HomeMy WebLinkAboutPermit Plumbing 2013-9-6 ' SPRINGFIELD _, 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
C - Phone: 541-726-3753
OREGON) Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02005
www.spnngfield-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: 136 W OLYMPIC ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274106700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Plumbing repair-136 W Olympic only
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 541-784-3787
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.
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
Notification Center. Those rules are set forth
1UTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
IM1MENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
en ()A`% PERIOD. calling the center. (Note: the telephone
• number for the Oregon UtiIi'v ,,loh'ic>rtior
•
Center is 1-EIi0-302 2;:
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Springfield Building Permit 9/6/2013 1:30:22PM Page 1 of 1
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' SPRINGFIELD -- CITY OF SPRINGFIELD
`j„,,,, 225 Fifth St
-C\OREGON TRANSACTION RECEIPT Spnngfieid,OR97477
541-726-3753
811-SPR2013-02005
www.springfieid-or.gov 136 W OLYMPIC ST permitcenter @springfleid-or.gov
RECEIPT NO: 2013001977 RECORD NO:811-SPR2013-02005 DATE:09/06/2013
DESCRIPTION r:-Na. � � am . I
UPCACCOUNTCODEITRANS CODE L_. ,.?:-L1AMOUNT DUE. f�
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�T•YPE PAYO RaASHIER:JLARSON COMMENTS AMOUNT PAID
Check Right-Way Plumping 93.60
8289
TOTAL PAID: 93.60
Plumbing Permit Application ..-.. -DEPARTMENT USE.ONLY
SPRINGFIELD
Zi
Permit no.: e( 1
��`"�CI�oF SPxnvGFIEL'�;O�iEGDN�,—� 5 1�` �'���� ( 2� �.�
225 Fifth Street• Springfield,OR 97477 • PH(541)725-3753 • FAX(541)726-3689 Date: F/l%//�
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 .GOVERNMENT APPROVAL . , =', ;?FEE.SCHEDULE * ..�: „
Zoning approval verified? ❑ Yes ❑No ;cost I Total.`s
Description Qfy r
Sanitation approval verified? ❑Yes ❑No ent i?a cost
_ New residential
?-ICATEGOIRY`;OF CONSTRUCTION 1 bathroom/1 kitchen(includes:first
❑Residential ❑Government ❑Commercial 100 feet ojwarer/sewer lines, hose
bibs, ice maker, underfloor low point $262.00 $
JOB`SITE,.INFORMATIO WAN D •LOCATION drains and rain-drain packages)
Job site address: 12 to OV4 wt41L S-c . 2 bathrooms/1 kitchen $411.00 $
Spc-�� S1Lk 1 3 bathrooms/1 kitchen $483.00 $
City: t, State: ZIP: Each additional bathroom(over 3) $104.50 $
Reference: . . Taxlot: Each additional kitchen(over 1) $104.50 $
DESCRIPTION'.'OF WORK,:', r, _=-, Residential fire sprinklers(includes plan review)
u-t- 0 *- in SW t e_0 cCatiCISfiS k va`A11 0 to 2,000 square feet $80.00 $
L'aY LptrV S Mt — le 1wv.Jd k ,t1 A.An. Mu.I , E 2,001 to 3,600 square feet $128.00 $
'# *-. _ - -g$ �- 3,601 to 7,200 square feet $192.00 $
_.,,,, , :.,_. PROPERTY"OWNER _
7,201 square feet and greater $255.00 $
Name: IA CGS k
Manufactured dwelling or pre-fab(circle one)
Address: So Cisaa'V,ttc‘e v0 Connections to building sewer and
water supply $80.00 $
City: Sp‘,,-\.,, i, & State:e o ZIP: Si 4211
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 $
.�5'i '=:CONTRACTOR'INSTALLATION•: ?7,-rtZ-_;;� �: Storm water retention/detrntionfacility $21.00 $
Business name:Rt ve- "1,(>,M P�sr m.,,N0 iN+t Irrigation systems $21.00 $
°J Piping or private storm drainage
Address: '¶p %01,_ 7or (o systems exceeding the first 100 feet $21.00 $
City: e1J I State:ers,ft ZIP:g'►(4-1 s
Specialty fixtures $21.00 $
Phone:cjq-c.t c 3`)%) Fax: - Rc Special re on requested of pec x fee per hr.) $80.00 $
/^� �t ` Special requested inspections(no.of
E-mail: ��9 vo.m.,\ve •i VJAckkoku . ,p34 hrs.x fee per hr.) $80.00 $
CCB license no.:C{115(e' BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no Medical gas,pipmg Minimum fee $
1, �, `1 Enter value of installation and equipment$ .
1C
Print name: kv- k a W
Enter fee based on installation and equipment value. $
Signature:t� YAP0610ANT I7SE 5 m ;
(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): _ - $ Y3 6.�
440-2500-1(4/12013/COM)