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Permit Plumbing 2013-7-18
SPRINGFIELD' ' 225 Fifth St "` CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 • PERMIT NO: 811-SPR2013-01631 www.springfieldor.gay permitcenter @spnngfield-or.gov PROJECT STATUS: Issued ISSUED: 07/18/2013 EXPIRES: 01/13/2014 STATUS DATE: 07/18/2013 APPLIED: 07/18/2013 SITE ADDRESS: •5234 B ST,Springfield,OR 97478 • SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702333103100 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replumb house OWNER: TERRICKCO INC Phone Number: ADDRESS: 83221 BRADFORD RD CRESWELL OR 97426 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 3500 Rough Plumbing Rough Plumbing: Prior to cover 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 pe i card is located at the fron of the property, and the approved set of plans will remain on the site at all times during coistru tion. AL � / Owner or Contractor Signature Date • ‘s90 aQN¢J �0� q:s, zu 0 o`OO.0 0\ago► yyd 0�\ Q,M\ \) ix ooc?�,sp, N0 sa. Soul asap'?\ACN N\SQO'ci1/4 o OQ x\00 �o, c.,6�dOa\aU,�gPo0a0 ���MENdayQ�C• . 0•J asap aa0 N¢� G NV-c00 K'p ol` • Springfield Building Permit • 7/18/2013 1:40:22PM - Page 1 of 1 SPRINGFIELD'— CITY OF SPRINGFIELD 225 Fifth St OREGON TRANSACTION RECEIPT SpdngfiieIQOR 97477 541-726-3753 811-SPR2013-01631 www.springfieldor.gov 5234 B ST pennitcenter©spnngfield-or gov RECEIPT NO: 2013001566 RECORD NO:811-SPR2013.01631 DATE:07/18/2013 DESCRIPTION , Sr " :.>3, l'-', M,Z rt ACCOLI NTCODE/PRANS-CODEt e: ka.,, AMOUNT.DUE. Bathtub 224-00000-425603 1005 21.00 Clothes washer 224-00000-425603 1005 21.00 • Dishwasher 224-00000-425603 1005 21.00 Hose bibb 224-00000-425603 1005 63.00 Shower/Shower pan 224-00000-425603 1005 21.00 Sink/basin/lavatory 224-00000-425603 1005 63.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 32.76 Technology fee(5%of permit total) 100-00000-425605 2099 13.65 Water closet 224-00000-425603 1005 42.00 Water heater 224-00000-425603 1005 21.00 TOTAL DUE: 319.41 P.AYMEN'T.TYPEli'SPAlOR> cnsHlEv®ft c'cnriaErilER p 'COMME'NTge AMOUNTiPAID , I ;,"A ' Credit Card terrickco inc 319.41 280662 TOTAL PAID: 319.41 • • Plumbing Permit Application DEPARTMENT USE ONLY T /eCt o ral y p ,'-r an " ' m-ifi..t"= m s „.„ g� �3 U / s � o S • A t La z — r L ,.u, Permit no S azr }rt 3- p . zv3°.i � ,Sdk > t, a r . , � 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 7 /45/3 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. ELOCAL,GOVERNMENT APPROVAL ; '. . ,' ,`FEE SCHEDIJLE 4:'. ?. Zoning approval verified? ❑ Yes ❑No 'DescnptiOn ' ' �r 4 !) Qh' east costl'' Sanitation approval verified? ❑ Yes ❑No New residential +', :::CATEGORY:'OF.it ONSTRUCTION > lf,' �/ . I bathroom/1 kitchen(includes:first 21 Residential ❑ Government ❑Commercial 100 feet maker,water/sewer lines,1,w-po $262.00 $ bibs, ice maker, underfloor low-point JOB'`.;SITE INFORMATION 'AND, LOCATION ir' drains and rain-drain packages) Job site address: 5-23 Y g c .3 +-RRe./7- 2 bathrooms/1 kitchen $411.00 $ City:S p4 LA State: C)(/ ZIP: 977,Q 3 bathrooms/1 kitchen $483.00 $ Each additional bathroom(over 3) $104.50 $ Reference: ' 7OZ.33 3 1 Taxlot.:O 3 / 0 0 Each additional kitchen(over I) $104.50 $ :l.t`::: { 'DESCRIPTION OF WORK: ' �'•' Residential fire sprinklers(includes plan review) it&PLv,---. ,-J-1.&5 g 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ 3(1/4( ,r • "%=PROP.ERTY gWNER ,, 3,601 to 7,200 square feet $192.00 $ Name: 1)68 9:1 KL �, S rig t.t.)�)U 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-Cab(circle one) Address: ,SZ .3 '1 73 St- Connections to building sewer and $60.00 $ City: 1a1 State: 0�- - ZIP: O/7'76 Commercial,industrial,and dwellings other than one-or Phone-9s2- (oyS/ Fax: - - two-family E-mail: (A S 0-,01 L , CUri- Minimum fee /� / U5 �\ $80.00 $ TER/21 c-X co Each fixture \ (/ This installation is being made on residential or farm property �(i t ( i $21.00 $ owned by m or a member of my immediate family, and is Miscellaneous fees exempt fro r censing requi,Iernert s un r OA 918-695-0020. 100' storm,sewer,water line '$83.50 $ ' Signature:/ A/�„+" dt/ / 13 Each fixture,appurtenance,and piping $21.00 $ ` ` �:CON""T""RAAC`''TOR'•IN�STALLATION- '` Storm water retention/detention facility� ,-'-r".xa„ ,k -; tY $21.00 $ Business name: 0 t f A/ 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. - - Fax. - - Special requested inspections(no.of E-mail: . hrs.x fee per hr.) $80.00 $ CCB license no.: BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no I)'Iedic l gas,plp in g,=.,..7:: ,._ , _ • Minimum fee $ Print name: Enter value of installation and equipment$— Enter fee based on installation and equipment value. $ Signature: ',.:1/4faW.VIMTFOP 0tANT USE, "c,kf t ' .v't', `a (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) ''73 (B)Investigative fee(equal to[A]) $ 2-_ -74. (C)Enter 12%surcharge(.12 x[A+B]) $ /! (D)Technology Fee(5%of[A]) $ / 6 �� TOTAL fees and surcharges(A through D): $3/ 141 440-2500-1(4/12013/COM)