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HomeMy WebLinkAboutPermit Plumbing 2014-1-29 SPRINGFIELD - -. 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 iit� Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 • PERMIT NO: 811-SPR2014-00180 www.springfield-or.gov permitcenter @springfield-or,gov PROJECT STATUS: Issued ISSUED: 01/29/2014 EXPIRES: 07/28/2014 STATUS DATE: 01/29/2014 APPLIED: 01/29/2014 SITE ADDRESS: 914 A ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703354203200 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sewer line, install in new easment OWNER: RANKIN WILLIAM E&SUSAN M Phone Number: ADDRESS: 914 N A ST SPRINGFIELD OR 97477 . CONTRACTOR INFORMATION Contractor Type • Contractor Name • Lic Type Lic No Lic Exp Phone Plumbing Contractor JOHN THE PLUMBER INC CCB 107810 07/24/2015 541-686-4888 INSPECTIONS REQUIRED i • • 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. • Lan/,,. 0 i /'2,-9 /2a I Owner or Contractor Signature Date • ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility . Notification Center, These rules are set forth in OAR 952-001-0010.through OAR 952-001 , 0090. You may obtain copies of the rules by I�T6CE1 IF THEWORK • calling the center. (Note: the telephone THIS PERMIT SHALL TXN ORE IS NOT number for 1-800-332-2344).ification ,,111t10RIZED UNOIS ABANDONED FOR Oregon Utility COW NNY 180 IMENCED DAY PEOR RIOD. Springfield Building Permit - 1/29/2014 1:48:55PM - Page 1 of 1 • rSPRINGFIELD++4,- R CITY OF SPRINGFIELD 225 Fifth E�aN TRANSACTION RECEIPT SpringfielgOR97477 - 541-726-3753 811-SPR2014-00180 www.springfieldor.gov 914 A ST permitcenter @spnngfield-or.gov RECEIPT NO: 2014000188 RECORD NO: 811SPR2014-00180 DATE:01/29/2014 i *9H7I:Atl kt,.,--i--^; r,-_.2.: ` nom_= in'ACCOUNTCODE/TRANSCODE '_' t„" ' i o r 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 P.AYMENTOTeYPE _ P.AYOR CnsNiEaaccgdgENTEa ,'a - COMMENTS -:-'1F--ii, *11 AMOUNTi.RAID Check RANKIN WILLIAM E&SUSAN M 97.70 1509 TOTAL PAID: 97.70 • Plumbing Permit Application DEPARTMENT USE ONLY - ' SPRINGFIELD PS'- �i a ,,, 3 0CITIORSPRI NGFIELD 6REGON _ Permit no.: S1 - � O *e , ae a - a ° 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: l/Z�//L/ 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. ,;'1, "• !;:ilocALIGovERNMENT AP PROVALiM:ifi ii 'tom" li.ti. IFEE',#SCFIEDULE _ `. z'" Zoning approval verified? ❑ Yes ❑No ;ID es-eri titi 6 n ,4 i si _S Qty {Costs t1 Total.t t ,. M�-1 : u s4�a 4,.<, .. ea 4cost Sanitation approval verified? ❑ Yes ❑No New residential CATEGORY,'OF' CONSTRUCTION ' $,5:}"'.Tr,'` l bathroom/] kitchen(includes:first k Residential ❑Government ❑Commercial 1 bibs, is makers/sewer, lines, hose $262.00 $ bibs, ice maker, underfloor low-point JOB'SITE*INFORMATION ;AND LOCATION-. W2 drains and rain-drain packages) Job site address: 6\ ( r-f A- S i 2 bathrooms/I kitchen $411.00 $ City:5 r Z,,, Si C \ A State: 0 t_ ZIP: ov1 L 11 3 bathrooms/1 kitchen $483.00 $ Each additional bathroom(over 3) $104.50 $ Reference 4 7 3Sy2-- Taxlo[ Q)zpc9 Each additional kitchen(over 1) $104.50 $ S' rOMESCRIPTION OF WORIO "'s't'' A ' Residential fire sprinklers(includes plan review) -e lk\'r-e CA- Sew e`r t r h eS 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ , (, ='PRO P ERTYLOWN E W:;tC: x k" ` "t°F,1M 3,601 to 7,200 square feet $192.00 $ Name: ' c / 7,201 square feet and greater $255.00 $ W I ( � G Vvx -P Jh-S0.V� 0.v \1 1ti Manufactured dwelling or pre-fab(circle one) Address: e( I L.( pk-- SA— Connections to building sewer and $80.00 $ City: Sr r ,,,4ie_ ` A State: 0lic water supply ZIP: Q� ill Commercial,industrial,and dwellings other than one-or Phone:5 LI (- eja(s-,SL'(n Fax: - - 1 two-family E-mail: S r et v`1< '‘,v,._ -. u_o -e.c cv 0 C c' Ll. Minimum fee $80.00 $ ' This installation is being made on resident 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 $6/2,S° Signature: ilk.1 . _' yu-.. . c-Relw- Each fixture,appurtenance,and piping ( $21.00 $ '.'':'u . %CONTRACTOR?'INSTALLATION 1 sl ., air Storm water retention/detention facility $21 A0 $ Business name: - .v�� .-y,-e_ 7\ Uy�pelr Irrigation systems $21.00 $ • _ - Piping or private storm drainage Address: 25 cy-b /91L z- /`C—I systems exceeding the first 100 feet $21.00 $ City:E--//t4rj7A-r I State: (fir ZIP: 97 4/05 Specialty fixtures $21.00 $ r - Reinspection(no.of hrs.x fee per hr.) $80.00 $ Phone: �Q�--line I Fax: - - Special requested inspections(no. of $80.00 $ E-mail: - hrs.x fee per hr.) CCB license no.: 4) 7 ,74BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no Medical gasplpmg =`c 1 s'E ` `„x' Minimum fee $ Print name: Enter value of installation and equipment$ Enter fee based on installation and equipment value. $ Signature: i',,;, v ti$,S `,rTAPPLICANT`USE t$k la (A) Enter subtotal of above fees $ if (Minimum Permit Fee$80.00) (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ /Off= (D)Technology Fee(5%of[A]) $ Vif TOTAL fees and surcharges (A through D): - $ y7 7°. 440-2500-J(4/1/2013/COM)