HomeMy WebLinkAboutPermit Plumbing 2013-8-12 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
�o OREGON Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01787
www.springfield-or.gov permitcenter@springtield-or.gov
PROJECT STATUS: Issued ISSUED: 08/12/2013 EXPIRES: 02/07/2014
STATUS DATE: 08/12/2013 APPLIED: 08/12/2013
SITE ADDRESS: 859 W M ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274303001 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace water line
OWNER: CAMPBELL JEFFREY D&LISA Phone Number: 541-606-4788
ADDRESS: 859 w wm st
Springfield OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
- INSPECTIONS REQUIRED i
Inspections -
3315 Water Line
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.
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Springfield Building Permit 8/12/2013 12:10:51PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
II+B _�t (Iw., 225 Fifth St
;
12- ``O EGON TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
• 811-SPR2013-01787 .
vr.w.springfield-or.gov 859 W M ST permitcenter @springtield-or.gov
RECEIPT NO: 2013001742 RECORD NO: 811-SPR2013-01787 DATE:08/12/2013
[DESCRIPTION - • • = _ACCOUNT CODE/TRANS CODE .AMOUNT DUES,_,
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
Water Line 224-00000-425603 1005 83.50
TOTAL DUE: 97.70
I PAYMENT TYPE ' . COMMENTS ' AMOUNT PAID . - '',iii PAYOR`` CASHIER:OBOWLSBY
Credit Card tim swift 97.70
781682
TOTAL PAID: 97.70
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Plumbing Permit Application DEPARTMENT USE ONLY
�/ 1
CE'CY'OF'S t ' OREGON\ i = . Permit no.:Si -0 / 70 7 t
-f :.- a : . ` ` (54 r 6 i
225 fifth Street • Springfield,OR 97477• PO541)726-3753 •FAX(541)726-3689 OREGON Date: zri/3 e
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 t
Zoning approval verified? ❑Yes ❑No Description Qty., Cost Total
ea. cost
Sanitation approval verified? ❑ Yes ❑No New residential
,,�� ....,,// CATEGORY OF CONSTRUCTION I bathroom/1 kitchen(includes:first
y: lcesidential ❑Government ❑Commercial
100 feet oft/ar. underfloor r low-pe $262.00 $
bibs.ice maker, underfloor lme-painl
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: 5 vi , (`4 S4 2 bathrooms/I kitchen $411.00 $
p 3 bathrooms/1 kitchen $483.00 $
City: iT,Jn ,) I/X State: ZIP: 7Q77
l " 1 Each additional bathtnom(over 3) $104.50 $ •
Reference: 17e) Z7 y 3 Taxlot.0 ad/ Each additional kitchen(over 1) $104.50 $ I
DESCRIPTION OF WORK Residential Ore sprinklers(includes plan review)
1
0.1 A - t , I_' ([h i 0 to 2,000 square feet $80.00 $ I
t
(4 �j t 2:001 to 3.600 square feet $128.00 $ I
'-° ���� 3.601 to 7,200 square feet $192.00 $
PROPERTY OWNER q � -
Name: do re // / I 7,201 square feet and greater $255.00 $ E
'vT '! ( Manufactured dwelling or pre-fob(circle one)
Address: - 1 �.� �, _, Connections to building sewer and / j
�� water supply / $80.00 $
City: � �.dIl2�L'itSS�E7/ �
Commercial,industrial,and dwellings other than one-or •
Phonq ,G€ 14 7g' Fax: - - two-family _
E-mail: 9Y4R— q Z— z�Z Minimum fee $80.00 $ }}
This installation is being made on residential or farm property Each fixture $21.00 $ 1
owned by me or a member of my immediate family, Miscellaneous Fe, _
Y Y Y.and is _
exempt from licensing ry uire .- is under OAR 918-695-0020. 100'storm,se r C venter line _
Y. / $83.50 ��,j � i`.
Signat Each fixture,appurtenance,and ping $21.00 $ 1
Ct�NT'ACTOR INSTALLATION Storm water retention/detention cility $21.00 $
Business name: �,9( ,_ litigation systems I $21.00 S [
Piping or private storm drainage $21.00 $ (
Address: systems exceeding the first 100 feet I
City: State: ZIP: Specialty fixtures ' $21.00 $ ,
Reinspeciion(no of hrs x fee per hr-) $80.00 S
Phone: - - Fax: - - - I
Special requested inspections(no.of $80.00 $
E-mail: hrs.x fee per hr.) ■
CCB license no.: BCD license no.: Each additional inspection: (1) $80.00 $
Plumbing license no.: Medical gas piping Minimum fee $ (
Print name:
Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $ r
Signature: I
APPLICANT USE j
(A) Enter subtotal of above fees �i 1
(Minimum Permit Fee$80.00) $ p_s� ,.."--- E
■
(B)Investigative fee(equal to[A]) $ I
(C)Enter 12%surcharge(:12 x[A+B]) $ /0 6.
(D)Technology Fee(5%of[Al) $ if ra
TOTAL fees and surcharges(A.through D): I $ 7 7D
1
440-2500-J(4/12013/COM) 1
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