HomeMy WebLinkAboutPermit Plumbing 2013-7-11 •
SPRINGFIELD 225 Fifth St
" CITY OF SPRINGFIELD - Springfield,OR97477
t Phone: 541-726-3753
'' OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01577
www.springfield-or.gov permitcenter @spnngfield-or.gav .
PROJECT STATUS: Issued ISSUED: 07/11/2013 EXPIRES: 01/06/2014
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STATUS DATE: 07/11/2013 APPLIED: 07/11/2013
SITE ADDRESS: 870 KELLY BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703341400200 • TYPE OF STRUCTURE: Residential
. PROJECT DESCRIPTION: Sewer service replacement-less than 1001f
OWNER: POWERS JOAN DOREEN Phone Number: .
ADDRESS: 4193 DATCHO DR .
SAN DIEGO CA 92117 •
CONTRACTOR INFORMATION •
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor ACE EQUIPMENT Si SPECIALTY SERVICES INC COB 154093 01/24/2015 541-729-6221
INSPECTIONS REQUIRED II
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 e ure that all required inspections are requested at the proper time, that each address is readable from the street, that the
per. •and is located at the front of the •roperty,and the approved set of plans will remain on the site at all times during
co •tion.
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Owne • I ontractor Signature Date
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Springfield Building Permit • 7/11/2013 9:47:49AM • Page 1 of 1 '
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SPRINGFIELD— CITY OF SPRINGFIELD
225 Fifth St
OREGON TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
811-SPR2013-01577
wwws911996eld-or.gov 870 KELLY BLVD permilcenterQspnngfield-ocgov
RECEIPT NO: 2013001493 - RECORD NO:811-SPR2013-01577 DATE:07/11/2013
o.) 1, ;11a,.._14; it t- E. .&. i,_:( -Z 'Z ACCOUNTCODE/TRANSCODE .?a+'43 6R-AMOUNTDUE`:(c
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
""'-"'-E AMOUNT'PAID
PAVMFNT TVPF _._PAV�RCASHIER:1080WL'SeY .c CCgMMENTS_._.__ Y� _ __._.. �: _.
Check ACE EQUIPMENT&SPECIALTY 97.70
8172 SERVICES INC
TOTAL PAID: 97.70
• Plumbing Permit Application -'DEPARTMENT USE ONLY ': '
SPRINGFIELD P'^.:n.:'�mn.w'
a a-COO SPRIN ITE 3REGON E Permit nt M
/
225 Fifth Street♦ Springfield,OR 97477 ♦ PH(541)726-3753 • FAX(541)726-3689 Date: (Z
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.
Y sr - i. t„.._".j „FEE 'SCHEDUL'E„ `?-°4»
, ,aLOCAL'�GOVERNMENT AP,P, ROVAL :„,max, „ , ,,,,�;._�
Zoning approval verified? ❑ Yes ❑No ' i ”' sx - sCo Total-Descrpton i ,' Qy Y
a.:_<r.a.4. 4, s:°� .. .. r,c ,- a _`cost =
Sanitation approval verified? ❑ Yes ❑No
New residential
''CATEGORY;OF.^CONSTRUCTION s=: a I bathroom/I kitchen(includes:first
,,(�,t, 100 feet of water/sewer lines,hose
pC,J Residential ❑Government El Commercial bibs, ice maker, underfloor low-point $262.00 $
yet- TJOB SITE':INFORMATION.;AND ''LOCATION t drains and rain-drain packages)
lob site address: S7 o 'ICGt,ly (3kO. 2 bathrooms/I kitchen $411.00 $
3 bathrooms/1 kitchen i $483.00 $
City: 5,ry v ..ift[cA State: b ZIP: 97 t•[i7 Each additional bathroom(over 3) $104.50 $
Reference. 17033tag Taxiot.eozom Each additional kitchen(over I) $104.50 $
.4r.`4 rft..1i:]rADESCRIPTION°OFD;WORKSV",. --. 'W,at: Residential fire sprinklers(includes plan review)
-
• c_t„-.e•,_ cr-c- -u d c.— t2tip lwtr-(v..c.,..._- 0 to 2,000 square feet $80.00 $
1 2,001 to 3,600 square feet $128.00 $
allMtinicVtISPROPERTWAOWNEKAWitTirlingge- 3,601 to 7,200 square feet $192.00 $
T 7,201 square feet and greater $255.00 $
Name:
,-4',„ c2,__S
Manufactured dwelling or pre-fab(circle one)
Address: '57 D Kcal q\VkO, Connections to building sewer and
nn water supply $80.00 $
City: +t-c.(J tate: QC ZIP: c1t(77
b Commercial,industrial,and dwellings other than one-or
Phone: - - 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 or a member of my immediate family,and is Miscellaneou ••s p7s^t
exempt from licensing requirements under OAR 918-695-0020. 100' sto ,eater line $83.50 $
Signature: . Each fixture,appurtenance,and piping $21.00 $ •
`'�"t `"`.itiCONTRACTOR:`INSTALI°ATION try$.tays�pta.+ � Storm water retention/detention facility $21.00 $
!•ra
Business name: IT[.ai . ut' J— Irrigation systems - $21.00 $
Piping or private storm drainage
Address: 3((1 W, Cbsl systems exceeding the first 100 feet $21.00 $
City: State: be_ ZIP:97y-77 Specialty fixtures $21.00 $
Reinspection(no.of hrs x fee per hr.) $80.00 $
Phone:/(-XI- `&3( Fax: - - - Special requested inspections(no.of
E-mail: hrs.x fee per hr.) $80.00 $
CCB license no.: /90 93 BCD license no.: Each additional inspection:(I) $80.00 $
Plumbing license no `Medical gas;pipmg k c : « „_ Minimum fee $
Print name: �p(.�y- - C . 5•w f kin
Enter value of installation and equipment$
n ature:
Sig - Enter fee based on installation and equipment value. $
Sign - A.aFtr e+"',xcin4APPLICANT.0$tI N` ; i? c`Va
(A) Enter subtotal of above fees $ �
(Minimum Permit Fee$80.00)
Sei
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ /0 C2
(D)Technology Fee(5%of[A]) $ 4 i S
TOTAL fees and surcharges (A through D): $ 7 7m
440-2500-1(4/12013/COM) •