HomeMy WebLinkAboutPermit Plumbing 2013-7-16 •
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SPRINGFIELD-
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
}. i Phone: 541-726-3753
°REGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01604
www.springfield-cr.gov permitcenter @springfield-ocgov
PROJECT STATUS: Issued ISSUED: 07/16/2013 EXPIRES: 01/11/2014
STATUS DATE: 07/16/2013 APPLIED: 07/16/2013
SITE ADDRESS: 2450 F ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703361117300 TYPE OF STRUCTURE: Residential _
PROJECT DESCRIPTION: Relocate kitchen sink and clothes washer
OWNER: MORRIS SUSAN E Phone Number:
ADDRESS: 1914 LEMMING AVE
EUGENE OR 97401
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CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor MARK ADKINS LEGACY HOMES INC GCB 160482 05/28/2015 541-914-2896
INSPECTIONS REQUIRED 11
Inspections
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3999 Final Plumbing Final Plumbing: Wien 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. 1Q
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
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NOTICE: % Notification Center. Those rules are set forth
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in OAR 952.001-0010 through OAR 952-001-
THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtain copies of the rules by
AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the teleph.4O
COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification
ANY 180 DAY PERIOD. Center is 1-800-332-2344).
Springfield Building Permit 7/16/2013 10:50:42AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
s
TRANSACTION RECEIPT Spnngfield,OR 97477
^.ice 541-726-3753
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OREGON 811-SPR2013-01604
www.springfeld-or.gov 2450 F ST permitcenter@spnngfield-or.gov
RECEIPT NO: 2013001542 RECORD NO:811-SPR2013-01604 DATE:07/16/2013
lef - • lthtl f`-;,tOx,s t2IkP.''."^_,ULEu`�' ,{7;tx:- irf ACCOUNT°CODE/TRANS"CODE'SAMOUNTADUE
Minimum Plumbing Fee (Three or Fewer Fixtures) 224-00000-425603 1057 80.00
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
PAYMENT IYPE.' R PAY,OR cASN��ieRSccaepriFER COMMENTS _ - , gAMQUNTLIPAID. ' , ; :_'a
Check MARK ADKINS LEGACY HOMES INC 93.60
1104
TOTAL PAID: 93.60
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Plumbing Permit Application I DEPARTMENT USE ONLY
i .1 Permit no.: 5 t 7 — I Go`I -
'''i Fifth Street •Springfield.OR 97177 o PHl-iJ 1172!.-37?3 a Fr\SI?a 117?G-3Gti9 t,t �,:i Date:
704113
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 ii work is suspended for 180(lays.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Description Qty. Cost Total
ea. cost
Sanitation approval verified? ❑ Yes ❑ No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:firs:
100 feet al rmw'sewer lines.hose
Residential ❑Government CI Commercial bibs. ice nmkrr- underfloor loo,-poiitr $252.00 $
JOB SITE INFORMATION AND LOCATION drains and rant-drain packages)
Job site address: ,;.:-/Sp F S f- 2 bathrooms/I kitchen $411.00 $
3 hathrooms/I kitchen $483.00 S
City: /71 State: giC ZIP: Each additional bathroom(over 3) $104.50 S
Referen e: /707 1611-
W I( Taxloi j 7 loo Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential lire sprinklers(includes plan review)
4&Jf--c ("El 7tI>e67/V S- iv L _ 0 to 2.000 square feet $80.00 S
fr7 ,7 ten/y, I� 2.001 to 3.60(1 square lied 5128.00 S
lam/ C
PROPERTY`OWNER 3.601 to 7,200 square feet 5192.00 5
�-�-I 5dirt. r - S 7,201 square feet and greater S255.00 S
Name: Orr"
Manufactured dwelling or pre-lab(circle one)
Address: (9 \ 14- Le,/-I-IVYIin y Ave_ Connections to building sewer and
�p healer supplt, S80.00 S
City:EAA. �1c--y State: Lam' , ZIP: COY°
S7I- 15 - 57 / Commercial,industrial,and dwellings other than one-or
Phone: Fax: - - two-family
E-mail: SUS„?,--)1/.2.-1.-e, fyr aSI .tel Minimum lee $80.00 $ .
This installation is being made on residential or farm property Each fixture $21.00 $ 4),
owned by me or a member of my immediate family,and is lliscellnneous fees
exempt from licensing requirements under OAR 918-695-0020. IOW storm.sewer, water line $83.50 S
Signature: t Each fixture.appurtenance.and piping $21.00 S
CONTRACTOR 'INSTALLATION Stone water retentionidelention facility $21.00 $
Business name: �`1 Ak& {fA0:h$ I ”sit—L," �/4f h ri�ation systems $21.00 S
3 Q (7 11'"""1„3 0 1-r systems exceeding storm the first lot)
Address: syslenhs exceeding due lint 100!eel $21.00 S
City: --1;( ,7( State: OiL ZIP:(75IVI Specialty fixtures $21.00 S
4 Reinspection(no.of hrs_x lee per hr.) $80.00 5
Phone: .]itt c 1 284 L Fax:5Lf-I - (g 6-3 /I 1"5— Special requested inspections I no.of
E-mail: `"eb v IA i 7') 4 I(Q,4po . �-0 M hrs.x lee per hr.) —$40.00 5
CCB license no.:) 60 1 L - llBCD license no.: "� Each additional inspection:I t) 580.00 .S
Plumbing license no.: 2� Itlq{J it �' 4j_ Medical gas piping Minimum tee 5
./ �� t/�L,r e
Enter value of installation and equipment$
Print name: /'tAKr/tj
I Enter Ice based on installation and equipment value. $
Signature: i , - I APPLICANT USE
(A) Enter subtotal of above lea ,l
(Minimum Permit Pee 580.00) S a(�
�� Iie��/� (B) Investigative fee(equal to IAI) S -
l IC)Enter 12%surcharge(.12 x IMBI) $ 9(0o
7 <� (DI Technology Fee(5%ofIAII $rr�' Go
�p'& l �Z J TOTAL fees and surcharges(A through D): I $9110°
Lingu0-!1.111/2111 3/CONII