HomeMy WebLinkAboutPermit Plumbing 2013-12-17 SPRINGFIELD-
; 225 Fifth St
'L' t" ' CITY OF SPRINGFIELD Springfield,OR 97477
-t ell
OREGON Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02682
www.spnngfeldor.gov permitcenter @spnngfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/17/2013 EXPIRES: • 06/15/2014
STATUS DATE: 12/17/2013 APPLIED: 12/17/2013
•
SITE ADDRESS: 844 C ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703351310000 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace water service line
OWNER: PAZ JAMES - Phone Number:
ADDRESS: 870 C ST - '
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
PHIL'S ROOTER SERVICE,LLC (PB)Plumbing Coi PB1044 07/01/2014 541-232-6006
INSPECTIONS REQUIRED
Inspections
3315 Water Line
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.
Owner or Contractor,gnat - Date
you.to
NOTICE: '�'�
AtTENTIpN: Oregon law Oregon Utllity THIS PERMIT SHALL EXPIRE IF THE WORK
follow rules adopted by AUTHORIZED UNDER THIS PERMIT IS NOT .
i3OAR952-0of COMMENCED OR IS ABANDONED FOR -
Notification Center. Those rules are set fort
in OAR 952 001-obt i��rop1es of the rule Y ANY 180 DAY PERIOD. • .
0090. You may 1 Note: the telephone
calling the center' ( Utility Nctiflcation
number for the
Oregon
332-2344).
Center is 1-800-
Springfield Building Permit 12/17/201 9:43:54AM Page 1 of 1
SPRINGFIELDsthissw CITY OF SPRINGFIELD
r. ^�.,;.� �� 225 Fifth St
* E�aN TRANSACTION RECEIPT Spnng6&d.oR97477
, city 541-726-3753
811-SPR2013-02682
www.springfieldor.gov 844 C ST permitcenter @spnngfield-or gov
RECEIPT NO: 2013002682 RECORD NO: 811SPR2013-02682 DATE: 12/17/2013
D - . :(o s..+'�'='- �..�f_-���, _�"� , p - 9 : • . C�3_:.�� _ �1YTr'IYf��'�.
�__�: r=�4- o � o 0 0 0 - 0 0
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
Water Line 224-00000-425603 1005 83.50
TOTAL DUE: 97.70
BAYMENT4IYP,E PAYOR llirAWCRPERTER COMMENTS „ • AMOUNTOo
Credit Card PHIL'S ROOTER SERVICE, LLC 97.70
519829
TOTAL PAID: 97.70
. . . . ;
Plumbing Permit Application DEPARTMENT USE ONLY
ItIS ;t : D�'QRI�' Irrd Permit no.: 5/3 --2 *. Y-L
225 Fifth Street •Springfield,OR 97477• PH(541)726-3753 • FAX(541)726 3689 "\08E60N Date: 7 2// 7// 3
• 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 180 days of issuance or if work is suspended for 180 days.
1
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE 1
Zoning approval verified? ❑Yes. ❑No Description Qty. ea. Total
ea. cost
Sanitation approval verified? ❑Yes ❑No New residential
CATEGORY OF CONSTRUCTION I bathroonrfl kitchen(includes:first
100 feel of waiensewer lines.hose
❑ Residential ❑Government ❑Commercial bibs, ice maker. underfloor lairpain! $262.00 $
to
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: E 91( t,. SF 2 bathrooms/I kitchen $411.00 S
City: S r t�-(� "LIP: 3 bathrooms/1 kitchen $483.00 S
(]- Each additional bathroom(over 3) $104.50 $
Reference: Tax lot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential tire sprinklers(includes plan review) pl
IV e W 10 w U 1-tr £C✓t// cc v i' f} 0 to 2,000 square feet $80.00 $ €
V PJ p-r, r 00A—) 10 o r I f 2,001 to 3,000 square feet 9128.00 $
// PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $
Name: _q (,t.)LS ?CC_ 7,201 square fezl and greater $255.00 $
,,—�.f �y l Man factored dwelling or pre-fah(circle one)
Address: v N C._ S7' Connections to building server and
$80.00 $
City: SI, c6 State: ZIP:
water supply I
Commercial,industrial,and dwellings other than one-or
Phone: - - Fax: - - two-family I
E-mail: Minimum fee $80.00 $ E
This installation is being made on residential or farm property Each fixture $21.00 9 I
owned.by me or a member of my immediatefamily,and is Miscellaneous fees i
exempt from licensing requirements under OAR 918-695-0020. 100'storm,sewer,water line ! $83.50 I $g-3 I
Signature: Each fixture,appurtenance,and piping $21.00 S
CONTRACT(OR ppIN�STAILLATII(O� N Storm water retentionidetention facility $21.00 I $
�I'1 X15 rw O4-er jC/'t/(Cc Irrigation systems I $21.00 S
Business name: ,
Piping or private storm drainage $21.00 S
Address: Q 01G U I o 13 systems exceeding.the first 100 feet
City: F . 4 State: OZ ZIPG(7t{Of$- Specialty fixtures $21.00 S
Reinspection(no.of his.x fee per hr.) 580.00 S
Phone:SY(- yN-f 57 Z Fax: - - Special requested inspections(no.of I
E-mail: hrs.x fee per hr.) $80.00 $
CCB license no.: BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no.: Medical gas piping Minimum fee S
Print name: } f (. W t,f.J , Enter value of installation and equipment$—
Enter fee based on installation and equipment value. $
Signature�� der—>:��� APPLICANT USE I
(A) Enter subtotal of above fees -�
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[.A]) 5
(C)Enter 12%surcharge(.12 x[A+B]) . $ Md Z
(D)Technology Fee(5%of[A]) S i t ar
TOTAL fees and surcharges(A through D): $ C,7r=
d40-2500-.I(41120131COht)