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HomeMy WebLinkAboutPermit Plumbing 2014-1-9 SPRINGFIELD 225 Fifth St it CITY OF SPRINGFIELD Springfield,OR 97477 ea Phone: 541-726-3753 OREGON Building I Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00055 www.springfield-or.gov pe rmitcenter©springfield-or.gay - PROJECT STATUS: Issued ISSUED: 01/0912014 EXPIRES: 07/08/2014 STATUS DATE: 01/09/2014 APPLIED: 01/09/2014 SITE ADDRESS: 1124 1ST ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703263302700 • TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sewer line OWNER: THOMAS E 8 CHERYL L KLUSMAN JOINT TRUST Phone Number: ADDRESS: 1124 1ST ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone INSPECTIONS REQUIRED Inspections 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. //L / / ��L [d17^Gl.- /9/020/-7 Owner or Contractor Signature Date • ATTENTION: Oregon law requires you to NOTICE: - follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 9 2 Center. Those rules are set 001- AUTHORIZED UNDER THIS PERMIT IS NOT • in OAR 952-001-0010 through OAR 952-001- 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 1/9/2014 2:23:27PM Page 1 of 1 SPRINGFIELD _. CITY OF SPRINGFIELD '14 225 Fifth St TRANSACTION RECEIPT Springfield,OR 97477 `t" OREGON 541-726-3753 811-SPR2014-00055 • www.springfield-or.gov 1124 1ST ST permitcenter @springfield-or.gov RECEIPT NO: 2014000047 RECORD NO:811-SPR2014-00055 DATE:01/09/2014 [DESCRIPTION _ACCOUNT CODE/TRANSCODE _ LL_,.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 L PAYMENT TYPE' PAYOR'- CASHIER:CCARPENTER 1 COMMENTS_ � 1 , AMOUNT PAID Check THOMAS E&CHERYL L KLUSMAN 97.70 5247 JOINT TRUST TOTAL PAID: 97.70 • • • • • Plumbing Permit Application DEPARTMENT . _ USE.ONLY:..1 1 414%;771, %117012:11.:76.11".3::iigifiaarriltr ejne-'''''' ez. 70;=.4.1r,-; &vat.,---.. .4t,E4- 531VITYDESPRINGEWILITOS4-VXVtl!!,,VP:ii ail y: Permit no.: c itf— O& 5-c . galFC:pii-0),:ke-s..-,es1:4;M:49.10.0aliThaMtnikt:AfekekrEta,Therestialt 2;ett -EaVili,1•44.a5:,:tri.van.Lzz,J,,,*„,,it,,,,,,,.6.,_,,,„ , __ 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689' Date: (/ //V This permit is issued under OAR 918-780-0060. Permits are i 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. "'S'Nitii" "ilt-11:11,;?iii;A;A1,11iN1:1fi;FEE;i,8:ciEDUILiEri;Atrv4:410.,4". ..2.,:z.,4), i. LOCAL":GOVERNMENT.,.:APPROVAL .e,....e., -get, ;..-..c. .„...A,,:..„„,,,,,..0,..„,v, Zoning approval verified? • 0 Yes n No 3escripEionT91-..i--..,, .3,7,: k17,-7,,,lk eirICC:il'AT-alp -4.-.7. ,'' ., -. ',-s-cost, Sanitation approval verified? 0 Yes 0 No New residential R.CATECORY'SOFitONSTRUCTION'.::: eri'lt4- ,, 1 bathroom/1 kitchen(includes:first 100 feet of water/sewer lines, hose 1E Residential li] Government El Commercial bibs, ice maker, underfloor low-point $262.00 $ j.oarisiTE i IN EORMATIO NaN D, LOC.ATIONV01;.?3,1, drains and rain-drain packages) Job site address: // e). 9 / 54 5 147-roe,/ 2 bathrooms/1 kitchen $411.00 $ 3 bathrooms/1 kitchen $483.00 $ City:61 i-'01-7,'e id State: O/ ZIP: 7 V 29 Each additional bathroom(over 3) $104.50 $ Reference: /7,3? 24073 I Taxlot.:02 700 Each additional kitchen over I) I $104.50 $ 0 F VAINOR ( ,1.11111MV;11.* Residential fire sprinklers(includes plan review) pepice;,..„ sewe-- /ir-e 0 to 2,000 square feet $80.00 $ • 2,001 to 3,600 square feet $128.00 $ 3'601 to 7'200 square feet $192.00 $ 7.201 1R11111121,1N1g11;1:11,:1:1:111'91PROP,E RTY:'';OWN E a\-=:.-t1551, 3;`'"51.174:74:4 square feet and greater $255.00. $ Name:--'or n )(.. A ery/ Kit/Sty-34n Manufactured dwelling or pre-fab(circle one) Address: I/ •D_51 /5 ' Ste-. Connections to building sewer and $80.00 $ City: -70 T.-i /;e/d State: C9/2 ZIP: 9 7V 77 water supply Commercial,industrial,and dwellings other than one-or Phone: -549 7q/- 94q/ Fax: - - two-family E-mail: Minimum fee $80.00 $ Each fixture $21.00 $ This installation is being made on residential or farm property owned by me or a member of my immediate family, and is Miscellaneous fees , exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line Aioa $83.50 Signature: , ,se4_...,/,2‘.‘e,a,,,„4„..„. Each fixture,appurtenance,and piping $21.00 $ tONTRAcToR,1NSTALLATION.':::;:!1"'ftk`f1,7,116,. ,,41 Storm water retention/detention facility $21.00 $ Business name: Irrigation systems , $21.00 $ di0Ciaten . Piping or private storm drainage • Address: systems exceeding the first 100 feet $21.00 $ City: State: ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs,x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of $80.00 $ E-mail: hrs.x fee per hr.) CCB license no,: BCD license no: Each additional inspection:(1) $80.00 $ Plumbing license no ' 'fflViteleicargac's.114141-1:-1-7Vii'fVf;fat.11 Minimum fee $ Enter value of installation and equipment$ Print name: Enter fee based on installation and equipment value. $ Signature: •Ild.Mlgt3telWit*MAPillil I CA kV08't 4tNeWON•Mg (A) Enter subtotal of above fees $ 532,- - . (Minimum Permit Fee$80.00) (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x [MS]) $ b0 L- (D)Technology Fee(5%of[A]) $ er F TOTAL fees and surcharges (A through D): $ q7 f7-2-1 440-25004(4/1/2013/COM)