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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 r•3 t � px ifz- figmt iezeAtVSy2-C ' y C „ _ < LOare P' ` kI OESPRINGFIEWREGONMMt r— _ Permit no S(-7—a19 ie Sa 4iFj" " xYx ESEt 4 ,Oba. l `'U 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)