HomeMy WebLinkAboutPermit Plumbing 2014-1-6 SPRINGFIELD
t 225 Fifth St
A' • CITY OF SPRINGFIELD Springfield,OR97477
Phone: 541-726-3753
OREGON Building / Residential. Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00019
www.springfield-or.gov permitcenter @springfield-ocgov
•
PROJECT STATUS: Issued ISSUED: 01/06/2014 EXPIRES: 07/05/2014
STATUS DATE: 01/06/2014 APPLIED: 01/06/2014
SITE ADDRESS: 345 14TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703362310400 • TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace 50'private sewer line
OWNER: CASEY MILDRED 0 Phone Number:
ADDRESS: 345 14TH ST
SPRINGFIELD OR 97477
•
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor JENCOURT ENVIRONMENTAL SERVICES LLC CCB 182531 06/11/2014 541-689-1711
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.
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. 1
//Owner or Contractor Signature Date c •
•
•
•
ATTENTION: Oregon law requires you to NOTICE: '
follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT
in OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR
0090. You may obtain copies of the rules by
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 1/6/2014 1:26:40PM Page 1 of 1
•
SPRINGFIELD CITY OF SPRINGFIELD
�`` TRANSACTION RECEIPT Sp Fifth
R97477
1 ___OREGON 541-726-3753
811-SPR2014-00019
www.springfeld-or.gov 345 14TH ST permitcenter@springfield-or.gov
RECEIPT NO: 2014000016 RECORD NO: 811-SPR2014-00019 DATE:01/06/2014
) *1MJ @ I' ? a ACCOUNT CODETIIRANS CODES-j AMOUNT'DUE,u
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
P.AYMENT�TiYP.E. . . . P.AY,OR .- cpsNlER:JLARSON COMMENTS .AMOUN,T.�'P.AIU _
Credit Card JENCOURT ENVIRONMENTAL 97.70
05119D SERVICES LLC
•
TOTAL PAID: 97.70
•
•
•
Plumbing Permit Application DEPARTMENT USE ONLY
SPRINGFIELD�
, -
OR E NGFIEL OREGQ 4
Permit no.: � � '70(3
OW
74 s r'
225 Fifth Street • Springfield.OR 97477 • PH(541)726J753 • fAA541)726-3639 s' :7' \0iGON Date: /// j
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 Clays.
—
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑ No Description Q �j Cost Total
_ t ea. cost
Sanitation approval verified? ❑ Yes ❑ No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:/sit
100 feet of watertseu er lines.hose
Residential ❑Government ❑ Commercial bibs. ice looker. owlet,/loor low-pobu $262.00 $
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) _ .
Job site address: `-'1 S _`j H
(-0-\ \ 2 bathrooms/I kitchen ¶411.00 S
��� 4��� �.--�� � 3 bath additional l kitchen $483.00 $
City: state: 71 P. Each additional bathroom(over 3
( 3) $104.50 $
Reference: I Tax lot.: Each additional kitchen(over I) $104.50 $
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
c- -?\ac-Q_ SN cc Sew* 0 to 2.000 square fed $80.00 $
ccC. n. �� kO 'Pitt 2.001 Io 3.600 square feet $128.00 $
a.
1 PROPERTY OWNER 3,601 to 7.200 square feet $192.00 $
1n
Name: V A \ \61.--Q.6 ` Cgs 2 i 7,201 square Ices and greater 5255.00 5
Manufactured dwelling or pre-fah(circle one)
Address': G_S 0.A,.00) Connections to building sewer and
580.00 $
City: State: ZIP: water supply
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 Eoch fixture $21.00
owned by me or a member of my immediate fainily, and is Miscellaneous fees /
exempt from licensing requirements under OAR 918-695-0020. 100' storm sewer, water line 50 $83.50 Si
Signature: Each lixture,appurtenance.and piping $21.00 S
CONTRACTOR INSTALLATION Storm water retention/detention I'acilit $21.00 5
Business name: — a\-e Irrigation systems $21.00 S
Piping or private storm drainage
Address: ��� �7 9� systems exceeding the first 100 Net $21.00 $
_ _ ______ _
City:
E�1( .14 L----_- State: OI ZIP:9,1L40. ( Specialty fixtures $21.00 Si
Reinspection(no.ol'llrS. x tee per Itr4 $80.00 $
Phone:9-41 (0 Cj_ / 1 t / Fax: - - Special requested inspections(nn.of
$80.00 $
E-mail: hrs.x fee per hr.)
CCB license no.: 18 2,53 t, BCD license no.: Each additional inspection: (1) $80.00 $
Plumbing license no,: c tu. ' Medical gas piping Minimum lee $
Print name: )(t�\_ ( 9c� Enter value of installation and equipment$
I Enter fee based on installation and equipment value. $
Signature: w�—✓1_/ APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00)
(13) Investigative fee(equal to Al)I .$
(C)Enter 12%surcharge(.12 x [A+BI) $
(D)Technology Fee(5%of IAI) $
TOTAL fees and surcharges(A through D): $ F—? 9_�
440-2500.1(4/1/2013/C0M)