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Home My WebLink AboutPermit Plumbing 2013-8-19 • 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-SPR2013-01842 www.springfield-or.gov - permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 08/19/2013 EXPIRES: 02/14/2014 STATUS DATE: 08/19/2013 APPLIED: 08/19/2013 SITE ADDRESS: 1980 J ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703254302200 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace Sewer Line-Private OWNER: WHITBY BARBARA D Phone Number:. ADDRESS: 1980 J ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 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 is located at the front of the property, and the app ; -t of plans will remain on the site at all times during uction. 1 • W.eel1 - -Z0/ 3 Owner or Contractor Signature Date • NOTICE: ATTEN requires you tot follow rules TION:adopted Oregon by law the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT In OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by Ail' 1 Rp DAY PERIOD. calling the center. (Note: the teleph: '�., number for the Oregon Utility Notification • Center is 1-800-332-2344). • Springfield Building Permit 8/19/2013 8:18:27AM • Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 T 541-726-3753 O Recor4 811-SPR2013-01842 www.springfeld-or.goy 1980 J ST permitcenter @spnngfield-or.gov RECEIPT NO: 2013001793 RECORD NO:811-SPR2013-01842 DATE:08/19/2013 f] Yy:71�tl[ di ,„;s k Ntet to T ` gg ACCOUNTsGODE TRANSICODE1i ,,.1/2 z-AMOUMPOUE'' 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 PATAYMENTsirxH .. P,AYOR1rcnswE'a: fiARso igarmcOMMNTS e `'ic J.k,PA op voRk Ipmftwitnal Cash WHITBY BARBARA D 97.70 TOTAL PAID: 97.70 • Plumbing Permit Application DEPARTMENT:USE ONLY <{ r�s ii;=17•ZSs ATAIMIgirti rAW: ate' 9 CITI OF SPRNGFIELWORE�yGON „ ' '' Permit no.: g/t ?ors 3 o I&y Z 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 9 / / q 1 1 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. °';_r. ::LOCAL,GOVERNNI ENT AP.PROVAL6 1 aVi ?, O_`' £,!+FEE,?SCHEDULEfi "Y "- Zoning approval verified? ❑ Yes ❑No Descrlptionr''`u t a`'` r 4T Qty Cost$ t Totals; Sanitation approval verified? ❑ Yes gv New residential rr� - = l•a ,�.,- :ea -cost_,,, ❑No New residential • CATEGORY OF itONSTRUCTION Wa n: .. 1 bathroom/1 kitchen(includes:first residential ❑Government ❑Commercial 100 bibs, ice maker, usewer lines,hose $262.00 $ bibs, ice maker, underfloor low point 4 ';=' ^JOBESITE,INFORMATION::,AND. LOCAT.ION; P drains and rain-drain packages) �� 2 bathrooms/1 kitchen Job site address�./93-O S � � $411.00 $ City_ / n Staten-C. ZIP:9 ' "7 3 bathrooms/1 kitchen $a83.00 $ ---\ Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ :x"r5 P:I t1;:r DESCRIPTIOICIJE WORKIC `M,uT ', Residential fire sprinklers(includes plan review) 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ I •�,2px w;4v Li 1 F,�rn s,,,g-;-r zt 3,601 to 7,200 square feet - $192.00 $ '4.,P„ROPERTY;�OWNER -i:1 w �(.t; .. Name: -tom-(�f1.�J4� /�,7,x,201 square feet and greater $255.00 $ p— i J14(anufactured dwelling or pre-fab(circle one) Address: / q ` s-(---- tt I Connections to building sewer and $80.00 $ Ci •. a 1 Stater_ ZIFQ 2�� water supply Commercial,industrial,and dwellings other than one-or Phone: - /.C2_/ 3/24.2.x: - - - two-family E-mail: - Minimum fee . $80.00 $ This installation is being made on residential or farm property Each fixture $21.00 $ owwed-by'm or a me 1 ber of'. plc ain' •i• is Miscellaneous fees exempt fr•n.' ensin• e• ' 'men.. nder Of • •18-69111Fr` 100' storm,sewer,water line / -$83.50 $ Signatu :— seas : �. Each fixture,appurtenance,and piping $21.00 $ ".r ?r+ , . liirk'CONTRACTOR'=INSTALL” •TION 7t`",4'"sa%w1'C,' ,` Storm water retention/detention facility $21.00 $ Business name: 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.) I $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.: 7-Medcal g as]`P in .+,[, .. :% .. Minimum fee $ Print name: Enter value of installation and equipment$ . Enter fee based on installation and equipment value $ Signature: ,.:.,,yap . a.'t`9 tq'�AP° fi :° r,,:;,, ; ��,. .�_ ..�..�„�r . <PLICQNT;USE}�,,z� �� x„ - (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)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through D): $ 0 440-2500-1(4/1/2013/COM) • . Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. • Please check the appropriate box: • I own, reside in, or will reside in the completed structure and my general contractor is: • Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. • Print Name of Permit A•- _-• s■-1111Palts A _AC_ 77--6 ignature of Permit Applica Date • • Permit#: • o F Address: :27-rat!/_t Issued by: Date: 5e • This Copy for Permit Offices