HomeMy WebLinkAboutPermit Plumbing 2014-1-14 • SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
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Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00099
www.springfield-or.gov permitcenter @spdngfield-or.gov
PROJECT STATUS: Issued ISSUED: 01/14/2014 EXPIRES: 07/13/2014
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STATUS DATE: 01/14/2014 APPLIED: 01/14/2014
SITE ADDRESS: 1249 L ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703264408200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace sewer line - -
OWNER: DEBRA JEAN HUDSON TRUST Phone Number:
ADDRESS: 687 ASPEN ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor BLACKLEY INC CGS 157871 12/03/2015 541-221-7200
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
construction.
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Owner or Contractor Signature Date
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AtTENTinN• Gregon is the Oregon UC+I�Y
foilo�'+ rules adopted brules are set With
• rater. These R952,°A-
Netiiicarse 001-0010 through OAhe rules by
in r'ou maY obtal (Note the telephone
GOc�lling the Genter. Mote Utilib) Notillcation
NOTICE: nurnber for the 01 800-332-2344).
THIS PERMIT SHALL EXPIRE IF THE WORK Genter 1s
AUTHORIZED UNDER THIS PERMIT IS NOT
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COMMENCED OR IS ABANDONED FOR
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ANY 180 DAY PERIOD.
Springfield Building Permit 1/14/2014 3:06:24PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
~?� - 225 Fifth St
ittb TRANSACTION RECEIPT Spnngfield,0R97477
OREGON 541-726-3753
811-SPR2014-00099
%N w.springfieldor.gov 1249 L ST permilcenter @spnngfield-or.gov
RECEIPT NO: 2014000092 RECORD NO:811-SPR2014-00099 DATE:01/14/2014
) 103�d , '._;L:s�' _re.�E�.K, om _ _,i N-u _
_, ACCOUNT
CODE/TR4NSiCODE_`C5 eZ-i=Zz, 'AMOUNTaDUEnnj
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
PAYMENT#T3YPE:,, P,AY,OR cgs irraarcc aEtWeT MME
CONTS - AMOUNTMAID `q
Credit Card BLACKLEY INC 97.70
08159b
TOTAL PAID: 97.70
x
Plumbing Permit Application _ DEPARTMENT USE ONLY
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�rITWOFSPRINGFIEt- 6REG ON pp S PflINGF
IEL0'
. Permit no.: 5/t- - coo c,
a igok` sa kAtia " . t g* 5 x.,
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225 Fifth Street♦ Springfield,OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689 Date: //79// y
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] •±ali _.` •,V ks :`!K' ,FEE:','SCHEDUL'E, ier4 , :4, sycf
Zoning approval verified? . ❑ Yes ❑No ;D , ,» d °tr ,Cost a?oa _escription a : -T y y
Sanitation approval verified? ❑ Yes ❑No New residential
;CATEGORY OF°CONSTRUCTION ` r=„' ? - :' 1 bathroom/1 kitchen(includes:first
❑Residential ❑Government ❑ Commercial I
bibs, ice maker)r/sewer, lines, hose $262.00 $
bibs, ice maker, underfloor low-point
5 ,`r ?JOB'`SITE'=INFOORMATION ND LOCATION'';Vft rc drains and rain-drain packages)
Job site address: v—: + Li I J 5 [,, 2 bathrooms/1 kitchen $411.00 $
City: S(l/I tY•- State: 0/ ZIP: i ti 7 3 bathrooms/I kitchen $483.00 $
Each additional bathroom(over 3) $104.50. $
Reference:/ 7,O3 Z(P c--/-47 Taxlot 4g7,0C_) Each additional kitchen(over I) $104.50 $
,,,"`r.,1; ; ?:`;?.'1",DESCRIPTION''OF -WORK1 ';7'n ;. aa '." Residential fire sprinklers(includes plan review)
t{CE 1ry,A.; n sbo, I(( p f P t 0 to 2,000 square feet $80.00 $
,(5•.,, h0.)5 e END SAL[( c( CE. 2,001 to 3,600 square feet $128.00 $
`s, fn.f ;.i' '=/tP•,ROPERTY°_O✓WNER %,t*1 `i:2 k'�_:t,,F: .t e 3,601 to 7,200 square feet $192.00 $
Name: J /y - Sp 7,201 square feet and greater - $255.00 $
Manufactured dwelling or pre-fab(circle one)
Address: t7 /Tr.'L71% Connections to building sewer and
.water supply $80.00 $
City: j4k o State: _ ZIP: nf' ?9,427
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 licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line / $83.50 $
Signature: Each fixture,appurtenance,and piping $21.00 $
'CONTRACT.OR'••INISTALLATIO1N °.:.,^ ,1:=: �' Storm water retention/detention facility $21.00 $
Business name: 0 fl LA.1 t ?1 Vim.`h"St Irrigation systems $21.00 $
Piping or private storm drainage
Address: -�P" . 0 . (3 ox 7.2-1 Z7 systems exceeding the first 100 feet $21.00 $
City: C_,/ bib,rG State: D l2._ ZIP: i 1 40 2- Specialty fixtures $21.00 $
Reinspection(no. of hrs.x fee per hr.) $80.00 $
Phone:Stli-$SZ s-51 8 Fax: - - Special requested inspections(no.of
E-mail: - hrs.x fee per hr.) . . $80.00 $
CCB license no.: i 5-7 811 BCD license no.: ' Each additional inspection:(1) $80.00 $
Plumbing license no/: t0 N O a.? _ '?_Medtcalsa'sp ipmgrl+ ', 'mot :;.-;-.` Minimum fee $
Print name: ``f[>./c-r' W q 1"e`kr Enter value of installation and equipment$ .
Signature: 7( � .� tt Enter fee based on installation and equipment value. $
�V°-�� =u,x- t+ r"'?,,a r,. r •r ,.t :rr. w es r
s• �+sr,=z�,�`"'.-�; =r.APPLICANTS'.USErrb�` �7�'t'.tt,,r";t�xur
(A) Enter subtotal of above fees - 5`I
(Minimum Permit Fee$80.00) $ 'J
(B)Investigative fee(equal to[A]) 5
(C)Enter 12%surcharge(.12 x[.A+B1) $ 42°2.
(D)Technology Fee(5%of[Al) $ ('if
TOTAL fees and surcharges(A through D): $ 47
440-25004(4/1/2013/COM) -