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HomeMy WebLinkAboutPermit Plumbing 2013-11-15 • SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 Iiirs Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone:541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02514 • www.springfield-or.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 11/15/2013 EXPIRES: 05/14/2014 STATUS DATE: 11/15/2013 APPLIED: 11/15/2013 SITE ADDRESS: 2760 D ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703361415100 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: replacing 45 feet of sewer pipe on private property OWNER: IVY AMBER L Phone Number: ADDRESS: 2760 D ST . SPRINGFIELD OR 97477 OWNER: IVY JUDITH A Phone Number: • ADDRESS: 2760 D ST SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION II Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED mil Inspections 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 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. • JI1 . �_-._-_ • //- /5 - /3 • �er or Contractor Signature / Date ' ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- • 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 • 11/15/201 10:04:56AM Page 1 of 1 • SPRINGFIELD - CITY OF SPRINGFIELD ' 225 Fifth St TRANSACTION RECEIPT Sphngfeld,OR 97477 rc s 541-726-3753 OREGON 811-SPR2013-02514 www.springfield-or.gov 2760 D ST permitcenter @springfield-or.gov RECEIPT NO: 2013002499 RECORD NO: 811SPR2013-02514 DATE: 11/15/2013 bESCRIPTION.,_ L,t tn MitraZa= �'-' I GOD i iRANS.CODE 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 irr AYMET4WINF1E P,AYOR casMER: RSDN - ,COMMENTS AMOUNT1PAID - Credit Card IVY JUDITH A 97.70 143274 TOTAL PAID: 97.70 Plumbing Permit Application DEPARTMENT USE ONLY _ ,r; .- 1 r . k SPRINGFIELD - CITY ORSPRINGFIELD, OREGOPT t *' -A''. Permit no.: go 20/3 oz-9 y 225 Filth Street• Springfield,OR 97477 • PH(541)726-3753 • WAa(541)72G 3689 = OREGON Dale: / ///'I/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 ISO days of issuance or if work is suspended for I80 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE •Zoning approval verified? ❑ Yes ❑No Description Qty. eat Total Sanitation approval verified? ❑ Yes ❑No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first ft es Hernial ❑ Government ❑Commercial bibs, ice maker, under//nor•Ion-po $262.00 S bibs, ice maker, underJlaor low-point JOB SITE INFORMATION AND LOCATION drains and rain-chain packages) . Job site address: 2 bathrooms/1 kitchen 5411.00 $ 3 bathroomsll kitchen $483.00 $ Ci'y gyri n[(p a 41 Slate:bp„, ZIP:9.7e/2 7 Each additional bathroom(over 3) $104.50 $ Reference: (/ Taxlot.: Each additional kitchen(over I) $104.50 S DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) AeflitL__21)keumk. taw 0 to 2.000 square feet $80.00 S . 2,001 to 3.600 square feet $128.00 $ PROPERTY OWNER 3.601 to 7.200 square feet $192.00 $ Name: II nn —�+ 7.201 square feet and greater $255.00 $ JIA CP 1 yqI ',� S I/I, Manufactured dwelling or pre-lab(circle one) Address: 4' /7 ✓7 LJ St, Connections to building sewer and $80.00 $ City: State: ZIP:L��Zr/7 water supply r Cl Commercial,industrial,and dwellings other than one-or Phone: y/-7 a $5$3 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 Inc or a member of my immediate family, and is Miscellaneous fees exempt firs licensing re]uirements under OAR 918-695-0020. 100' storm,sewer, water line 583.50 $ Signatur�- 1 0- Each fixture,appurtenance,and piping 521.00 $ CONTRACTOR INSTA TION Storm water retention/detention facility $21.00 $ Business name: Irrigation systems $21.00 $ Piping or pi.'vale storm drainage $21.00 $ Address: systems exceeding the first 100 feet City: State: I ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of $80.00 $ E-mail: hrs.x fee per hr.) - CCB license no.: BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no.: Medical gas piping Minimum fee $ Print name: Enter value of installation and equipment$ . • Enter fee based on installation and equipment value. $ Signature: APPLICANT USE (A) Enter subtotal of above tees $ (Minimum Permit Fee$80.00) (13)Investigative fee(equal to[A]) $ (C:)Enter 12%surcharge(.12 x[A+R]) i $ (D)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through D): $ (G 7"7O .Id0-25110-.1 1d/1/2013/COM)