HomeMy WebLinkAboutPermit Plumbing 2013-11-8 •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
0,40 Phone: 541-726-3753
:OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02482
www.springfield-or.gov permitcenteraspnngfield-or.gov
PROJECT STATUS: Issued ISSUED: 11/08/2013 EXPIRES: . 05/07/2014
STATUS DATE: 11/08/2013 APPLIED: 11/08/2013
SITE ADDRESS: 1034 4TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703352104000 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replumb 4 fixtures
OWNER: STERUP CHRISTOPHER&POPPIE Phone Number:
ADDRESS: 1034 4TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor BERNARD PETERSEN INC COB 93126 08/23/2015 541-343-9339
INSPECTIONS REQUIRED II •
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
constr tion.
O ner or Contractor Si•f ure Dat
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
;.. 4.:
Notification Center. Those rules are set forth I`!OTICE:
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
calling the center. (Note: the telephone AUTHORIZED UNDER THIS PERMIT IS NOT
number for the Oregon Utility Nctifica;;Df COMMENCED OR IS ABANDONED FOR
Center is 1-800-332-2344). ANY 180 DAY PERIOD. •
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Springfield Building Permit 11/8/2013 11:31:17AM Page 1 of 1
SPRINGFIELD"" • CITY OF SPRINGFIELD
L;14■ ..,wts. 225 Firth St
TRANSACTION RECEIPT Springfiel&OR 97477
OREGON 541-726-3753
• 811-SPR2013-02482
w .v.springfieldocgov 1034 4TH ST • permitcenter @springfield-or.gov
RECEIPT NO: 2013002470 RECORD NO:811SPR2013-02482 DATE: 11/08/2013
1UESCRIR,tTIONaMatn' lefriaitatrigrSka' , Mit-COl1NTFCODEfPRANSTCODEt!si �AIIAOUNIT/DUE
Bathtub 224-00000-425603 1005 21.00
Sink/basin/lavatory • 224-00000-425603 1005 21:00
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
Water closet • 224-00000-425603 1005 21.00
Water heater - • 224-00000-425603 1005 21.00
TOTAL DUE: 98.28
�••iniT i4r ;COMMENTS:::: 4: `L,ran t='/,CMOI!1 P%IPeaa`®x�n "ERR
. P.AYMENTr���M'lYP„EsY''�P.AY.OR ,<aasRleR:�oeowlsav ;g.� -
Credit Card maribeth jones 98.28
013615 •
TOTAL PAID: 98.28
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Plumbing Permit Application DEPARTMENT.USE ONLY
'en n? u+ fi-a, ..s t r J.71 t',1.' r $ T SPR NGFIEO
CITY OF SPRINGFIELD OREGON 1 .
, Permit "°.:S 0 - 0Z4 72.
*c.r = ... igi. :' ., talc C. titi /I/))
225 Fifth Street • Springfield,OR 97477 • P11(541)726-3753 • 1A\(5.11)7263689 ix USEGt7N Date: /1 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/1 kitchen(includes:first
Residential ❑Government ❑Commercial 100 feel aftrarer9rver lines, hose $262.00 S
-1Y� bibs, ire maker, rmdedlnor low-poba
JOB SITE INFORMATION
, A D LOTION drum and rahrdrain packages)
Job site s /03 / 9' 2 bathrooms/I kitchen $411.00 S •
/ �/ ZIP: 77 3 bathrooms/I kitchen 5483.00 $
City: �f State:
6Y Each additional bathroom(over 3) 5104.50 $
Referee e: 17e33s z ( I Taxlo0C(600 Each additional kitchen(over I) $104.50 S
DES R PTION OF WORK Residential fire sprinklers(includes plan review)_
1 7, r,.� / / A 4- 0 10 2,000 square feet $80.00 $
di Mlg/.ai 'i AT 0 )LI-c f 2,001 to 3.600 square feet $128.00 $
`i�� PROPERTY a WNER 3.601 to 7,200 square feel 5192.00 $
Name: clats, 7.201 square feel and greater _ 5255.00 $
Manufactured dwelling or pre-fah(circle one)
Address: ) 0 7 14 q f Connections to building sewer and $80.00 $
City: ih4fQ State:t/'a_____ ZIP: txn water supply
Commercial,industrial,and dwellings other than one-or
Phone: - - 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 antler OAR 918-695-0020. 100'storm,sewer,water line 583.50 $
Signature: Each fixture,appurtenance.and piping 1 $21.00 $ 0,_12/ •
.CONT A TOR INSTAL •TIO Sturm Crater retcniiunldetention facility 521.00 $
Business name: (H / ■ Irrigation systems $21.00 $
/ Piping or private storm drainage $21.00 $
Address: r systems exeecdine the first 100 fee
'� i7, s /)�]l(� Specialty fixtures $21.00 $
City'- .''4G,'!/ it State: /
zip:"ll /�(/7/
wy� '/ ��//-- Reinspection(no.of hrs.x fee per hr.) $80.00 S
Phone: - - t„y/3 y665•' / Special requested inspections(no.of
( hrs.x fee r $80.00 $
per hr.)
E-mail: • 1
CCB license no.613 126, I BCD li'-me no.:;U -35 Each additional inspection:(I) $80.00 S
Plumbing license no.:7,5V 7'/ ddd Medical gas piping Minimum fee $
Print name: a / / 2c_s Enter value of installation and equipment$ .
� Enter fee based on installation and equipment value. S
Signature: Ca �// APPLICANT USE
(A) Enter subtotal of above fees $ U ��
(Minimum Permit Fee 580.00)
(B)Investigative fee(equal to IAI) $ e
(C)Enter 12%surcharge(.12 x[A-(B)) $ r� O
tt(D)Technology Fee(5%of[A]) $ to
TOTAL fees and surcharges(A through D):
440-2500-.1(4/1/20 13/CO\q