HomeMy WebLinkAboutPermit Plumbing 2013-12-3 SPRINGFIELD --- 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
tz `lam ' Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
• PERMIT NO: 811-SPR2013-02594
www.springfield-or.gov permitcenterespringfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/03/2013 EXPIRES: 06/01/2014
STATUS DATE: 12/03/2013 APPLIED: 12/03/2013
SITE ADDRESS: 1264 36TH ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702304300801 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Sewer line repairs
OWNER: LYDIA E SENTER REVOCABLE TRUST Phone Number:
ADDRESS: 3529 KATHRYN AVE
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
ROTO ROOTER SERVICE&PLUMBING (PM)Plumbing Bu PM4 07/01/2014 541-731-1947
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 alrwork 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 can 's located at the front of the property, and the approved set of plans will remain on the site at all times during
constr tior.
I l er l2////�/13
Owner or Contractor Signature Date ! `
•
ATTENTION: Oregon law requires you to NOTICE:
rules adopted by the Oregon Utility
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 12/3/2013 9:01:52AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
_s__....... dei
t.4 -rte. 225 Fitth St
cam: TRANSACTION RECEIPT Springtield,OR97477
OREGON 541-726-3753
811-S P R2013-02594
www.springfield-ar.gov 1264 36TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2013002588 RECORD NO: 811-SPR2013-02594 DATE: 12/03/2013
1.DES `_ACCOUNT CODE/TRANS_CODE AMOUNT_DUE
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 PAID r'T _-:j
Check ROTO ROOTER SERVICE&PLUMBII 97.70
1364 •
TOTAL PAID: 97.70
Plumbing Permit Application DEPARTMENT USE ONLY
I
y
S� 3 —2 l � `.
C T3 OFSP tiFIELl) Q G , r `t -, Permit no.: k
225 Fifth Street • Springfield,OR 97477 • PH(541)726-3753 •FAX(:41)726-3689 ',ORFGON Date: `Z/ 3,7/7
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 1
Zoning approval verified? ❑ Yes ❑No Description Qty eat cot l
Sanitation approval verified? ❑ Ycs ❑No New residential •
(((,,,jjj CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first
p�Residential ❑Government ❑Commercial bibs, ice of,eurersewer lines,hose $262.00 $
I bibs, ice maker. mrdery7oor low-point
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: ( r 3 _ S\---- 2 bathrooms/I kitchen $411.00 $
City: StateQ4, Z)P �' 3 bathrooms/1 kitchen $483.00 $
J Each additional bathroom(over 3) $104.50 $ I
Reference: /202. ?p Taxlot.: I
DESC�IP�+� r���G 1 Each additional kitchen(over I) $104.50 S t
1 OF WORK Residential fire sprinklers(includes plan review)
Ce1 t -p r 1 qv\Q etc) ,{yt r 0 to 2.000 square feet $80.00 $ i
1 v--` 2;001 to 3,600 square feet $128.00 $
PROPERTY OWNER 3,601 10 7,200 square feet $192.00 $
Name: ,^ Y.l%�fL/ 7,201 square feet and greater 5255.00 $ I
�/1( v\� Manufactured dwelling or pre-fah(circle one)
Address: M Connections to building sewer and
water supply 1 $80.00 $
City: State: ZIP: E
Commercial,industrial,and dwellings other than one-or
Phone: 5y/- 77?.4 S'79 ax: - - two-family
E-mail: Minimum fee I $80.00 I $ p!
This installation is being made on residential or farm property Each fixture $21.00 I $ V
owned by me or a member of my immediate family,and is Miscellaneous fees it
exempt from licensing requirements under OAR 918-695-0020. 100'storm,server,water line ( $83.50 I $33--O I
Signature: Each fixture,appurtenance,and piping $21.00 I $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 I $ I
Business name: Kp� ���� In"igation systems $21.00 S
Piping or private storm drainage
Address: L-1c3 'u Sy; 44 systems exceeding the first 100 feet $21.00 $
City: 6,e_ State: at ZIP:9 r4CCD Specialty fixtures $21.00 $
%_j[ ` Reinspection(no.of hrs.x lee per hr.) $80.00 $ ]
Phone:(J'�j (--) L l Fax c(w— ( ? Special requested inspections(no.of $80.00 $ t
E-mail: t J u ) x ,-p ca‘c,cj-kl/, Levi_ hrs.x fee per hr.)
CCB license no.:(g'Z]3 ( BCD license no.: Each additional inspection: (1) 580.00 $ I
Plumbing license no.: Medical gas piping Minimum fee $
Print name:
( - Enter value of installation and equipment$_.
�� 1 ri . Enter tee based on installation and equipment value. $ 1
.Signature: eartar*l APPLICANT USE
(A) Enter subtotal of above tees
(Minimum Permit Fee$80.00) 5 g-7 — I
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) S /0 `"2
(D)Technology Fee(5%of[A]) $ l
TOTAL fees and surcharges(A through D): S �2 r= '
1
440-2500-J(4nn_ol3rcoht)