HomeMy WebLinkAboutPermit Plumbing 2013-9-6 SPRINGFIELD 225 Fifth St
..F.. ; CITY OF SPRINGFIELD 225 Fifth
97477
S, �� Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02002
www.springfield-or,gov perm itcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/06/2013 EXPIRES: 03/04/2014
STATUS DATE: 09/06/2013 APPLIED: 09/05/2013
SITE ADDRESS: 1678 KELLY BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274100101 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Plumbing repair-1678 and 1696 Kelly
OWNER: HOUSING AUTHORITY&URBAN Phone Number:
ADDRESS: 177 DAY ISLAND RD- .
EUGENE OR 97401
L 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
\11
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. ./
eiVki t� ,red O!(o/ag
Owner or Contractor Signature Date
NOTICE: , ' ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility
AUTHORIZED UNDER THIS PERMIT IS NOT Notification Center. Those rules are set forth
in COMMENCED OR IS ABANDONED FOR 0090.OAR Y uzmay obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
- number for the Oregon Utility Notification
Center is 1-800-332-2344). •
Springfield Building Permit 9/6/2013 126:19PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
c TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-SPR2013-02002
www.springfield-or.gov 1678 KELLY BLVD permitcenter @springfield-or.gov
RECEIPT NO: 2013001975 RECORD NO:811-SPR2013-02002 DATE:09/06/2013
tDESCRIPTION _ ` ` ACCOUNT CODElTRANSCODE AMOUNT DUE'
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 TYPE PAYOR _.CASHIER:CCAReENTER _ _ COMMENTS-_- w._,.� AMOUNT PAID
Check _ _ SUSAN JANE ARNOLD 93.60
8289
TOTAL PAID: 93.60
Plumbing Permit Application DEPARTMENT USE ONLY '.:
SPRINGFIELD
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 7757/
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 •Cost Tofal
❑No :Description-,':::,7 `NQtS ;;e
Sanitation approval verified? ❑ Yes ❑No New residential
`CATEGORY''„OF CONSTRUCTION : I = 1 bathroom/] kitchen(includes first
❑Residential ❑ Government ❑Commercial
100 bibs, ice maker,water/sewer lines, hose $262.00 $
bibs, ice maker, underfloor low point
' 'JOB'`SITE'•INFORMATI0NN;;'AND LOCATION drains and rain-drain packages)
Job site address: 1(p1 s *- ` Ip-r(p kt.i.\rl %\j41I 2 bathrooms/1 kitchen $411.00 $
\,.,� State: Q ZIP:0041 3 bathrooms/I kitchen $483.00 $
City:
P^ 7 Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $
' `; :.,-DESCRIFITION‘'OEI:WORicn:11::::"1:Y'Atat
Residential fire sprinklers(includes plan review)
/ tw,1 awt Nn •tJ C e_$, S
WW1) 0 to 2,000 square feet $80.00 $
F kax1 S m% — snw.w.�0 k C TH tth.m1 l,t,A t 2.001 to 3,600 square feet $128.00 $
oft "i1PROPERTY•:OWNER :. yyi-'iµ*+ `'' 3,601 to 7,200 square feet $192.00 $
7,201 square feet and greater $255.00 $
Name: N t\c.S A
Manufactured dwelling or pre-fab(circle one)
Address: `'ion c.,A‘s\tu.‘",.4a Connections to building sewer and - $80.00 $
y Sptl'vn ,`t�9. O'o, water Commercial,City: S State: ZIP: 91 7 Commercial,industrial,and dwellings other than one-or
Phone: - - Fax: - - two-family
E-mail: Minimum fee / moo $
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 $
l ' iii . !'CONTRACTOR:•INSTALLATION'S 1, d. 0tV Storm waterretention/detentionfacility $21.00 $
Business name: "l Irrigation systems $21.00 $
r� Q� } P�mkan,.,\6`10 Piping or private storm drainage
Address: Y O 301 7 oca.,(o systems exceeding the first 100 feet $21.00 $
City: SQc_.Lt's I State:044, ZIP:1141S Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone:[t(ratb4 37 7 Fax: - -
n Special requested inspections(no.of
E-mail: Q V,, 4\L1.M,,SAki( vJ(\zk a\Vt N,�,'� hrs.x fee per hr.) $80.00 $
CCB license no.:415(0 t BCD license no.: Each additional inspection: (1) $80.00 $
Plumbing license no 'Medical gaspipmgA Minimum fee $
1, tea,1 Enter value of installation and equipment$
Print name: lC ky- ti W Enter fee based on installation and equipment value. $
Signature: . r _ - APPLICANT `USE ` -,_,.;,,t R%4
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[Al) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Technology Fee(5%of[.A]) $
TOTAL fees and surcharges (A through D): $ 0J�/pl✓/
440-2500-1(4/12013/COM)