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HomeMy WebLinkAboutPermit Plumbing 2013-11-4 SPRINGFIELD 225 Fifth St -�- CITY OF SPRINGFIELD Springfield,OR 97477 • ( t Phone: 541-726-3753 i \OREGON Building I Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02443 www.springfield-or.gov perrnitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: , 11/04/2013 EXPIRES: 05/03/2014 STATUS DATE: 11/04/2013 APPLIED: 11/04/2013 SITE ADDRESS: 200 21ST ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703361306100 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sewer line OWNER: BOOTH MAXINE&KEVIN ALAN Phone Number: ADDRESS: 200 21ST ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION II Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor ROYAL FLUSH ENVIRONMENTAL SERVICES INC CCB 153694 12/23/2013 541-895-2072• INSPECTIONS REQUIRED / ` _ Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 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. ��J/n� ,,�---- /1�aC/'i3 Owner or C ntr for Signature Date • ATTENTION: Oregon law requires you to . follow rules adopted by the Oregon Utility 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 for the Oregon Utility Notification • ANY 180 DAY PERIOD. Center is 1-800-332-2344). • Springfield Building Permit 11/4/2013 3:40:15PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD TRANSACTION RECEIPT 225 Fifth St Springfield.OR97477 ' OREGOIN 541-726-3753 811-SPR2013-02443 www.springfield-or.gov 200 21ST ST permitcenter©springfield-ocgov RECEIPT NO: 2013002422 RECORD NO: 811-5PR2013-02443 DATE: 11/04/2013 (DESCRIPTION _ _ � _ACCOUNT CODE/TRANS CODE .'''AMOUNT_DUE_33 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 -PAYMENT_TYPE . PAYOR CASHIER:CCARPENTER COMMENTS. '.. '' • AMOUNT') ' Credit Card — JEFFRY BOWERS 97.70 045870 TOTAL PAID: 97.70 Plumbing Permit Application DEPARTMENT USE ONLY e;V, + -:.7 _ € SPRINGFIELD - -"- CITY OF S'1'RINCFIELD 'UREGONi * - Permit no.: 513=211413 225 Fifth Street • Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 7 \LOi EGON Date: i(/Y/( I 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 Qfy. Cea.ost I Total cost Sanitation approval verified? ❑ Yes ❑No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:firm 100 feel of water/sever lines. ham l]'Residentlal ❑Government ❑Commercial bibs, ice ranker, underAnor low-paim $262.00 $ JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) Job site address: Zoo 2 I S'' 2 bathrooms/I kitchen 5411.00 $ 3 bathrooms/I kitchen $483.00 $ City:Sev t.s.c4 I� l State°/ ZIP: X71-11 - ., Each additional bathroom(over 3) -, $104.50 S Reference: //v 3 7 p/3 Taxlot.:(/QQ Each additional kitchen(over I) $104.50 S DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)__ Set....JCV Lt ac ye pia_ Q< aeick- 0 to 2.000 square feet — $80.00 $ 2,001 to 3.600 square feet $128.00 $ PROPERTY OWNER 3,601 to 7,200 square feet S192.00 $ Name: (��� 7,201 square feel and greater 5255.00 $ 1/VI,A,X C iJ Q Manufactured dwelling or pre-fah(circle one) Address: 7_co z Oct u-e.._.-k- Connections to building sewer and City: ao.e.9 , State: OV ZIP: water supply $80.00 $ °t Commercial,industrial,and dwellings other than one-or Phone: qbs= Iccis Fax: - - two-family E-mail: Minimum fee $80.00 $ This installation is being made on residential or farm property Each fixture $21.00 I $ owned by me or a member of my immediate family,and is Miscellaneous fees exempt from licensing requirements under OAR 918-695-0020. I(1(1 storm,sewer,water line / $83.50 $8 Signature: Each fixture,appurtenance,and piping 521.00 $ CONTRACTOR 1 INSTALLATION Storm water retention/detention facility $21.00 $ Business name:�`o(A2 I tttl�Lx £r.Wtronwsesc{ad C ell Irrigation systems $21.00 $ V t'�/J G, systems exceeding storm Me first drainage 00 Address: ll "Y "six-, systems escecd s the Oat I(Ill feet $21.00 $ Cit State Q-�( ZIP Specialty fixtures $21.00 $ 7 Oyes vie 1,( Yt"14 2 6 Phone: g Fax4t ag5 Rcinspeclion(no.of hrs.x fee per hr.) $80.00 $ 35Z D_IJ Za, Special requested inspections(nu.of $80.00 5 E-mail:120Lnp,1 tuclke Jr - - -c e (,t wiAIco,".. co . hn. x fee pet hr.) COB license n(51536014 BCD license no.: Each additional inspection:I I) $80.00 $ Plumbing license no.: - Medical gas piping Minimum fee $ Print name: -zeu-•�jp toe f$ Enter value of installation and equipment Enter fee based on installation and equipment value. I $ Signature: /7 a.-- APPLICANT USE . (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) 83/ (B)Investigative fee(equal to[Al) $ (C)Enter 12%surcharge(.12 x[A+HI) $ /Q en- (D)TechnologyFee(5%of[A]) $ ? TOTAL fees and surcharges(A through D): $ 7 Z- • 440-2500-1(4/1/201 3./CONI)