HomeMy WebLinkAboutPermit Plumbing 2013-6-28 c
' SPRINGFIELD 225 Fifth St
" 5 CITY OF SPRINGFIELD Springfeld,OR 97477
gig , Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01461
www.springfieldor.gov permitcenter @springfield-ocgov
PROJECT STATUS: Issued ISSUED: 06/28/2013 EXPIRES: 12/24/2013
STATUS DATE: 06/28/2013 APPLIED: 06/28/2013
SITE ADDRESS: 1498 S A-ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703363206100 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Backflow
OWNER: CARTER HALE E Phone Number:
ADDRESS: 1498 S A ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No _ Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED 1
Inspections
3620 Backflow Device Backflow Device: Prior to covering and provide a copy of the test report on site at the
time of inspection. •
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 requ> ed to fhe proper time, that each address is readable from the street,that the
permit card is located at the front of the pr.s--y,and the approved set of plans will remain on the site at all times during
construction.
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Owner or Contractor Signature Date
. : ...... ....__. _ ATTENTIO
NOTICE:
follow rulesN Oregon law requires
•
Notification Ce d e t Those the ruleOsrare et forth
THIS PERMIT SHALL EXPIRE IF THE WORK In OAR gsZ_0o]-0010 throw h 9°n Utility
AUTHORIZED UNDER THIS PERMIT IS NOT You may obtain hr Ig ofAR 9152-0 by
-
0090.
COMMENCED OR IS ABANDONED FOR calling the center, (Note: the tthe rules
ANY t 30 DAY PERIOD number for the Ore o
Center is ]-800 332�12344�tttication
•Springfield Building Permit 6/28/2013 1:19:46PM Page 1 of 1
•
SPRINGFIELD CITY OF SPRINGFIELD
... ...etiii
, R 225 Fifth
TRANSACTION RECEIPT . 3pdngfield.aR 87477 St
:Cs 541-726-3753
OREGON 811-SPR2013-01461
www.springfield-or.gav 1498 S A ST permitcenter@spdngfield-or.gov
RECEIPT NO: 2013001383 RECORD NO: 811SPR2013-01461 DATE:06/28/2013
DESCRIP RO :.k, i._gCt41MIESMt1laVa' ACCOUkTCODE/T-_;,_.SCgt13 g -vs � noUNiCdDU^ s
Backflow preventer - 224-00000-425603 1005 21.00
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00
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
4 4 a�'?`CASHIER:'JLARSO `,'9t>?'4tt;L.'a -'.CO MENTS∎o;_,ffi�.w"W-� . snmtc'L`-SfAMOUNI'P,.AID:':' :ay,`l. _e•'e.—'
P•YME ,TYP ��
Cash Hale Carter - _ 93.60
TOTAL PAID: 93.60
Plumbing Permit Application DEPARTMENT.USE ONLY.
SPPINGFIELD"t='.iLY _
F� �6 ' IIICIt'IIPermit no.: 81(20(3 ocgc,l
G g1I/
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: G /z- ( 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+ „':LOCAL'-GOVERNMENT APPROVALv\ 1:' , r", :z„s . '. .xf__ ' `FEE;`SCHEDULE , `,
Zoning approval verified? Yes No - [ ` t j;,Cost Totalc
g PP ❑ ❑ Description Q y.
Sanitation approval verified? ❑ Yes ❑No id is ea - ..gctist
New residential
;;'CATEGORY:`OF}'CONSTRUCTION 4`?. ik ' '' 1 bathroom/1 kitchen(includes:first
❑Residential ['Government 11]Commercial
100 feet of water/sewer lines,hose $262.00 $
bibs, ice maker, underfloor low point
C .,' JOB"SITE,INFORMACTIONN. AND, LOC • IONI!.+ '-:',"'„ drains and rain-drain packages)
Job site address: 4' Sort 1. ' / 2 bathrooms/1 kitchen $411.00 $
f 3 bathrooms/1 kitchen $483.00 $
City: 5." State:g g ZIP: f
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $
t 41,.fl.?. -7¢]<DESCRIPTIQN;''OF WORK' ' M* Residential fire sprinklers(includes plan review)
$y6 /lam /4 4., Gfr//4z 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
. ' ,' x. .i,r `'`;PROP RTY :OWNER .” �;q`f f, 3,601 to 7,200 square feet $192.00 $
Name: 6/P 7,201 square feet and greater $255.00 $
C. ,�/y/ Manufactured dwelling or.pre-fab(circle one)
Address: 1�i f s//`' Connections to building sewer and
Vh water supply $80.00 $
City: f State: O8 ZIP: 97171
Commercial,industrial,and dwellings other than one-or
Phone:31fF 14S ‘,..q Fax: - -- two-family
E-mail: ,....----A---
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 immed' v-family, and is Miscellaneous fees
exempt from licenss' gtyeeme'L, OAR 918-695-0020. 100' storm,sewer,water line -$83.50 $
Signature: ;�-"" < i/ Each fixture,appurtenance,and piping $21.00 $
`11.:1 '7,� � ':%CONTRACTOR?'INSTALLATION ''tG Storm water retention/detention facility $21.00 $
Business name: Irrigation systems ,,j $21.00 $
Piping or private storm drainage"., _'A $p1.00 $
Address: systems exceeding the first 100 feet
City: State: ZIP: Specialty fixtures I $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.)
CCB license no.: BCD license no.: _ Each additional inspection:(1) $80.00 $
Plumbing license no.: "Medical gas ptpmg4 + [°t v __ Minimum fee $
Print name: '
Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature: l + yAFPLICANT USES$ ; t '
(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): $
440-2500-1(4/12013/COM)