HomeMy WebLinkAboutPermit Plumbing 2013-12-5 (2) •
SPRINGFIELD 225 Fifth St
LLIL,
-'. , CITY OF SPRINGFIELD Springfield,OR 97477
LONEGON Phone: 541-726-3753
Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02625
www.springfield-or.gov pe rmitcenter @springfield-or.goy
PROJECT STATUS: Issued ISSUED: 12/05/2013 EXPIRES: 06/03/2014
STATUS DATE: 12/05/2013 APPLIED: 12/05/2013
SITE ADDRESS: 400 26TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703361418200 TYPE OF STRUCTURE: Residential
• PROJECT DESCRIPTION: Sewer line
OWNER: _ BURKE JUDITH A Phone Number: 337-1613
ADDRESS: 400 26TH ST
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor READY ROOTER DRAIN CLEANING&REPAIR SERVICE I CCB 92524 02/18/2015 541-744-7991
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.
) z —S — ► 3
Owner r Contractor Signature Date
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ATTENTION: Oregon law requires you to -�ji�E:
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth ,-HIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- .tUTHORIZED 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 12/5/2013 9:54:45AM Page 1 of 1
SPRINGFIELD -- CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
((. OREGON 541-726-3753
811-SPR2013-02625
www.springfield-or.gov 400 26TH ST - permitcenter @springfield-or.gov
RECEIPT NO: 2013002616 RECORD NO:811-SPR2013.02625 DATE: 12/05/2013
!DESCRIPTION ', ,. - ' ' ,. -' . ACCOUNT.CODE/TRANS CODE _AMOUNT„DUE:1-1
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
h_PAYMENT TYPE -r. PAYOR... CASHIER:CCARPENTER COMMENTS `.- AMOUNT PAID'
Credit Card READY ROOTER DRAIN CLEANING t - - 97.70
6557d REPAIR SERVICE INC
TOTAL PAID: 97.70
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Plumbing Permit Application DEPARTMENT USE ONLY 1
` SPRINGFIELD--
Cr n�`OF SPR[NGFLEL --aiT N f:..1:: Permit no.: 5/?'?t2 S t
µ225 Fifth Street • Springfield,OR 97477 • P11(541)726-3753 •FAX(541)726-3689 \OR€GOtI Date: /2-7c7/ S t
i
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits i
expire if work is not started within ISO days of issuance or if work is suspended for 180 days. i
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Description Qty. Cost Total
ea. cost
Sanitation approval verified? ❑ Yes ❑No New residential t /
CATEGORY OF CONSTRUCTION I bathroom/! kitchen(includes:fast
100 feet of water/sewer lines.hose
ggesidential El Government ❑Commercial bibs,ice maker, underfloorloupoLtl $262.00 $ }
_
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)Job site address: L-100 IOO Z Co r e 2 bathrooms/i kitchen $411.00 $ I
fr
3 bathrooms/I kitchen $483.00 _ $
City: �j rr f�-y4c e,1 0 State: D f ZIP: I-u-77 Each additional bathroom(over 3) $104.50 $ 3
Reference: /70 ✓(( 7 /`1 Tax los/. -00 Each additional kitchen(over 1) $104.50 $
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
0 to 2,000 square feet 580.00 $ I
�� S��- LrM1/L q
2:001 to 3.600 square feet $128.00 $ 1
PROPERTY IOWNER 3,601 to 7,200 square feet $192.00 $ {i{
Name:,V 13 I -r if-, )l v! Y//12. 7.201 square feet and greater $255.00 $
Manufactured dwelling or pre-fab(circle one) 1
Address: kW 2..6 lim Connections to building sewer and
r —u water supply $80.00 $
City: ✓t 7Cs�,,�•1 State:D R ZIP: /m Commercial,industrial,and dwellings other than one-or t
Phon0.J)]-37,-) ].(„13 Fax: - - two-family
E-mail: Minimum fee $80.00 $ i
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 d r,.� :
exempt from licensing requirements under OAR 918-695-0020. 100'storm,sewer,water line $83.50 $ ✓
Signature: Each fixture,appurtenance,and piping $21.00 $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $
Business name: }2,einu ev Irrigation systems $21.00 5. 1
"' , Piping or private storm drainage $21.00 $ 1
Address:qQ S;1 I 't),141 systems exceeding the first 100 feet
City: L92.he.— State: O� ZIP:Ci 74 (S Specialty fixtures $21.00 $ I
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone t.[(- -)N'1 1j' ?let I Fax: - - Special requested inspections(no.of
$80.00 $
E-mail: hrs.x fee per hr.)
CCB license no.:
®SL '2L1 BCD license no.: Each additional inspection: (I) $80.00 $
Plumbing license no.: Medical gas piping Minimum fee $ !
Print name:__iC Y-m �_o,is uv-Y Enter value of installation and equipment$_ i
^ Enter fee based on installation and equipment value. $ i
Signature.�,`,,/.Nfj - APPLICANT USE I
(A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $ i
(B)Investigative fee(equal to[A]) $ t
(C)Enter 12%surcharge(.12 x[A+B]) S /0 6 L'
(D)Technology Fee(5%of[A]) S i O
TOTAL fees and surcharges(A through D): $ Ti 1
i
1
440-2500-J(4/12013/COM)