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HomeMy WebLinkAboutPermit Plumbing 2013-6-27 • SPRINGFIELD 225 Fifth St -'' CITY OF SPRINGFIELD Springfield,OR 97477 east N Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01426 www.springfieldor.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/27/2013 EXPIRES: 12/23/2013 STATUS DATE: 06/27/2013 APPLIED: 06/27/2013 SITE ADDRESS: 1716 CARTER LN,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703253215400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace Sewer line OWNER: COWAN MARVIN D&JANET M Phone Number: • ADDRESS: 1716 CARTER LN SPRINGFIELD OR 97477 CONTRACTOR INFORMATION • Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor READY ROOTER DRAIN CLEANING&REPAIR SERVICE I CCB 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. -27 -� Owner or o rector Signa Date • NOTICE: ATTENTION: Oregon law requires you to THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility 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 telephnno number for the Oregon Utility Notification Center is 1-600-332-2344). • • Springfield Building Permit 6/27/2013 9:58:42AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 6..--.." 4 OREGON 541-726-3753 811-SPR2013-01426 www.springfieid-cr.gov 1716 CARTER LN permitcenter@spdngfield-or.gov RECEIPT NO: 2013001371 RECORD NO:811SPR2013-01426 DATE:06/27/2013 ` : SA000UNT CODE/TRANS CODE 4,1-.E,e +::AMOUNTDUE-, . 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 PP,AYMENTII YPE BAYOR. .cASNIER,ccARPENTER ..COMMENTS AMOUNTI PAID Credit Card David Nichols - 97.70 005228 TOTAL PAID: 97.70 • Plumbing Permit Application DEPARTMENT USE ONLY *. I?H ,z5 x.y�yr . ry i CI of SPRINGFIEL RE60 � y 11 Permit no T S i3 —/4'2c 22 Springfield, )7 x, ,.n.. 5� Fs;'Y - //2i7/I� 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date:/D 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 , #,: ' 4::: ;"-',,,YA I ; ., ,FEESGWEDULEy,.?R f Zoning approval verified? ❑ Yes ❑No q`Dest7rlr tlort"% a I i'`','4 "31 s'ci;:tt Qty , ,Cost/, :,.:2:--TOtal ;; Sanitation approval verified? ❑ Yes r.,'':;\ 'P r" x` ":Ea ` !. 9 ea „ ost ,, ❑ No New residential CATEGORY, OF CONSTRUCTION 1, r';++� I bathroom/1 kitchen(includes:first 100 feet of water/sewer lines,hose KResidential ❑ Government ❑ Commercial $262.00 $ bibs, ice maker, underfloor low-point JOB-,SITE:INFORMATION:,AND LOCATION± z;;; drains and rain-drain packages) • Job site address: 7`(a (" a/4-z` l� 2 bathrooms/1 kitchen $411.00 $ City:�I yt9-�I State:0R- f ZIP:1 7G 7 3 bathrooms/1 kitchen $483.00 $ l Each additional bathroom(over 3) $104.50 $ Reference: 0 3 Zr 3 2- 1 Taxlo[:/fe/OO Each additional kitchen(over I) $104.50 $ . : r d , '-ftt':YDESCRIPTION)`OF„WORK[ :Tx,.`tra Residential fire sprinklers(includes plan review) Se wit f (9,04(9,n n e I�� 0 to 2,000 square feet -$80.00 $ 1 -pv V 2,001 to 3,600 square feet $128.00 $ ' is'.r i ::._' ` "`%:PROP.ERTY°EOWNER. ;.-r s4EZ T 3,601 to 7,200 square feet $192.00 $ Name: ' Y t j\1 V i N .. (ot,Q6, 7,201 square fee[and greater $255.00 $ �R� 1 Manufactured dwelling or pre-fob(circle one) Address: 17 LL€ R tn- Connections to building sewer and City: Sr 1 1^� /R)Ci State:( 2 ZIP: 47� 77 water supply $80.00 $ ll Commercial,industrial,and dwellings other than one-or Phone: 5y1- 3,0 -772/ Fax: - - two-family E-mail: - Minimum fee $80.00 $ This installation is being made on residential or faun property Each fixture $21.00 $ 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 r $83.50 $g3 Signature: Each fixture,appurtenance,and piping $21.00 $ i`'1 .+;CO�NITRA 1CTOR' INSTALLATION v't.L'4 '� ` Storm water retention/detention facility $21.00 $ Business name:'i2 na�t Cf —� Irrigation systems $21.00 $ 9 74 systems or exceeding g storm the first drainage $21.00 $ Address: [.4 V� p�O r� systems exceeding the first 100 feet City: �JJZhsL State: dew ZIPf 7Qo.2— Specialty fixtures $21.00 $ �l 7l� 7! / I Reinspection(no. of hrs.x fee per hr.) $80.00 $ Phone: Fax: - - Special requested inspections(no.of E-mail: hrs.x fee per hr.) $80.00 $ CCB license no.:[ 2 ') BCD license no.: Each additional inspection:(1) $80.00 $ Plumbing license no *Medical gas#plpmgra,l,t,Itey s"t 1T k,J:"4 Minimum fee $ Print name: y /ilAl44/ . Enter value of installation and equipment$ . / \l Enter fee based on installation and equipment value. $ Signature: o �j „ , r'. v /V) T m MITT T AP.PLICANT�,USE " tr` k,"NI (A) Enter subtotal of above fees (Minimum Permit Fee$80.00) $ DSO (B)Investigative fee(equal to[A]) $ ' (C)Enter 12%surcharge(.12 x[A+B]) $ /0°2- (D)Technology Fee(5%of[A]) $ 4'i TOTAL fees and surcharges(A through D): $ 97 22- 440-2500-1(4/12013/COM)