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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)