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HomeMy WebLinkAboutPermit Plumbing 2013-12-13 SPRINGFIELD 225 Fifth St -� CITY OF SPRINGFIELD Springfield,OR 97477 Phone 541-726-3753 OREGON Building l Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02667 www.springfield-or.gov permdcenter©spnngfield-or goy PROJECT STATUS: Issued ISSUED: 12)13/2013 EXPIRES: 06/11/2014 STATUS DATE: 12/13/2013 APPLIED: 12)13)2013 SITE ADDRESS: 1048 S 34TH PL,Springfield,OR 97478 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1802062402100 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replacement of Master Bath Tub OWNER: WAGNER GLENN C &LANA R Phone Number: ADDRESS: 1205 CLEARWATER LN SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor DON LEWS PLUMBING SERVICE LLC GCB 167921 01-00/2014 541-688-1931 INSPECTIONS REQUIRED 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 construction. X2 /3/ 3 Owner or Contractor Signature Date EIF THE WORK f.S PERMIT IS NOT FOR Spnngfield Building Permit 12/13/201 10:01:45AM Page 1 of 1 , SPRINGFIELD CITY OF SPRINGFIELD iLdammigi 111111Let T RANSACTION RECEIPT Springfield.OR97477 EGON 541-725-3753 811-SPR2013-02667 www.springfield-or.gov 1048 S 34TH PL permitcenter @springfield-or gov RECEIPT NO: 2013002660 RECORD NO:811-SPR2013-02667 DATE: 12/13/2013 I . TI'r?IfiR.k (c1 nr97d. a o':: : . - Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00 Bathtub 224-00000-425603 1005 21.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 Check TOM G.WIRFS Enterprises, INC 93.60 9454 TOTAL PAID: 93.60 • . Plumbing Permit Application DEPARTMENT USE ONLY SPRINGFIELD CITY OF SPRINGFIELD, OREGON ilk Permit no.:0/f-7olj- OZ.667 225 Fifth Streets Springfield,OR 97477•PH(541)726-3753 •FAX(541)726-3689 O EGQ;i Date: /2-4: /,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. Cellos Total . cost Sanitation approval verified? ❑Yes ❑No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first ❑Residential 0 Government I ❑Commercial Meet makers"nderfl lines,hose $262.00 $ bibs, ice maker, underfloor low point JOB SITE INFORMATION AND LOCATION drains and rain-dram packages) Job site address: /ee f' 5, -Le/ 1-11 2 bathrooms/1 kitchen $411.00 $ ' 3 bathrooms/1 kitchen $483.00 $ City: 4 , d State: ZIP: Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) k 4 6, fi r en.-ze i e T M45 k� 0 to 2,000 square feet $80.00 S bKf , L, 2.001 to 3.600 square feet 5128.00 $ [ �- PROPERTY OWNER 3,601 to 7,200 square feet $192.00 S 7,201 square feet and greater $255.00 $ Name: `7 _ .(- 6,/e h-1 UreA',,-- Manufactured dwelling or pre-fab(circle one) Address: /Zed ,/,-Q-- (...)(4-' Connections to building sewer and water supply $80.00 $ City: S / State: C?e ZIP: 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 licens. 'Tuiretnents under OA 9l 95,0020. 100' storm,sewer,water line $83.50 $ Signature: O. INSTALLATION�L A f�oc ggbt Each fixture,appurtenance,and piping / $21.00 S C• TRACTOR INSTALLATION Storm water retention/detention facility $21.00 $ Business name: 1")ei,,,t Le.,.....,is Irrigation systems $21.00 $ Piping or private storm drainage { $21.00 S Address: Z 9 ad, /t , s` systems exceeding the first 100 feet City: e Cy C State: I ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $80.00 S Phonerv/-6 —(9'5/ Fax: - - Special requested inspections(no,of E-mail: hrs_x fee per hr.) $80.00 S CCB license no.:/&7 92/ 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. I S Signature: APPLICANT USE (A) Enter subtotal of above fees S (Minimum Permit Fee$80.00) (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) S (D)Technology Fee(5%of[A]) S TOTAL fees and surcharges(A through D): S?3_4°!.— 440-2500-J(4/1/2013/COM)