HomeMy WebLinkAboutPermit Plumbing 2013-9-11 SPRINGFIELD ° 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Ita "' Phone: 541-726-3753
c OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
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PERMIT NO: 811-SPR2013-02044
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/11/2013 EXPIRES: 03/10/2014
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STATUS DATE: 09/11/2013 APPLIED: 09/11/2013
SITE ADDRESS: 705 FLAMINGO AVE,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703223109200 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Water line
OWNER: SPRINGFIELD SCHOOL DISTRICT 19 Phone Number:
ADDRESS: 525 MILL ST
SPRINGFIELD OR 97477
_ CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lic No Lic Exp Phone
' _ INSPECTIONS REQUIRED
Inspections
3315 Water Line
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. .
cfiti (r5
er or Contractor Signature Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
NOTICE: pIRE 1F THE WORK Notification Center. Those rules are set forth
THIS PERMIT UNDE EX in OAR 952-001-0010 through OAR 952-001-
A
COMMENCED Is ABANDONED fOR oT 0090. You may obtain copies of the rules by
0 calling the center. (Note: the telephone
ANY 180 DAY PERIOD- number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 9/11/2013 11:02:42AM Page 1 of 1
SPRINGFIELD - CITY OF SPRINGFIELD
225 Fifth St
<` 6�oN TRANSACTION RECEIPT Sphngfield,OR97477
541-726-3753
811-SPR2013-02044
www.springfieldor.gov 705 FLAMINGO AVE permitcenter @springfield-or.gov
RECEIPT NO: 2013002007 RECORD NO: 811SPR2013-02044 DATE:09/11/2013
. :..7. . _, ,,_a. . ,lC___ _.._.ACCOUNTCODE/TRAN§:CODE. .taa��-»'"�1d14[ofYI:gR7e111�*�
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 - 17.58
Technology fee(5%of permit total) 100-00000-425605 2099 7.33
Water Line 224-00000-425603 1005 83.50
Water Line-Each additional 100 feet or portion of 224-00000-425603 1005 63.00
TOTAL DUE: 171.41
�PAYMENTkTYP--EEP-AY.OR cnsru"'ER:.ccii' PenTER COMMENSS AMOU_N_TP,AID
Credit Card Willamalane 171.41
078654
TOTAL PAID: 171.41
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Plumbing Permit Application
SPRINGFIELD:= DIIL . I '
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agelati.F•SPRIN.ertElink_OREGONSAi il-• "="1=7---="'-P
;4 Permit no.: S/7- 2o q'-
at 4ticti
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 9/////J
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 AP I?ROVAL ;;ixg-sii:::;:(.,: :::p:i7v,::::= : :::::,:,:::,-FEE:rcSCH ED ULE:t.liif:= :;f1:::::: 5:72:?
Zoning approval verified? 0 Yes 0 No t:Deoeiritign,':':-•.,•:T •,.z.re.ay.:-•-,:---::---L.:1, Qfy. :',.:`,....e5t•••-: :::•-:.--To91
Sanitation approval verified? 0 Yes D No New residential
• ..:::::, ,, 'CATEGORY!;OF CONSTRUCTION:::'.." :`Vg!. 1 bathroom/1 kitchen(includes first
l 00 feet of water/sewer lines, hose
n Residential 0 Government 0 Commercial $262.00 $
bibs, is maker, underfloor low-point
;1.,1•'.:, :JOB'-SITE 2INFORMATION.::AND LOCATION:1:::?0.:::1:4 drains and rain drain packages)
Job site address: J- n-havt 1 rvto AV 5.- 2 bathrooms/1 kitchen $411.00 $
3 bathrooms/1 kitchen $483.00 $
City: 5peaTri an State: 0e_, ZIP: •
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.:22045 Each additional kitchen(over 1) $104.50 $
,,7.:YDEscRIPTIoa.:0F.::VvoRESM:;";)11PtV Residential fire sprinklers(includes plan review) ..
Tvje.n.--Ail "Z1 1 o rm. Liu prirAt 14 AAE...., 0 to 2,000 square feet $80.00 $ •
2,001 to 3,600 square feet $128.00 $
rte, ■-9-aVICC-.... 2k 1-1‘at .-! '..s.- 3 601 to 7200, square feet
PROPERTY.;,:OWNER.:h:thi.Tti,l''Zi.:`St134'::: ' $192.00 $
7,201 square feet and greater $255.00 $
Name:1A)+1\AvIt'vAL ill,f'\ir-- PAI22-', 12a. TX-;12-1c--1 Manufactured dwelling or pre-lab(circle one)
Address:2.!_cc, 583114 32 j1/44.0 - '1_ Connections to building sewer and 1
$80.00 $
water supply
City: . :7121•1ttinats,) State: efig ZIP: 1347 t Commercial,industrial,and dwellings other than one-or
Phoncrt241-123-6 _L1-04C1 Fax: - - two-family
Minimum fee $80.00 $
E-mail' 3 ArICCIP—a Will AornAGAri --. OW-.
Each fixture $21.00 $
This installation is 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 3 $21.00 $CareSt-
1'.1'2]..:1C.:::7■, ECONTRACTOR:ANSTALLATION:::;:VWiCeiniA Storm water retention/detention facility $21.00 $
Irrigation systems $21.00
Business name: To Eft poi rem Dv RA° _
Piping or private storm drainage
$21 $
. $00
Address: systems exceeding the first 100 feet
City: State: ZIP: Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone: - - Fax: - -
Special requested inspections(no. of
$80.00 $
E-mail: hrs.x fee per hr.)
CCB license no.: BCD license no.: Each additional inspection: (1) $80.00 $
Plumbing license no Jgecheal gas.pipingi-'.;; ..:-::- -,•'•.::,•:, ..;.; Minimum fee $
4_,&,47,0ztv.4.,,zit pp-,ElotiTh,t.flis'EHAt2,,,,,,.-4,..t.;t%%:V.I1S2'12I.li
Enter value of installation and equipment$ .
Print name:
Enter fee based on installation and equipment value. $
Signature:
(A) Enter subtotal of above fees ,,
(Minimum Permit Fee$80.00) $/ ,-g-
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ /7 .
(U)Technology Fee(5%of[A]) $771—
TOTAL fees and surcharges(A through D): $ /7/42---
440-25004(4/1/2013/COM)