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
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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
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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).
•
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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
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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)