HomeMy WebLinkAboutPermit Plumbing 2013-9-30 •
SPRINGFIELD • - 225 Fifth St •
CITY OF SPRINGFIELD Springfield,OR97477
i„ar Phone: 541-726-3753
: OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02190
www.springfield-or.gov • permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/30/2013 • EXPIRES: 03/29/2014
STATUS DATE: 09/30/2013 APPLIED: 09/30/2013
SITE ADDRESS: 1390 CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703253307700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace private sewer line-Private side •
OWNER: SWINEHART DOUGLAS K Phone Number:
ADDRESS: % FIFTH THIRD BANK OF COLUMBUS •
COLUMBUS OH 43215
CONTRACTOR INFORMATION 1
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
• ROTO ROOTER SERVICE 8 PLUMBING (PM)Plumbing Bu PM4 07/01/2014 541-731-1947
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.
1/30A1
Owner or Contractor Signature Date
ATTENTION: Oregon law the requires Utitty
follow rules adopted by Oregon 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 COMMENCED OR IS ABANDONED FOR
number Center is Oregon 1-800-332-2344).Ificatlon ANY 180 DAY PERIOD.
Springfield Building Permit 9/30/2013 12:57:44PM Page 1 of 1
51)RINGFIELDsesaw CITY OF SPRINGFIELD
225 Fifth St
,�tEG N TRANSACTION RECEIPT Spnngfield,OR97477
, 541-726-3753
811-SPR2013-02190
www.spnngfield-or.gov 1390 CENTENNIAL BLVD permitcenter Ca+spnngfield-or.gov
RECEIPT NO: 2013002172 RECORD NO:811SPR2013-02190 DATE:09/30/2013•514Yo : 1JI ek u��-a�.P r'9r: :!"e! d+.
AC000NSCODE(LR4NS€CODE e •114
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
tePAYMENT2TYP,E- - PAYOR: Easel`intasoe,.. t,COMMENTS ratM/A°kJ NITOWDMISISVOKO
Check JENCOURT ENVIRONMENTAL 97.70
1355 SERVICES LLC
TOTAL PAID: 97.70
•
.Plumbing Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
' P L
° Permit n0.: 3--� I�O
CITY�,U .� NGFIELD, UREGO . -.-�..t� �(_[-Zcz�
,,,� ; .',x. 43' `, d p 225 l filth Street ♦ Springfield,OR 97477 • PF1(s41)726 37'3 • I AN(541)726-3689 OREGON Date: //3e13
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(lays.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑Yes ❑No Description Qty, Cost Total
— ea. cost
Sanitation approval verified? ❑ Yes ❑ No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first
l00 feel oft i n(e,vsetier lines, hose
❑ Residential ❑Government ❑ Commercial bits, ice maker, unrfe:fioor low-poise $262.00 5
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Z (''� ry 1 ---
Job site address: - L() C Q_v� `CW‘c,.\ 2 bathr oms/I kitchen _ $411.00 S
City: (� y e-1 �, State(�'Z ZlP:"ilu'��} 3 athronls/I kitchen _ .$483.00 $
1t t � - �`y, much Iddiliunal bathroom(over 3) $104.50 $
Reference: Taxlot.: _--,__- Rich additional kitchen(over 1) $104.50 $
DESCRIPTION OF WORK Residential lire sprinklers(includes plan review)
ee Q\0.L-e s u.,-e C G to 2.000 square feet $80.00 $
2.001 to 3.600 square feet $128.00 $
PROPERTY OWNER 3.601 to 7.200 square leer _ _ $192.00 $
7,201 square feet and greater $255.00 $
Name:
�` \ \ hi:um facture('dwelling or pre-fah(circle one)
Address: '7R y% C V\\--QV 'VN lcL \ Connections to building sewer and
$80.00 $
water supply
City: S22c4J cif\6 late: c?_ ZlP:q-jl(l ',
co mmercial,industrial,and dwellings other than one-or
Phone: - - Fax: - - two-family
E-mail: Minimum fee $80.00 $
Si
This installation is being made on residential or farm property Each Fixture 521.00
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 9 $83.50 $
Signature: Each fixture,appurtenance.and piping $21.00 $
CONTRACTOR INSTALLATION Storrs water retention/detention facility $21.00 $
Mignon systems $21.00 $
Business name: 0-� ��-e.1 _L._ ---
Piping or private storm drainage 521.00 $
Address.'-,_(k %.._. �� \5I- 5 execedine the first 100 feet
Speu dtt fixtulCS $21.00 $
City: � (� State. 0 fL ill c(lC(O L
-- 12einvpccliou(no onus x ire per hr.) 580.00 $
Phone: r7"L{\ - ts ci -t 11t Fax SpecLd requested inspections(no.of
E-mail 1 111e_.e Ice per hr.) $80.00
CCD license no.`.c4,2S31 BCD license no.: ' t I Each additional inspection:(I) . $80.00 $
Y
Plumbing license no.: w _ , Medical gas piping Minimum Ice $
Print name: 1 FL]0 5�� Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature:
APPLICANT USE
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.10) $
(13)Investigative fee(equal to IAI) $
(C)Enter 12%surcharge(.12 x[A+RI) $
(D)Technology Fee(5%of[A]) _ $ _
TOTAL fees and surcharges(A through D): .$ `-
440-2500-)U/I/2013/COPq