HomeMy WebLinkAboutPermit Plumbing 2013-9-6 SPRINGFIELD - - 225 Fifth St
tt CITY OF SPRINGFIELD Springfield,OR97477
i Phone:541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02003
www.springfield-or.gov permitcenter@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: 441 FAIRVIEW DR,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274100101 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Plumbing repair-441 and 459 Fairview
OWNER: HOUSING AUTHORITY 8 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
L 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.
/
111 ta) (6(-416e gll(a/906
Owner or Contractor Signature Date - ,
, WpRK
. - (}TtCE: ` •p1RE\E�NEISNO1•
THIS PERMIT SHAD RTH1S PERNUjfrOR
ou to �UTHDRIZED QA IS ABANDONED
ATTENTION: Oregon law requireson Utility ENDED
follow rules adopted by the Oregon DDMI� DAy PERIOD.
Notification Center. Those rules are set forth \IVY 180
in OAR 952-001 obtain copes o the ru e Oby
0090. You he center. (Note: the telephone
calling on Utility Notification
number for the Oreg
Center is 1-800-332-2344).
Springfield Building Permit 9/6/2013 1:23:40PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
`o EGON TRANSACTION RECEIPT Springfleld.OR W477
•
541-726-3753
811-S P R2013-02003
www.springfield-orgav 441 FAIRVIEW DR permitcenter@springfield-or.gov
RECEIPT NO: 2013001973 RECORD NO:811-SPR2013-02003 DATE:09/06/2013
'_DESCRIPTION , _� _ . ACCO.UNTCODE/TRANS_CODE,___._ ._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:ccARPENTER_ _ _ COMMENTS. AMOUNT PAID
Check SUSAN JANE ARNOLD 93.60
8289
TOTAL PAID: 93.60
•
•
•
•
•
Plumbing Permit Application 'DEPARTMENT USE ONLY.
SPRINGFIE LD
2�Pt IP S5 FaitK ��T_ ty tril 14
e" � Prmit no.: 51 - Zoo gF R N FE6 R N '
Id�i fr Yr �, h tr xgialrX . w� al i^ w
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: ell/
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.
LOCAC 'GOVERNMENT APPROVAL =x ' FEE•:SCHEDULE ""
Zoning approval verified? ❑ Yes ❑No Qty .Cost TotaI
Oescntlon �
Sanitation approval verified? ❑ Yes ❑No New' ea cost
N residential
%CATEGORY`. OF CONSTRUCTION V " 1 bathroom/1 kitchen(includes:first
❑Residential
100 feet of water/sewer lines, hose
❑Government ❑Commercial $262.00 $
bibs, ice maker, underfloor low porn[
JOB`;SITE'+INFORMATION::•AND LOCATION drains and rain-drain packages)
Job site address: H 14 1 9 4Sc f'a J st.n) Or, 2 bathrooms/I kitchen $411.00 $
City:Spc.Lb State:O ZIP: C17 417
3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference: I Taxlot.: Each additional kitchen(over 1) $104.50 $
DESCRIPTION.-OF WORK,- "sF_'• Residential fire sprinklers(includes plan review) _
Cw} c A ; .1 ee- ay\ 1pr l 0 w 2,000 square feet - $80.00 $
2,001 to 3,600 square feet $128.00 $
r W 1 LLAV
'` ` 9' ti ROFERTY 1,OWNER . Rif ^: 3,601 to 7,200 square feet $19100 . $
Name: `k A_C.S 7,201 square feet and greater $255.00 $
Manufactured dwelling or pre-fab(circle one)
Address: 3Go h,4. .jC .J Connections to building sewer and
water supply - $80.00 $
City: S e State:Q� ZIP: r17'17'7 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 $
CONTRACTOR`•..INSTALLATION- ?r,. ";4 h Storm waterretention/detention facility $21.00 $ •
Business name: • 'rti,.1., ' -7 � � - Irrigation systems $21.00 $
V " Piping or private storm drainage $21.00 $
Address: pc. (4j dk q t�^}-� systems exceeding the first 100 feet
Specialty fixtures $21.00 $9 State: 0 /L, ZIP: �7
M'1 r
Reinspection(no.of hrs x fee per hr.) $80.00 $
Phone:(-yly 310 Fax: - - Special requested inspections(no.of
hrs.x fee per hr.) $80.00 $
E-mail: a,1.3t--yJAs PlAtit
CCB license no.: '-1Q S6 / BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no ;113edmal gas`pipmg W : Minimum fee $
d I fill Enter value of installation and equipment$ .
Print name:
K lr.M I �C P tid Enter fee based on installation and equipment value. $
�" f 1_
Si afore: ;. APPLICANT :USE -,
(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]) $ C7
(D)Technology Fee(5%of[A]) $ 4L6°
TOTAL fees and surcharges(A through D): $ 90i
440-2500-1(4/1/2013/COM)