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Permit Plumbing 2013-9-6
• SPRINGFIELD 225 Fifth St hocCITY OF SPRINGFIELD Springfield,OR 97477 "+ Phone: 541-726-3753 ¢c°" Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02008 www.springfieldar.gov permitcenter @springfield-ocgov PROJECT STATUS: Issued ISSUED: 09/06/2013 EXPIRES: 03/04/2014 STATUS DATE: 09/06/2013 APPLIED: 09/05/2013 SITE ADDRESS: 1530 1ST ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703263200300 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Plumbing repair-1530 and 1540 1st •OWNER: HOUSING AUTHORITY&URBAN Phone Number: ADDRESS: 177 DAY ISLAND RD EUGENE OR 97401 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor SUSAN JANE ARNOLD CCB 49561 12/16/2014 541-484-3787 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 is located at the front of the property,and the approved set of plans will remain on the site at all times during construction. CA/tic �1ct. 0e° ilk /966 Owner or Contractor Signature Date Oregon law requires you to ATTENTION:rules dopg NOTICE: follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WDRK in OAR 952-001-0010 through OAR 952-001- 0U9-•0. You may obtain copies `ttelenhles y AUTHORIZED UNDER THIS PERMIT IO NOT ca'Png the center. l° '`; . Ali COMMENCED OR IS ABANDONED FOR n•I• a. 1 „.. •' '!Y 180 DAY PERIOD. Springfield Building Permit 9/6/2013 1:17:27PM Page 1 of 1 • • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St• TRANSACTION RECEIPT Spnngfeld,OR97477 eOREEiON 541-726-3753 811-SPR2013-02008 www.spnngfield-orgov 1530 1ST ST permitcenter©spnngfield-ar.gov RECEIPT NO: 2013001971 RECORD NO:811-SPR2013-02008 DATE:09/06/2013 . 'i~ i °il e cfMeACCOl1NT'CODEIrRANS CODE *_i°'_ i `e o o Inirgrri Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 38.00 Fixture 224-00000-425603 1005 42.00 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 TOTAL DUE: 93.60 PAYMENT ,:,. : -'r :,L,:-.AMOUNT PAID ' TYPE.-.._ PAYOR::'-.''CaSNIER::JLAR50Nr.�t_''_�=_COMMENTS �._� =& .�. ,a-.:'- .. ' Check Right-Way Plumping 93.60 8289 TOTAL PAID: 93.60 • • Plumbing Permit Application DEPARTMENT USE ONLY SPRIN6FlEL0 _- - _ - , 5 CITgOF,ST liNGF L-De UREiO � S Permit no.: rjl( 20 I3 oZc� r. � p S e � E " . s ? w L 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 a FAX(541)726-3689 Date: 74)//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. LOCALLGOVERNMENT APPROVAL _ - _ FEE SCHEDULE -- Zoning approval verified? ❑Yes ❑No Description s Qty Oust Ttital. Sanitation approval verified? ❑ Yes ❑No ea ost_; _ New residential 'CATEGORY`,;OF CONSTRUCTION 1 bathroom/1 kitchen(includes:first ❑Residential ❑Government 0 Commercial 100 feet of water/sewer lines,hose bibs, ice maker, underfloor law-point $262.00 $ s JOB-LSITEiINFORMATION:;.AND LOCATION =; drains and rain-drain packages) Job site address: \5 alp 4 \ t,\0 aJ , - Rtes- SA'. 2 bathrooms/I kitchen $411.00 $ 3 bathrooms/1 kitchen $483.00 $ City:S p t State: ZIP:00 9' 1 Each additional bathroom(over 3) $104.50 $ Reference: - ' Taxlot: Each additional kitchen(over 1) $104.50 $ � W -':; DESCRIPTION`OF ORK. r = s, Residential fire sprinklers(includes plan review) `` 1 tti - ev„� Mr) S.o tie.$ F`\-A-, .,.5S z. Vial\1 0 to 2,000 square feet - $80.00. $ 1. \.P.V S Nk — 4l o v. r. N`4� E 2,001 to 3,600 square feet $128.00 $ ;" ,. , -PROPERTY:OWNER "y 3,601 to 7,200 square feet $192.00 $ �" - 7,201 square feet and greater $255.00 $ Name: [-1 j\GS k Manufactured dwelling or pre-fab(circle one) Address: Sc - J Connections to building sewer and water supply $60:00 $ City: Spry\„ �t\rA State:p� ZIP: S i Lin 7 S Commercial,industrial,and dwellings other than one-or Phone: - - Fax: - - , two-family E-mail: Minimum fee $80.00 $ 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 $21.00 $ r 'V <CONTRACTOR'-INSTALLATION-` `t ' Storm water"retention/detentionfacility $21.00 $ Business name:R1 �..._ 1/./43.-1/4i P],�,,,tti� 1v� Irrigation systems $21.00 $ n Piping or private storm drainage $21.00 $ Address: '' O ` ,o 7 o (o systems exceeding the first 100 feet _City: SEQ-Lt State:(pg, ZIP:t)(Al CZ _ Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $80.00 $ Phone:cyj-c.454 3`)%) Fax: - - - Special requested inspections(no.of E-mail: V,} PlutwL\qh.5 a_ \ACVIAokye •(a,t'F -hrs.-x-fee per hr.) $80.00 $ CCB license no.:1-4151e>I BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no ;Medical gas_.pipmg - _° Minimum fee $ . 1, Enter value of installation and equipment$ . Print name: K■s. - ti kck Enter fee based on installation and equipment value. $ Signature: t 2 �i �$ x 3 - �..,_ � AP__PyLICANT':A1SE �Wi �s (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): $ 93 440-25004(4/12013/COM)