HomeMy WebLinkAboutPermit Plumbing 2013-7-15 •
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. SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
7:t{} -1 . Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01598
www.spdngfield-or.gov permitcenter@dspringfield-or.gov
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PROJECT STATUS: Issued ISSUED: 07/15/2013 EXPIRES: 01/10/2014
STATUS DATE: 07/15/2013 APPLIED: 07/15/2013
SITE ADDRESS: 1520 6TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703264201002 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: extend sewer line Private
OWNER: PRANE JADA Z Phone Number:
ADDRESS: 36292 GRAVES LN
SPRINGFIELD OR 97478
OWNER: WOOLFE RICHARD C • Phone Number:
ADDRESS: 36292 GRAVES LN
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
• Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor CURTIS FRANK GARNICK CCB 134387 08/24/2013 541-913-8082
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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 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.
jj 112-alx 0 , -7-1S- 3
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to NJTICE:
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
n OAR 952-001-0010 through OAR 952-0 ot- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note'. the teleph..•t`.'
number for the Oregon Utility Notification . ANY 180 DAY PERIOD.
CertPr Is 1:500-332-2:3•14).
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Springfield Building Permit 7/15/2013 3:09:49PM Pagel of 1
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• SPRINGFIELD —' CITY OF SPRINGFIELD
225 Fifth St
< ,�y TRANSACTION RECEIPT Spnngfield,OR 97477
. ^• 541-726-3753
OREGON 811-SPR2013-01598
www.spdngfield-or goy 1520 6TH ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013001532 RECORD NO: 811SPR2013-01598 DATE:07/15/2013
u 110N3Pv>rzt,:.€aaj.L.:,= i#I .F?la�7'NT. %\CCOUNT:CODERRANSrCODE m:_'s�'�r n •1�o_ e
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
PAYMENTmTYPE P,ra cash a dLARSOR !,COMMENTS AMO_I—N AID F_
Credit Card PRANE JADA Z 97.70
047870
' - TOTAL PAID: 97.70
Plumbing Permit Application DEPARTMENT USE ONLY "
3.L� b �p y.- yy'� SPRINGFIELD . - ..
�ae'k�f—Y'. "i ti P Wt 7r ni:t:t: ` h' e.:: `'�� '4®`'�— r�2 4
t �C`II � 5 RINGR_ LWOREGON Permit no.:OH Zal 3 b/ 89 8
• 225 Fifth Street♦ Springfield,OR 97477 • PH(541)726-3753 ♦ FAX(541)726-3689 Date: 7/5-4 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.
0,,r,, ',' g; _ >;FEE'SCHEDULE, , `' u n
Zoning approval verified? ❑ Yes ❑No Description ' `' ` ,,'t f Qty }iCostl,� +";Total
Sanitation approval verified? ❑ Yes x�t ''';"' - v, !. ea „ , '.;icbst,;
❑No . New residential
CATEGORY OF.^CONSTRUCTION - _k' I bathroom/1 kitchen(includes:first '
❑Residential ❑Government ❑Commercial 100 feet ojworer/sewer lines, hose
bibs, ice maker, underfloor.low point $262.00 $
V' - TJOBY'SITE'iINFORMATIONt AND LOCATION ! ; drains and rain-drain packages)
Job site address: /rSao — �O St- - 2 bathrooms/1 kitchen $411.00 . $
City:c5 r';n9�7 e Hof State:0 R ZIP:Cr'?4 I 3 bathrooms/1 hrooms/1 kitchen $483.00 $
P LJ Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $
54 , ; DESCRIPTION:'OF;,WORK[£' r`1?ik" ,. „1"`a Residential fire sprinklers(includes plan review)
e.)4Q,1Ad rpr'ija4-e-, `aQ oQ-r 1 IhQ.. 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
a 7 4 t; �: . r, + ry e 3,601 to 7,200 square feet $192.00 $
�T.,e. ,�5,^P,TR�OP,ERTY OWNER � ,t;t�ra
I Name: Tad r r(,1y(Q_ 7,201 square feet and greater $255.00 $
I _� Manufactured dwelling or pre-fab(circle one)
Address: 3(22_9 a. 6y oveS Lo yt e. Connections to building sewer and
ry water supply $80.00 $
City: (j([ e ct State:OP, ZIP:9191,p
Commercial,industrial,and dwellings other than one-or
Phone: 541' - -q-q 70,31 Fax: - - two-family
E-mail: ' Minimum fee $80.00 $
�4daprare p 90)mal F> cam
This installation is being made on res dential or farm property Each fixture $21.00 $
owned by me or a member of my immediate family, and is Miscellaneous fees
exempt from licensing re utrements under OAR 918-695-0020. 100' storm,sewer,water line SZ $83.50 $
Signature:�-L iCea ,/7/2.z97 Q. Each fixture, appurtenance,and piping $21.00 $
`,Ki-;:„I;:„I bIlg':14:CONTRACTOR;..INSTALLATION r 'tka;'. ''t,.' Storm water retention/detention facility $21.00 $
Business name:CMt+ CarnldC 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: 57p-q/3-gaga Fax: - - ' Special requested inspections(no.of
E-mail: hrs.x fee per hr.) $80.00 $
CCB license no.: 131-13g r7 BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no ?Medical gass,plpmg „.4` `r �, '' f Minimum fee $
Print name:
Enter value of installation and equipment$—
Enter fee based on installation and equipment value. $
Signature: actinCeriA:PPLICANT1USE'- &...- r*•
(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): $ `j 7 7°
440-2500-1(4/1/2013/COM)