C ON STRU CTION:c':'2:-W-yl%42r/--. I bathroom/1 kitchen(includes:first 100 feet of water/sewer lines, hose It Residential ['Government El Commercial $262.00 $ bibs, ice maker, underfloor low-point ?:(rr 40 BS ITE-;INFORMATION AND LOCATION 1:05 drains and rain-drain packages) Job site address: .5-0 if cs 1.,+4 3 2-4 S-1:: 2 bathrooms/1 kitchen $411.00 $ --7 3 bathrooms/1 kitchen $483.00 S City:Stirrn -fi..'e(S State: 0 I-, ZIP: 97 4-7 ( Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ tr.l.";l.::`,F:1"::r;::lin:gl D ESC RIPTIO a 1:*,:-WO RICW,Mq*Vaa, Residential fire sprinklers(includes plan review) got, f- 9 (.4 tters a lid r Lt.1-, ac-r" To 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ 3-fret?: ::.:A'!;"Me..:1;5'0hC'',74.1R0 P E RTYP:30VVN ER C--YAVVriTITilgatTf 3,601 to 7,200 square feet $192.00 $ C La I I Name: hks- ._....14449,4,r,et 2 tA 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-fab(circle one) Address: rel if co c„-t-4 -31: - c IT Connections to building sewer and $80.00 $ water supply City:5 p' tr:tlicle.Id State: 6 irk ZIP: cr 7f-7 7 Commercial,industrial,and dwellings other than one-or Phonent7f6 0 cf Lt:0 Fax: - - two-family E-mail: Minimum fee $80.00 $ This installation is being made on residential or farm property Each fixture $21.00 $ owned by me r a membe of my immediate family,and is Miscellaneous fees exempt fro censing re uirem nts under OAR 918-695-0020. 100' storm,sewer,water line / $83.50 . $ns-D ---"Signature: ..6 i - Each fixture, appurtenance,and piping $21.00 $ 1 .,kt 0 NT CIORk-7INSTALliATIOW:gfeW0ga Storm water retention/detention facility $21.00 $ Business name: /9'2,J4,42•.-- 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 E-mail: hrs.x fee per hr.) Tit_ $80.00 $ 4 rd CCB license no.: BCD license no.: — Each additional inspection:(1) e r ft / I $8k $ 7.....- Plumbing license no.: 5MWial3aPiiiiii.ifaiiiY47/Z4:;12 Minimum fee $ _ Enter value of installation and equipment$ . Print name: Enter fee based on installation and equipment value. $ Signature: otacagaroo'iltorivitiltigeleS.,&qa'a4 (A) Enter subtotal of above fees $ /67 7u,) c-0 ° (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): $ 440-2500-J(4/1/2013/COM)