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Permit Plumbing 2013-9-18
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SPRINGFIELD 225 Fifth St • 't' CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 "'' OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax:541-726-3676 PERMIT NO: 811-SPR2013-02102 www.springfeld-or.gov permitcenter @spnngfield-or.gov PROJECT STATUS: Issued ISSUED: 09/18/2013 EXPIRES: 03/17/2014 STATUS DATE: 09/18/2013 APPLIED: 09/18/2013 SITE ADDRESS: 2120 G ST,Springfield,OR 97477 SCOPE: Plumbing Only • ASSESOR'S PARCEL NO: 1703361207200 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Sanitary sewer 50ft Private OWNER: BARRY SHEILA Phone Number: 'ADDRESS: 2120 G ST SPRINGFIELD OR 97477 _ CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp - Phone Plumbing Contractor JENCOURT ENVIRONMENTAL SERVICES LLC CCB 182531 06/11/2014 541-689-1711 INSPECTIONS REQUIRED 7 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 constru ion. . /! /!3 Owner or Contractor Signature Da{e ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth NOTICE:PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- THIS • 0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification 1NY 180 DAY PERIOD. Center is 1-i,)0-9;:_ 2344). • Springfield Building Permit 9/18/2013 2:09:27PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR97477 "6 OREGON 541-725-3753 811-SPR2013-02102 www.springfeld-ar.gay 2120 G ST permitcenter©spnngfield-or.gov RECEIPT NO:. 2013002062 RECORD NO: 811-SPR2013-02102 DATE:09/18/2013 DESCRIPTION_' tlm, rr 1n1�'' ` 4, 8.7.if w ACCOUNTCODE/TRANS CODE 1 Y*sz"- 'AMOUNT4DUE -1 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 P.AYMENTmT17E ��PAYOR CASNIERi.JSLA t COMMENTS IAMOUN e,AID a Check JENCOURT ENVIRONMENTAL , 97.70 1198 SERVICES LLC TOTAL PAID: 97.70 . Plumbing Permit Application DEPARTMENT USE ONLY � SPRINGFIED CI YME SPRINGEIELD/OREGON Permit no : 8!( ?©t 3 O Zl Z 225 Filth Street• Springfield.OR 97477 • PH(541)726 3753 • I AX(5411726-3689 OREGON bete: 7/e// 3 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 ISO days. LOCAL GOVERNMENT APPROVAL _ FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Description 1QIyj Cea.ost Teot:cost d Sanitation approval verified? ❑ Yes ❑No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first W{{{,,, 100 fee(of wenerrsewer lines, hose esidentlal ❑Government ❑Commercial bibs, ice ranker, underlloar low-paint $262.00 S JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) Job site address: a,l . C CD Si— 2 bathrooms/I kitchen $411.00 S 3 bathrooms/I kitchen 5483.00 $ City: I_State_ ZIP RiC4-11 Each additional bathroom(over 3) $104.50 $ Reference: Taxiot,: Each additional kitchen(over I) $104.50 $ ��- DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) _ \c\pcc.„_c_c SAS \rAT eA h 1. 0 to 2.000 square Ives $80,00 $ s y 2.00110 3.600 square feet 5128.00 $ PROPERTY OWNER 3-601 to 7,200 square feet $192.00 $ Name: L — I 7,201 square feel and greater $255.00 $ ,- Manufactured dwelling or pre-fab(circle one) Address: 2/a• Cyi S'{ Connections to building sewer and 5 Willer supply $80.00 $ City: SQ ./r Slate: ZIP : . Commercial.industrial,and dwellings other than one-or Phone: - - Fax: - - two-family E-mail: Minimum fee $80.00 $ _.__.- ._--.....-._.._...__-..._- Each $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' stone.sewer.water line ( $83.50 $ Signature: Each fixture.appurtenance.and piping 521.00 $ CONT: 'CTOR INSTALLATION Storm water retention/detention facility $21.00 $ Business name: Irrigation systems 521.00 $ y Piping or private storm drainage Address: k-o-kg, \ A,%-t (ST zL,(kc. systems exceeding the first IOO feet $21.00 $ City: C-- ke Stated ZIP -(4.( Specially fixtures $21.00 $ �,o,L.1N� Reinspection(nu.of he.. x fee per hr.1 $80.00 $ Phone:S`(I- (-'(t V Fax: - - Special requested inspections(no.of $80.00 $ E-mail: hrs.x fee per hr.) CCB license no.: fvac3 1 BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no.: O L, . Medical gas piping Minimum fee $ c / Enter Value of instillation and equipment$ ;mine:ne: __c% \ p�l — nter fee bused on installation and equipment value. $ Signature: . APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) (14)Investigative fee(equal to IA I) $ tEl Enter 12%surcharge(.12 x[A+13I) $ (D)Technology Fee(5%of[A]) 5 TOTAL fees and surcharges(A through D): $ ?7 ?St 440-2500:1 we./2013/Comp