HomeMy WebLinkAboutPermit Plumbing 2013-10-16 •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
' � Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02310
www.spnngfieloor.gav permitcenter(dspringfieltl-or.gov
PROJECT STATUS: Issued ISSUED: 10/16/2013 EXPIRES: 04/14/2014
STATUS DATE: 10/16/2013 APPLIED: 10/16/2013
SITE ADDRESS: 529 W CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703274305805 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Two sinks,grease trap and dishwasher
OWNER: CENTENNIAL SHOPPING CNTR LLC Phone Number:
ADDRESS: 7831 SE STARK ST STE 103
PORTLAND OR 97215
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor SUSAN JANE ARNOLD COB 49561 12/16/2014 541-484-3787
INSPECTIONS REQUIRED
Inspections
3150 Underslab Plumbing Underslab Plumbing: Prior to filling the trench and including required testing.
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3610 Grease Trap/Interceptor
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.
Owner or Con actor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility • 1 i ICE:
Notification Center. Those rules are set forth ?IS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- UTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by :OMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone
number for the Oregon Utility Notification ;NY 180 DAY PERIOD.
Center is 1-800-332-2344).
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iJ�. .. .
Spnngfeltl Building Permit 1-- aJ v/ 10/16/201 2.56:06PM Page 1 of 1•
SPRINGFIELD CITY OF SPRINGFIELD
i14 .a.- 225 Fifth St
,�,�yy TRANSACTION RECEIPT Springfield,OR 97477
11 St. 541-726-3753
OREGON 811-SPR2013-02310
wvrw.spnngfieldor.gov 529 W CENTENNIAL BLVD permitcenter @springfeldor.gov
RECEIPT NO: 2013002292 RECORD NO:811-SPR2013-02310 DATE: 10/16/2013
1e5 (s cn a ilofI - _'.'3. •u-- .:.._ ACCOUNT CODEITRANS'CODE-°'. r7:::*-£effralirMI lillrai2
Dishwasher 224-00000-425603 1005 21.00
Interceptor/grease trap 224-00000-425603 1005 21.00
SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 487.47
SDC: Reimbursement Cost- Local Wastewater 442-00000-448024 1183 998.77
SDC:Total Sewer Administration Fee 719-00000-426604 1175 74.31
Sink/basin/lavatory 224-00000-425603 1005 42.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.08
Technology fee(5%of permit total) 100-00000-425605 2099 4.20
TOTAL DUE: 1,658.83
. P.AYMENTTYPE. , . 1TP.AYOFt' cnsliaccAiFrpi R `COMINE li - M AMOUNTOPAID.', 'y._,-
Check Benedetti's 1,658.83
2100
TOTAL PAID: 1,658.83
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Plumbing Permit Application DEPARTMENT USE ONLY
SPRIN FILL)
� [TY OF PRINGFIELD� REGOI�I Permit no.: s/3—2.3ra
225 Fifth Street • Springfield.OR 97477 • PR(541)726 3753 • FAX(541)726-3689 �2. OREGON Date: /07/ 47 3
This permit is issued under OAR 918-780-0060. Permits are issued only to die 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 Total
ca. cost
Sanitation approval verified? ❑ Yes ❑No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(inchtdee:first
100 feel of truler%seu er lines,hose
El Residential ❑Government Commercial bibs, ice maker, wtderiloor low-point $262.00 $
JOB SITE INFORMATION AND LOCATION drains and rain-drain
Job site address: DCl Wes-} Cc 1&,a iL ?pa. 2 bathrooms/I kitchen _ $411.00 $
SPet 3 bathroomsfl kitchen $483.00 $
City: Y ^4c -,Q,� State: 71P: 017471
Each additional bathroom(over 3) $104.50 $
Reference: 'I'axlot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
2�J ( . . -K ,� / S f7�/�� y r- 0 to 2.000 square teal _ ___ $80.00 $
- pc"?' 62/C-" 2.001 to 3.600 square lieu $128.00 $ •
PR PERTY OWNER 3.601 to 7,200 square feet $192.00 __$
Name: 30,..)-04 c4'fit "R, y , 7,201 squat c feet and greater $255.00 5
Manufactured dwelling or pre-fah(circle one)
Address: Connections to building sewer and
water supply 580.00
City: 17eQ�Lici.t.)d State'Q ZIP :
Commercial,industrial,and dwellings other that one-or
Phone: - - Fax: - - two-family
E-ml:
fee .$80.00 $
This installation is being made on residential or farm property Each fixture I $21.00 ji
owned by me or a member of my immediate family, and is aliscellareous fees
/' exempt iron .cei • requirements under OAR 918-695-0020. IOU' storm, sewer. water line $83.50 $ .
/ Signature Each fixture.appurtenance.and piping $21.00 $•
ACTOR INSTALLATION Sturm water retention/detention facility $21.00 $
Business n.me: "IR q kit Cs1 ?Oa i'll i lv'f1 Irrigation systems $21.00 $-J
Piping or private storm drainage $21.00 $
Address: systems exceeding the first 100 feet
�� Specialty fixtures 521.00 S
City: fljuriojU� Slater ZIP:
J Reinspecliun(nu.ul'hri.s fee per hr.) $80.00 S
Phone: - Fax: = Special tcquested inspections(no.of
E-mail' hrs. x ice per hr.) _
$80.00 _..__
CCB license no: _( / 5 r/// BCD license no.: Each additional inspection:(I) $80.00 $
Plumbing license no.: Medical gas piping Minimum fee $
Print name: _ Enter value of installation and equipment$ .
Enter fee based on installation and equipment value.
Signature: APPLICANT USE
(A) Enter subtotal of above fees $ 8�
(Minimum Permit Fee$80.110)
(li)Investigative fec(equal to IAI) - $
(C)Enter 12%surcharge(.12 x IA+RI) 5/0 OA
(D)Technology Fee(5%of[AI) $ //l
TOTAL fees and surcharges(A through D): $ 77 -3—
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440-2500-J(4/1/2013/CONI)