HomeMy WebLinkAboutPermit Plumbing 2013-8-12 •
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 SPR2013-01788
www.spnngfield-cr.gov • permitcenter@springfield-or.gov
•
PROJECT STATUS: Issued ISSUED: 08/12/2013 EXPIRES: 02/07/2014
STATUS DATE: 08/12/2013 APPLIED: 08/12/2013 •
SITE ADDRESS: 1071 B ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703351419300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Reconfigure Drain and replace valve.Install water heater
OWNER: ANDERSON HAROLD L&DOLORES G Phone Number:
ADDRESS: 1071 BST
SPRINGFIELD OR 97477
OWNER: DRINKARD BUD D - Phone Number:
ADDRESS: 1071 B ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor LEAFGUARD NORTHWEST INC CCB 116960 09/11/2014 503-646-0224
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
. permit card's located at the front of the roperty, and the approved set of plans will remain on the site at all times during
construe•
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
•
follow rules adopted by the Oregon Utility.
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK n OAR tion e ter. through OAR 952- t
o h
Y obtain
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You ma ob p by
COMMENCED OR IS ABANDONED FOR NY 180 DAY copies of the rules b
e n thph:;, c,
DAY PERIOD. number calling for the Oregon ter. (Note:Utility Notificativn
Center thce jS 1-800-332-2344).e tele
Springfield Building Permit - 8/12/2013 12:37:42PM Page 1 of 1
SPRINGFIELDsa CITY OF SPRINGFIELD
tl - 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-SPR2013-01788
www.springfield-or.gov 1071 B ST permitcenter@springfield-or.gov
RECEIPT NO: 2013001743 RECORD NO: 811SPR2013.01788 DATE:08/12/2013
Je]XYoadllabik. ..'_ t'" =ACEOUNTCODEIGRANS oe i « _ ,yE'pV0UNT?DUES-
=
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 38.00
Bathtub 224-00000-425603 1005 21.00
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
Water heater 224-00000-425603 1005 21.00
TOTAL DUE: 93.60
P,AY,MENT,9TYP.E BAY,OR CASHIER:.JLARSON COMMENTSP' . ;AMOUNT'FAID, '' t�,�y'.
Cash LEAFGUARD NORTHWEST INC 4.00
Check LEAFGUARD NORTHWEST INC 89.60
2073
TOTAL PAID: 93.60
•
Plumbing Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
CITY OF SPRINGFIELD, OREGON Permit no.: jl( 7 13 O(7Q of
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FA.X(54l)726-3689 OREGON Date: D//L/(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.
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:first
100 feet of water/sewer lines, hose
Residential ❑Government I ID Commercial bibs, ice maker,underfloor low-poitu $262.00 $
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: \0-1 I ib 5Sv 'Ge-'-c 2 bathrooms/I kitchen $411.00 $
3 bathrooms/I kitchen $483.00 $
City r t r c�a�ti State:oR ZIP:gn Lin-)
Each additional bathroom(over 3) $104.50 $
Reference: Taxlol.: Each additional kitchen(over I) $104.50 S _
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
Q-e r n t1 c■cicure (-I rn t n -' ✓CP/Q(.ya 0 to 2,000 square feet $80.00 $
Va I V r • s--c I I WO 4-c, hearer 2,001 to 3,600 square feet $128.00 $
PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $
i f aVO I _I n p��i��, 7,201 square feet and greater $255.00 $
• Name: Yt e 'T
Manufactured dwelling or pre-fab(circle one)
Address: \(Df \ m -sere c Connections to building sewer and $80.00 $
Ci[ c ryI State: f� Zlp: water supply
y' rt I�1 ` Q" ����� Commercial,industrial,and dwellings other than one-or
Phone:�� y 1 -144- 2.16 Fax: - - two-family
E-mail: \ Minimum fee $80.00 $ Bb°
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 Miscellaneous fees
exempt from licensing requirements under OAR 918-695-0020. 100'storm,sewer,water line $83.50 $
Signature: Each fixture,appurtenance,and piping 'Z $21.00 $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $
Business name: Lea-Q jjyr3 N\/1) Irrigation systems $21.00 $
Piping or private stonn drainage
Address: 11,5 0 9-o—r fed-ernarr A U-C systems exceeding the first 100 feet $21.00 $
City: --ii aro( State: ZIPg12- Specialty fixtures $21.00 $
Phone�l) �--`1p -QZZ (o 2-�� Reinspection(no.of hrs.x fee per hr.) $80.00 $
'.\ Fax:50-3 �{ Special requested inspections(no.of
\rv't rv1 e_ Q.\06cver�. Co hrs.x fee per hr.) $80.00 $
E-mail: vGl'f12��t - n'1
CCB license no.: 11 (.o (aO BCD license no.: 9 eg Each additional inspection:(I) $80.00 S
Y
Plumbing license no.: Pb-7t-13 Medical gas piping Minimum fee $
Print nam \J(_(n ,bay�]e� Enter value of installation and equipment$ .
\ le: QC,S Enter fee based on installation and equipment value. I $
•Signature: APPLICANT USE _ _ _
. (A) Enter subtotal of above fees a�
(Minimum Permit Fee$80.00) $ 60.66
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+13)) $ R.
(D)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through D): $ S1.W
440-2500-1(4/1/2013/COh1)