HomeMy WebLinkAboutPermit Plumbing 2013-9-13 •
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• SPRINGFIELD -.. • 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
O Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02063
www.springfieldbcgov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/13/2013 EXPIRES: 03/12/2014
STATUS DATE: 09/13/2013 APPLIED: 09/13/2013
SITE ADDRESS: 1215 MAIN ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703354108200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace 75 ft of private sewer line
OWNER: JANZ ANGELA T Phone Number:
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ADDRESS: PO BOX 2567
EUGENE OR 97402
OWNER: JANZ CHARLES G Phone Number:
ADDRESS: PO BOX 2567
EUGENE OR 97402 •
CONTRACTOR INFORMATION 11 •
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor HENDRICKSON WELL DRILLING INC CCB 68857 10/27/2014 541-942-0843
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench 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. -�
7/ lie
Own- •r Contract. Sig • u - Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE:
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note. the telephone
number for the Crn ofl L''�i v Notification CAOM1 E DAYD P RIODBANDONED FOR
C I I 3 L
�l''er lS � 't!: ;
Springfield Building Permit 9/13/2013 9:09:23AM Page 1 of 1
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SPRINGFIELD _ CITY OF SPRINGFIELD
225 Fifth St
�j TRANSACTION RECEIPT Springfeld,OR97477
'- OREGON 541-726-3753
811-S PR2013-02063
www.springfleld-cr.gov 1215 MAIN ST permitcenter @springfield-or gov
RECEIPT NO: 2013002027 RECORD NO: 811-SPR2013-02063 DATE:09/13/2013
DESCRIPTION.5fi `A .e M ,x_,'->:t_ii-. =',ACCOUNTTCODE/TRANS COD nS :9 rAMOUNT DUETS
Sanitary sewer 224-00000-425603 1005 83.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.02
Technology fee(5%of permit total) 100-00000-425605 2099 4.18
TOTAL DUE: 97.70
`."PAYMENT-TYPE _v„P.AYOR:-''CASHIER:..WARSON r !V. ?' := e u u . _t.'_^'^',a;=Ltiz AMOUNTPAID.,.f a,., t;rt.._
Check South Valley Properties LLC 97.70
576
TOTAL PAID: 97.70
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Plumbing Permit Application DEPARTMENT USE ONLY
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SPRINGFIELD i +
€IMVPSP NGFIEI 6,REGON33 !-r- z Permit no �// ZOl oZp(
225 Fifth Street♦ Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: ?4 3,1/ '.
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 ❑No ,; �.Chst Total j7
Description Qty
Sanitation approval verified? ❑ Yes ❑No
New residential
CATEGORY:OF CONSTRUCTION =;T 1 bathroom/1 kitchen(includes:first
❑Residential ❑ Government ❑Commercial f 00 feet maker,water/sewer lines, hose $262.00 $
m
bibs, ice maker, underfloor low point
. `'JOB'-SITE INFORMATION;}:AND i LOCATION ^;, drains and rain-drain packages)
Job site address: t It-air 2 bathrooms/1 kitchen $411.00 $
✓" ` ,ems l7 �7 3 bathrooms/1 kitchen
City: State:/ 1? ZIP:7 7q<�j $483.00 $
C, Each additional bathroom(over 3) $104.50 $
Reference: . Taxlot.: Each additional kitchen(over I) $104.50 $
v "- Tpp`-z'DESGRIPTION:.OF ORK,5-; r .- -'e` ± Residential fire sprinklers(includes plan review)
�t QAaC mPO A�L44 .. /" 0 to 2,000 square feet - $80.00 $
"77 - ill/// 2,001 to 3,600 square feet $128.00 $
t 'TROP/ERTY OWNER ;. 'f a ,d;..,4r. ;< 3,601 to 7,200 square feet - $192.00 $
Name: Ip,t //V- "1- 7,201 square feet and greater $255.00 $
-^� Manufactured dwelling or pre-fab(circle one)
Address: Mf,0_5y, 1•ry Connections to building sewer and
Q �� water supply $80.00 $
City: `a Stater ZIP:92/g7
E'np Q' Commercial,industrial,and dwellings other than one-or
Phone: GAO- 572,9/33 I Fax: - - two-family
E-mail: 2 Minimum fee $80.00 $
�'S,, (( �� li �t t C Each fixture $21.00 $
This installatiorNs being made on residential or farm property
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 $
: t" Storm water retention/detention facility', ■ '.CONTRACTOR INSSALL'ATION , � ,5�.:; ., ,; Ty $21.00 $
Business name: • I ' ■ , /., 0 0; . Irrigation systems $21.00 $
° Piping or private storm drainage
Address: systems exceeding the first 100 feet $21.00 $
�7 d� Specialty fixtures $21.00 $
City: l 03 D J J� State: ( 3/9 ZIP:
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone: 31/ � _ 5 . Fax: - - Special requested inspections(no.of
E-mail: hrs.x fee per hr.) $80.00 $
CCB license no.:E%-67 BCD license no.: _ Each additional inspection:(1) $80.00 $
Plumbing license no -.Medical gas'pipmg Minimum fee $
Print name: Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature 'z. t - s'„w� ti r. � 1
��'°.. ,�„- AP_PLICANT�USE °F'� � +
(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): $ 9,7 Ze-
440-2500-1(4/1/2013/COM) '