HomeMy WebLinkAboutPermit Miscellaneous 2013-11-7 SPRINGFIELD 225 Fifth St
: t CITY OF SPRINGFIELD Springfield,OR 97477
ko OREGON Phone: 541-726-3753
Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-7263676
• PERMIT NO: 811-SPR2013-02473
wvnv.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014
STATUS DATE: 11/07/2013 APPLIED: 11/07/2013
SITE ADDRESS: 1501 MOHAWK BLVD,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703253404401 . TYPE OF STRUCTURE:
PROJECT DESCRIPTION: water service repair-no encroachment
OWNER: MIT PROPERTIES LLC • Phone Number
ADDRESS: PO BOX 214
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp • Phone
Plumbing Contractor C 8 R PLUMBING LLC CCB 167015 07/01/2014 541-736-9582
•
_ INSPECTIONS REQUIRED
Inspections
3315 Water Line
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
constru on.
7,-----k---- 12 �� //`- 7-1-S - . .
wner or Contras • Date
•
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth •
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone -
number for the Oregon Utility Notification
Center is 1-800-332-2344). •
Springfield Building Permit 11/7/2013 10:04:05AM Page 1 of 1
•
,' SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth"`t0 EGON TRANSACTION RECEIPT SpnngfeldiOR 97477
541-726-3753
811-SPR2013-02473
www.spdngfieldor.gov 1501 MOHAWK BLVD permitcenter @spnngfield-ar.gov
RECEIPT NO: 2013002452 - RECORD NO:811-SPR2013-02473 DATE: 11/07/2013
DESCRIPTION '".Sttata_': -SW*. i kit_+ t ACCOUNT CODE/TRANSfCODE! �se�"r !AMOUNFDDUE y'?
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
Water Line 224-00000-425603 1005 83.50
TOTAL DUE: 97.70
,1M..�..v.--E.�m .� .. , ,.n. -�rUr,.. _.- x=. `AMOUNTWAID'y, : :ri;. .. r
_:PAYMENTTYPEt _4£s:PAYORrf'''CASHIER.tl^gLAR50N _:tyl „`COMMENTS'�:;a,; �'."�°'�sy�' i: �M1" ' �s+.14ra.;+��4Ut�,
Credit Card C&R PLUMBING LLC 97.70
597244
TOTAL PAID: 97.70
•
Plumbing Permit Application DEPARTMENT USE ONLY
- r�r ,�.,� £ SPRINGFIELD
::C;IxC�+ Q SPtRINGFIELD•.t REGO Permit no.: 4� I ( zo t 3 oZL17 5
225 Fifth Street • Springfield.OR 97477 • P11(541)726-3753 • FAX(541)726-3639 ‘t‘g's- OBEGON Date:
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 ISO days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Description Qty, Bost Totsfl
Sanitation approval verified? ❑ Yes ❑No Nev residential
CATEGORY OF CONSTRUCTION 1 bathroom/I kitchen(includes:J,rsr
❑ Residential ❑Government • ❑Commercial 1011 Jeer ofumrer%se,rer lines, hose $262.00 $
bibs, ice ranker. underpaor loin-Point
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: "l Ste! p/lp A/( NJ. 2 bathrooms/1 kitchen $411.00 $
City: 14I4 I State:d'p ZIP: 9?'77 3 bathrooms/1 l kitchen $404.00 $
S �---- Duch additiunul bathroom(over 3) ' . $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 S
DESCRI•TION OF WORK Residential lire sprinklers(includes plan review)
J
, f-e( &e vie Q jatr I - rt 0 to 2.000 square feet S80.00 s
f - i 2,001 to 3.600 square feet $128.00 $
� 3.601 to 7.200 square feet S192.00 $
�P_ROP0; a O -
Name: k r►� 7,201 square feel and greater $255.00 5
nJ(AIS�'��- a t�� �.r- -• -,i r !Manufactured dwelling or pre-lab(circle one)
Address: 0 fix (LI Connections to building sewer and $80.00 $
water supply
City: s _eid. • state:pfd zlp:47N 7 Z-
Commercial.industrial,and dwellings other than one-or
Phone: - - 1 Fax: - - two-family
E-mail: Minimum fee $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 Miscellaneous fees
exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer.water line !M
$83.50 $
Signature: Each fixture.appurtenance.and piping $21.00 $
CONTRACTOR INSTALLATION Storm water retention/detention facility. $21.00 $
Business name: f _±-Z_ 4 f w,ax.0 c,n Cam Irrigation systems _ $21.00 $
(� Piping or private storm drainage $21.00 $
Address: 7 g' re 112,y cF tf e . systems exceeding the first 100 feet
City: �/� Stare: /� ZIP: g7 7 7 Specialty fixtures $21.00 $
y S c, y I.__.-. �I P- Reinspectiun(no. DMus.x feu per hr.) $00.00 $
Phone:54 f-65'x- I'6 9'0 Fux$.9L36 —34v/5 spcci:d tequested inspections(no.of
co L 11// hrs.x fir per hr.) $80.00 $
E-mail: L1A'k`�. (� 7'c..�rc rM I .
CCB license no.:i b 70(5 BCD
D license no.: Each additional inspection:(I) $80.00 $
Plumbing license no.: q b3 Z J 1 ' Medical gas piping Minimum fee $
Print name: / , N C I 9 Enter value of installation and equipment$—
,, e..y s
iInler fee based on installation and equipment value. $
Signature:
APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
• (I3) Investigative fee(equal to[Al) $
(C)Enter 12%surcharge(.12 x[A+RI) 5
(D)Technology Fee(5%of[A]) $
TOTAL fees and surcharges(A through D): $/ 7—,2y
440-2500-1(4/I/2013/CON) t