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HomeMy WebLinkAboutPermit Plumbing 2013-7-22 , SPRINGFIELD 225 Fifth St '' '� CITY OF SPRINGFIELD • Springfield,OR 97477 ua 4 Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01657 www.springfield-or.gov pennitcenter @springfield-or.gov 'PROJECT STATUS: Issued ISSUED: 07/22/2013 EXPIRES: 01/17/2014 STATUS DATE: 07/22/2013 APPLIED: 07/22/2013 SITE ADDRESS: 247 17TH ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703363102303 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Sewer line rerouting/replacement: PARCEL TAG-NO ADU APPROVAL FOR THIS PARCEL OWNER: LEE DALE C JR&DIANNA L Phone Number: ADDRESS: 75630 LONDON RD COTTAGE GROVE OR 97424 CONTRACTOR INFORMATION - Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone ROTO ROOTER SEWER AND DRAIN SERVICE (PB)Plumbing Col PB837 07/01/2014 541-899-4494 INSPECTIONS REQUIRED i 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, nd the approved set of plans will remain on the site at all times during cons lion. S /1X Owner or Contractor Signature Date - -. ,-rv'r '4 O;egon law requires y UHI ty • i iv c. adopted by the Oereg NOTICE. o—cation Center. Those ruh 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 call ng the oenOter�(Note• the telephc:rio nOMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification qn (14Y PERIOD. Center is 1-800-332-2344)' Springfield Building Permit 7/22/2013 11:59:45AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD he • O .":e TRANSACTION RECEIPT 225 Fifth St Springfiel d,OR 97477 OREGON 541-726-3753 811-S P R2013-01657 www.springfield-or.gov 247 17TH ST permitcenter©springfield-or.gov RECEIPT NO: 2013001593 RECORD NO: 811-SPR2013-01657 DATE:07/22/2013 ;DESCRIPTION _ - —:,..-7. ACCOUNT_CODEITRANS CODE : . _AMOUNT;DUE_ _; 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 "-- ' AMOUNT PAID . •- PAYMENT TYPEPAYOR ; CASHIER:ccgRPENTER - COMMENTS _,- �„ _v,_I Check LEE DALE C JR&DIANNA L 97.70 8519 TOTAL PAID: 97.70 Plumbing Permit Application DEPARTMENT,USE ONLY ■fan .. , �1 �\ **4-4 /V�\ ) ='tP" 1 2 :! -4�1 S al G L t Permit nn. ✓/ -/6 225 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 d oing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. FEE,SCHEDULE, LOCAL' GOVERNMENT APPROVAL- (',�t.,,t< , 1 .T � �'` . a Zoning approval verified? ❑ Yes ❑No '_Description Sanitation approval verified? ❑ Yes No ❑ New residential "',CATEGORY'OF.'CONSTRUCTION 'r`? 1 bathroom/1 kitchen(includes:first 100 feet of water/sewer lines, hose Residential ❑Government ❑ Commercial $262.00 $ bibs, ice maker, underfloor low point • „'`JOB 'SITEiINFORMATION_-AND LOCATION` drains and rain-drain packages) Job site address: J-j 7 1 Th S {Y-tL-f" 2 bathrooms/1 kitchen $411.00 $ City 5. 4 State: Q ZIP: I'� 17'7 3 bathrooms/I kitchen $483.00 $ Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ '::gDESCRIPTION OF ,WORK°' ,- , ' , ? Residential fire sprinklers(includes plan review) p :-{b S-e 6v 0 to 2,000 square feet $80.00 $ Y 2,001 to 3,600 square feet $128.00 $ 3,601 to 7,200 square feet - $192.00 $ Name: 1)4,s] e -e D I a vi,p. Lee 7,201 square feet and greater $255.00 $ tl v� ([ Manufactured dwelling or pre-fab(circle one) Address:"9-SC,, bre n O n Connections to building sewer and $80.00 $ water supply City: �, e: }- yQ �,d,rf6tate: Q'� ZIP: I ��-� Commercial,industrial,and dwellings other than one-or Phone:S- 4 - ?�f(a'-]- a4S�Fax: 5-C - ip--146Q two-family I ,l Minimum fee - $80.00 $ E-mail: p Cr 'j w C Each fixture $21.00 $ This installat n is being made on residential or farm property owned by me or a member of my immediate family,and is Miscellaneous fees exempt from tensing requirements ii5derQAR 918-695-0020. 100' storm,sewer,water line j $83.50 s' 1U Signature: .�1�I��_ r� Each fixture,appurtenance,and piping / $21.00 $ 'CONTRACTOR,tYt�INSTALL'ATION '�`tw'=„ , c Storm water retention/detentionfacility $21.00 . $ Business name: � i �-o-f`e� 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:(1) , $80.00 $ Plumbing license no.: Medical gas piping v; ` r- (;, Minimum fee $ Enter value of installation and equipment$ ' Print name: Enter fee based on installation and equipment value. $ Signature: _ ,,-, ,� a ,;,-, w s - , �....,w,?? tk�',: *�`.,APPLICANTh"USE ���.�sss..����,�e•t (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 (D)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through D): $ 440-2500-1(4/1/2013/COM)