HomeMy WebLinkAboutPermit Plumbing 2014-1-20 .. .., . . .
Plumbing Permit Application -,:-. :7‘'DEPARTMENT U8E ONLIi '-':'
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invEITY-;::OFISPRINGEFELWOREGONTr$t ., ,......- . - : 4,s_ Permit no.: Si j — LL0,02--
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date:
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.
T:.i'Si,:;:':i:LOCA If:GOVERNM ENT:AP P ROVALMAtigag Mil,:qiie:gitanEEIISPHEDLILIEif,61WC;ME4-4V
Zoning approval verified? 0 Yes 0 No 0:ilArir,‘A'wV941-.:44.tortt:4::: iat'Z'Tr`' 'Y cCii§l'..-' .ck-Tortn1-4
- `f.Description,72-i,l+rr.,,,-;i'r,:v,">,Lq 14--- -..;&- ts.' -- Sf
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Sanitation approval verified? 0 Yes ill No New residential
;";','C0zM' OATECORY:2OF;;;CONSTRUCTIOW5:1-lai. 1 bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
'a/Residential D Government 0 Commercial $262.00 $
bibs, ice maker, underfloor low-point
;:n.rd.owisITEHNFORMATIONV;AND..120,CATION WE drains and rain dram packages)
Job site address: 203k -11h iteck 2 bathrooms/1 kitchen $411.00 $
City: Scit\4)\- State: 0 ZIP: 911-07 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.:. Each additional kitchen(over I) $104.50 $
iiE.A--*';in:=Yi.j.i.TA D ESCRIPTION':0 FifkVVORKCiteMglea Residential fire sprinklers(includes plan review)
0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00, $
iRANKAnFl;T;$WPROP ERTY4OWNER-V:2:M±Irggia*PYA" 3,601 to 7,200 square feet $192.00 $
Name: -icr, 7,201 square feet and greater $255.00 $
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Manufactured dwelling or pre-fab(circle one)
Address: \\CS Ye/ 5\-1/4-tz\-- Connections to building sewer and
$80.00 $
City: 4,kAcW2_ State: Or- ZIP: q11-\0 I water supply
Commercial, industrial,and dwellings other than one-or
Phone:54 A'41-OGS\ 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 $83.50 $
Signature: Each fixture, appurtenance,and piping $21.00 $
t4CONTRACTORINSTALLATIONT1?,Int,a4 Storm water retention/detention facility $21.00 $
Business name: CaSC04.)1/4Q. Ua\\C\\ vv..\\thn Irrigation systems $21.00 $
Piping or private storm drainage
Address: 77q€S <Ark( A--, systems exceeding the first 100 feet $21.00 $
City:- t• et,.k.mAcx•Q tate: 0.?... ZIP:611462 Specialty fixtures $21.00 $
Reinspection(no of hrs.x fee per hr.) $80.00 $
Phone:54 5fi- ."25)t‘ Fax: - -
Special requested inspections(no.of
$80.00 $
E-mail: (*ith C.(104 k a ev ittEcOokilol@ p).5\06 .Lon hrs.x fee per hr.)
CCB license no.:2.00I-C66.) CD licen no.: ?bine Each additional inspection:(1) $80.00 $
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Plumbing license no.: —131S-..1? ,,Medicatgas,piptriggrytA:ii..i.cx,}c.,4„,-,..t.' Minimum fee $
Print name: ?Jack - 91-stacc\D Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature:- . / . Via:WeitgriPaPP-Lllt-Arf0Ef.tSSEP:WPWRK4.'Z't
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(A) Enter subtotal of above fees
(g -Ct)( , (Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A-FBI) $ eta,
$95.1
A (D)Technology Fee(5%of[A]) $
i
A \ , TOTAL fees and surcharges (A through))): $ If 7 III_
N -
440-2500-1(4/1/2013/C0M) ' •W
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SPRINGFIELD "-,- CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
811-SPR2013-02602
www.springfield-or.gov 2001 7TH ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014000180 RECORD NO:811-5PR2013-02602 DATE:01/28/2014
ACGOUNTCODE/TRANSCODE ; rAMOUNTDUEL
Sink/basin/lavatory 224-00000-425603 1005 21.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 5.04
Technology fee(5%of permit total) 100-00000-425605 2099 2.10
Water closet 224-00000-425603 1005 21.00
TOTAL DUE: 49.14
.. _ - _ C __ - _ - AMOUNT PAID
{�,PAY,MENT TYPE �`. PAYOR�: -cnswErc ccArsPENreR `:r .,�„COMMENTS.wrv,: `„ ,__,,,_,;,,,_-,,�.� . . -�. r_,„,;,;,, __ :;..;:
Credit Card v CASCADE VALLEY PLUMBING INC 49 14
318253
TOTAL PAID: 49.14