HomeMy WebLinkAboutPermit Plumbing 2013-10-10 •
SPRINGFIELD 225 Fifth St
{ 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-SPR2013-02275
www.springfeldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 10/10/2013 EXPIRES: 04/08/2014
STATUS DATE: 10/10/2013 APPLIED: 10/10/2013
SITE ADDRESS: 1891 HAYDEN BRIDGE RD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703252113200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Sewer connection and tank demo for emergency annexation
OWNER: STARK CATHY LEE Phone Number:
ADDRESS: 1891 HAYDEN BRIDGE RD
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
INSPECTIONS REQUIRED 1
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
7170 Septic Tank Abandonment •
. 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.
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O er o ontractor Signature Date
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NOTICE; ATTENTION: Cregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK follow riles adopted by the Oregon Utility
AUTHORIZED UNDER THIS PERMIT IS NOT n OARa952 Center. Those rules are set forth
n OAR You may obtai through OAR 952-s by
COMMENCED OR IS ABANDONED FOR 00 allingothe Cnoter. (Note1etheftelephoneby •
ANY 180 DAY PERIOD. number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit 10/10/201 2:31:27PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD TRANSACTION RECEIPT • Spnngfield,OR 97477
OREGON 541-726-3753
811-SPR2013-02275
www.springfield-or.gov 1891 HAYDEN BRIDGE RD permitcenter(oJspringf1eld-or gov
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RECEIPT NO: 2013002261 RECORD NO: 811-SPR2013.02275 DATE: 10/10/2013
ACCOUNmCODE/TRANSt•4o1e1d.. :iiZ!itr.`AMOUNTDUE-
In lieu of Assessment 409-00000-448051 1153 3,016.29
SDC:Administrative Fee-MWMC Regional Wastewater SDC 611-00000-426604 1189 10.00
SDC: Compliance Cost-MWMC Regional Wastewater SDC 444-00000-426607 1113 22.58
SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 1,114.24
SDC: Improvement Cost-MWMC Regional Wastewater SDC 445-00000-448025 1187 1,448.64
SDC: Reimbursement Cost- Local Wastewater 442-00000-448024 1183 2,282.88
SDC: Reimbursement Cost-MWMC Regional Wastewater SDC 444-00000-448024 1186 114.41
SDC:Total MWMC Administration Fee—Local 719-00000-426604 1121 79.78
SDC:Total Sewer Administration Fee 719-00000-426604 1175 169.86
Sanitary sewer 224-00000-425603 1005 83.50
Sewer cap/septic tank demolition 224-00000-425603 1005 80.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 19.62
Technology fee(5%of permit total) 100-00000-425605 2099 158.99
TOTAL DUE: 8,600.79
P.AYMENIZY P,AYOR casNlERi:75wGLF COMMENTS AMOUNTjI�PAID
Credit Card Mitch Jamisse 8,600.79
05770p
TOTAL PAID: 8,600.79
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Plumbing Permit Application DEPARTMENT USE ONLY
/q� .i, n $Pti1NGFIELO
I OF}SPR NGE'TELD, FOREGO u- Permit no.: 513 - 22 7S
=Y
5a= t ?.ei 'rmrt t x 5j' +xp
225 firth Street • Springfield,OR 97477 • P14(541)726-3753 • FAX(541)726-3689 -\ OREGON Date: /Q//O //
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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 Description Qty.. Cost T 0 t a I
ea. cost
Sanitation approval verified? ❑ Yes . ❑No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first
100 feet of walerbse web lines, base
(1 Residential I ❑Government ❑Commercial bits. ice umker, underpuor low-point $262.00 $
JOB SITE INFORMATION AND LOCATION drains mud rain-drain packages)
Job site address: 2 bathrooms/I kitchen £411.00 S
/�C [� �"" 3 bathrooms/I kitchen 5483.00 iil�i. ib a__. _�iiiYi _�� I Each additional bathroom(over 3) � $104.50 $
Referenc•' Taxlot.: Each additional kitchen(over I) $104.50 S
ESCRIPTION OF WORK Residential lire sprinklers(includes plan review)
3 9 l✓�A 0 to 2.000 square feet $80.00 $
- l' 2,001 to 3.600 square feet $128.00 $
R I RTY OWNER 3,601 to 7,200 square feel $192.00 $
1 7,201 square feet and greater 5255.00 $
Name: - - ------
_ `� manufactured dwelling or pre-I'ab(circle one)
Address: Connections to building sewer and
FT.V water supply $80.00 $
Slate: /_II :
Commercial.supply
industrial,and dwellings other than one-or
Phone: - 7 Fax: - - two-family
E-mail: Minimum fee S80.00 $
This installation is being made on residential or farm property Each fixture 521.00 $
owned by me or a membe of my immediate family, and is Miscellaneous fees
exempt from I jet s Ig r-quirements under OAR 918-695-0020. 100' storm,sewer.water line 1 $83.50 $p cv
itSignature: „77_______,----- Each fixture,appurtenance.and piping $21.00 $
1 ON "ACTOR INSTALLATION Storm water retention/detention facility $21.00 $
Business man
In keation systems $21.00 $
��, -4, s -____ Pepin e4 prremc alarm drainage
Address: system exc cline the first 100 feet 521.00 $
Chong. 6i „ � State: .__.-.__.. ____
(--1 L .� s Specialty fi<lures £21.00 $
City: r�\"n7�` State: ZIP:
ReinspeUimt(no of hrs.x fee per hr.) $80.00 $
1_ / =�, 1-G� ax - - Special requested inspections(no.of
C t / hr>.s ter er hr.) $80.00 $
E-mat : ✓ - s /1 ` - < - ■ I
CCB license no.: /d ' -, `:r� BC(license no.: Each ndditiyn6i ¢I�ti r8 iA(I) ,nom $80.00 $ S'400
Plumbing license no.: Medical gas piping Minimum fee $a a
Print name: Enter value of installation and equipment$ .
Enter lee based on installation and equipment value. $
Signature: r APPLICANT USE
(A) Enter subtotal of above lees �
(Minimum Permit Pee$80.111) 63
(13)Investigative lee(equal to IAI) $
. (C)Enter 12%surcharge(.12 x [A+RI) SW/
(D)Technology Fee(5%or[AI) S�/(/�
TOTAL fees and surcharges(A through D): $ / %f-�
440-2500-314/1/2013/LOW