HomeMy WebLinkAboutPermit Plumbing 2013-12-26 SPRINGFIELD 225 Fifth St
' -yal CITY OF SPRINGFIELD Springfield,OR97477
" �oecoN Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02738
www.springfield-orgov permitcenter @spdngfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/26/2013 EXPIRES: 06/24/2014
STATUS DATE: 12/26/2013 APPLIED: 12/26/2013
SITE ADDRESS: 4853 ELDERBERRY LOOP,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1802051100115 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace sanitary sewer up to 1001f •
OWNER: WINEBRENNER BARRY S&SANDRA K Phone Number:
ADDRESS: 1040 TYINN 5
EUGENE OR 97402
CONTRACTOR INFORMATION -
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
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
construe ion.
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Springfield Building Permit 12/26201 2:39:16PM Page 1 of 1
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SPRINGFIELD - CITY OF SPRINGFIELD
A 4 � +- 225 Fifth St
t`o E�oN TRANSACTION RECEIPT Spnngfield,OR 97477
541-726-3753
811-SPR2013-02738
www.springfield-ocgov 4853 ELDERBERRY LOOP permitcenter @spnngfield-or gov
RECEIPT NO: 2013002743 RECORD NO:811-SPR2013-02738 DATE: 12/26/2013
DESCRIPTION x T ''x ? _. X? -_-� x .r_. i]2 ACCOUNT CODEIIRANS'CODE ;V:t °AMOUNT a S
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
r P.AYMEN t17(1 E. w PAYOR cnsHieR'loeowLSer COMMENTS AMOUNTiP,dID
Credit Card WINEBRENNER BARRY S&SANDRF 97.70
h74629
TOTAL PAID: 97.70
Plumbing Permit Application DEPARTMENT USE ONLY
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225 Fifth Street • Springfield,OR 97477• P11(541)726-3753 • FAl(541)726 3689 OReGON Date: /00 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, Cost Total
ea. cost
Sanitation approval verified? ❑Yes ❑No New residential
,fir CATEGORY OF CONSTRUCTION I bathroom/1 kitchen(includes:first
,�I Residential El Government ❑Commercial 10 s, ice,nuke,'.underfloor lines, hose $262.00 $
e bibs. ice ranker. underfloor lour-poim
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: y g S 3 err d�AaJwLvA.4, 2 bathrooms/l kitchen $411.00 S
City: 5 Pt-'—Q State:4-- ZIP: 5,4 73 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference:/802, et S.(( Taxlot.00 II r Each additional kitchen(over 1) I $104.50 $
DESCRIPTION OF WORK
Residential fire sprinklers(includes plan review)
12-6.41/411-- 5:4•04:+04-.7 [h_ 0 to 2,000 square feet $80.00 $
2.001 to 3.600 square feet $128.00 $
PR4 PERTY OWNER 3,601 to 7,200 square feet I $192.00 $
Name: ? 'Arr UV/F.f I �NF4L Manufactured facturfd dwelling ng ore $255.00 $ p!
! s Nlmmfaetured dwelling or pre-fob(circle one)
Address: 1 040 1-t./l4,i '-) Connections to building sewer and
$80.00 $
City: EL1L� F State: QlL ZI P:9246y water supply [t[
Commercial,industrial,and dwellings other than one-or
Phone:54k- 9015-- zel-S o Fax:54/ l&BS-3480 two-family
E-mail: 1 Minimum fee $80.00 $
ba Fty CC ] prOLOtagraCh)49.-COm Each fixture $21.00 $
This installation is being made on residential or frrm property
owned by me or a member of my immediate family,and is fees I1)
exempt from li ;sing re/ are ents tier OAR 918-695-0020. Citrus
rsn<water line I $83.50 I $ 6 ) r_Signature: /,f �l .' c2GllGO�- ixture,appurtenance,and piping $21.00 $
•NTR'CTOR INSTALLATION Storm water retention/detention facility I $21.00 $
Business name: �(�w C^_
Irrigation systems I $21.00 $ -
Piping or private stonn drainage ( $21.00 5
Address: systems exceeding the first 100 feet
City: I State: ZIP: Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 S
Phone: - - Fax: - Special requested inspections(no.of
E-mail: hrs.x fee per hr.) $80.00 5
CCB license no.: BCD license no.: Each additional inspection:(1) $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 fees $61 S"O
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) 5
(C)Enter 12%surcharge(.12 x[A=B]) S
(D)Technology Fee(5%of[A]) S
TOTAL fees and surcharges(A.through D): 1 $ Q>70
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440-2100-1(41112013/COb1) '