HomeMy WebLinkAboutPermit Plumbing 2013-10-31 SPRINGFIELD 225 Fifth St
` CITY OF SPRINGFIELD Springfield,OR 97477
'� ay Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
• PERMIT NO: 811-SPR2013-02424
www.springfield-or.gov permilcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 10/31/2013 EXPIRES: 04/29/2014
STATUS DATE: 10/31/2013 APPLIED: 10/31/2013
SITE ADDRESS: 2857 HAYDEN BRIDGE RD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702193200403 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Backflow
OWNER: PAULSON RONALD V&BARBARA J Phone Number:
ADDRESS: 2857 HAYDEN BRIDGE RD
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION 1
Contractor Type Contractor Name Lic Type Lic No - Lic Exp Phone
Plumbing Contractor MICHAEL CROSS CONSTRUCTION INC CCB 121700 03/30/2014 541-673-2249
INSPECTIONS REQUIRED
Inspections
•
3500 Rough Plumbing Rough Plumbing: Prior to cover 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.
-� 07s 1713
Owner or Contractor Signature Date
•
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth NOTICE:
SHALL EXPIRE IF THE WORK •
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT
0090. You may obtain es of the rules by 1UTHORIZED UNDER THIS PERMIT IS NOT
copies
Calling the center. (Note: the telephone
number for the Oregon Utility Notification -,OMIMENCED OR IS ABANDONED FOR
Center is 1-800-332-2344), ,NY 180 DAY PERIOD.
Springfield Building Permit 10/31/201 • 1:50:24PM Page 1 of 1
•
SPRINGFIELD CITY OF SPRINGFIELD
hr- 225 Fifth St
to OREGON TRANSACTION RECEIPT SpringFeld.oR97477
541-726-3753
811-SPR2013-02424
wwwspringfield-or.gov 2857 HAYDEN BRIDGE RD permitcenter@springfeld-or.gov
RECEIPT NO: 2013002394 RECORD NO:811-SPR2013-02424 ` DATE: 10/31/2013
D ESCRIPTION " " " ig-t` c :t .- vh �6L oe
RANS'COD s�.�.,i AMOUNTiDUE-.:
Backflow preventer 224-00000-425603 1005 21.00
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
PAYMENTETYPE 4SPAYOR=_ UASHIER::JI:ARSON.3y.� ?j ±!-cCOMMENTS v: =1.0- . �'.:.s'AM•UNT PAID_sd. - "?,"`_y'
Credit Card Chelsea's Landscapes - 93.60
055842
TOTAL PAID: 93.60
•
Plumbing Permit Application DEPARTMENT USE ONLY
SPRINGFIELD -
c .
t Permit I1e7( 2 � I2y CIIY1017: NGFI ) GO -
225 Fifth Street • Springfield,OR 97477 • P11(541)726-3753 • I AX(541)726-3689 GREGON Date: t o/3/, /( 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 180 days.
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
I00 jeer of t'atenseu er lines, hose
❑ Residential ❑Government ❑Commercial _ bibs, ice tanker, underpoor loin-point $262.00 S
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: 2- S 57 H'y J . r.S kol• 2 bathrooms/I kitchen $411.00 $ -
3 bathrooms/I kitchen .5483.00 S
City: ,y. -/1 state: 0X ZIP: p7•t77 —
-� _ Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential lire sprinklers(includes plan review)
0 to 2,000 square feet $80.00 S
2,00 I to 3.600 square feet $128.00 $
PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $
7,201 square feet and greater $255.00 $
Name: 10.„ ,u r
lad Pa- rs'- —
—
Mannfnetured dwelling or pre-fab(circle one)
Address: —J -- o Connections to building sewer and $80.00 $
City: water supply
S� /d, State: ZIP: Commercial,industrial,and dwellings other than one-or
Phones-47-Sit 753 0 Fax: - - two-family
E-mail: Minimmnfee $80.00 $
This installation is being made on residential or farm property Each fixture _ $21.00 $
owned by me or a member of my immediate family, and is hl iscella neous fees
exempt from licensing requirements under OAIt 918-695-0020. 100' storm,sewer,sealer line $83.50 $
Signature: Each fixture,appurtenance, and piping 521.00 $
CONTRACTOR INSTALLATION Sfulm eater relentior✓detention facility $21.00 $
' 1 J-ro` a,�ys hi Option systems $21.00 $
Business name: 75,...A4 4 s L....cdsu�< - t -------- --- -
7 — Piping or private storm drainage $21.00 $
Address: f a. .toy 7 PfY systems exceeding the first IOU feet
_City: St/e% State: oA- ZIP:? 74,7S Specialty fixtures . $21.00 $
Rei nspection(no. of hrs. x fee per hr.) $80.00 $
Phone: SLF( 79'F—713.T Fax: Sew,o. ' Special requested inspections(no.of
E-mail: c ar e�,.. SGl' 6 s--r+. c 0'—s- hrs.x fee per hr.) $80.00 $--
CCB license no.: /7-/7 0 BCD license no.: 6 7,30 Cash additional inspection:(I) $80.00 S
Plumbing license no.: Medical gas piping Minimmilt fee $
Print name: icerr"''+� S�L�547 Enter value of installation and equipment$
A)(Enter 5ubtlotal installation
above Lion and equipment T UE value. $
Signature: �- "-
I� APPLICANT USE
ve fees $
(Minimum Permit Fee$80.00)
(B)Investigative fee(quail()[Al) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Technology fee(5%of[A]) $
TOTAL fees and surcharges(A through D): $ c7_1G?
440-2500-3 H/1/2013.4:ONI)