HomeMy WebLinkAboutPermit Plumbing 2014-2-25 SPRINGFIELD 225 Fifth St
hir CITY OF SPRINGFIELD Springfeld,OR 97477
Phone: 541-726-3753
REGON - Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00407 •
www.springfieldor.gov permitcenter @springfeld-or.gov
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PROJECT STATUS: Issued ISSUED: 02/25/2014 EXPIRES: 08/24/2014
STATUS DATE: 02/25/2014 APPLIED: 02/25/2014
SITE ADDRESS: 1720 17TH ST,APT#1,Springfield,OR 97477 SCOPE: .Plumbing Only
ASSESOR'S PARCEL NO: 1703253104700 . TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace water line
OWNER: NGUYEN DO Phone Number:
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ADDRESS: PO BOX 11294
EUGENE OR 97440
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 •
3315 Water Line •
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 d is located at the front of he property, and the approved set of plans will remain on the site at all times during
con- on. / /
i ; , /I 9A5—//4
Owner or Contractor Signature _ - Date
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
NOTICE: Notification Center. Those rules are set forth'
THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952.001-
AUTHORIZED UNDER THIS PERMIT IS NOT . 0090. You may obtain copies of the rules by
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calling the center. (Note: the telephone
COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification"
ANY 180 DAY PERIOD. ' - - Center is 1-800-332-2344)..
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Springfield Building Permit 2/25/2014 8:43:49AM Page 1 of 1
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SPRINGFIELD' - CITY OF SPRINGFIELD
.., 225 Fifth St
°E�aN TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
811-SPR2014-00407
www.spnngfieldor.gov 1720 17TH ST.APT 1 permitcenter @spnngfield-or.gov
RECEIPT NO: 2014000401 RECORD NO: 811-SPR2014-00407 DATE:02/25/2014
jul45ol' ,0111Sr[ ,' ;d ,.. -tL.,(__1 __._,_ .ACCOUNIICODE/TRANS CODE-_.. AMOUNT DUE' '?
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
Water Line 224-00000-425603 1005 • 83.50
TOTAL DUE: 97.70
IFTPAYMENTfTY,P,E . PAY.OR cnssioec A.Ka TeR COMMENTS _ AMQUNT,0241D
. Check JENCOURT ENVIRONMENTAL 97.70
1381 SERVICES LLC
TOTAL PAID: 97.70
.Plumbing Permit Application DEPARTMENT,USE ONLY
TR
r t� ITY OFISPRINGFIEL- 6REGON
Permit no o;%— 907
fit s ' + °ir ' " k u . m " 'a 3 2 i.. bA.
c� _ .
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 2/ 25// 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.
7., : .LOCAL'-";GOVERNMENT APPROVAL F= n x ih.!Al '4 _ XEE;}SCHEDULE . r +°`• ^4
Zoning approval verified? ❑ Yes ❑No 'Description �Ir ' Qty ,#Cost;� +=
Total=
dix.., av1:tra as 3 x : rsi• r...,;ea . , cost s°t
Sanitation approval verified? ❑ Yes ❑No New residential
`?s' :CATEGORY OF"'CONSTRUCTION ti A':k-- ,.} I bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
Residential ['Government bCl Commercial $262.00 $
LO,O ice maker, underfloor low point
..d:, JOBISITEIINFORMATIQN,-AND LO,C TIONk uR='' drains and rain-drain packages) ,
Job site address: 17 a0 1 7-I in r7 T, 2 bathrooms/1 kitchen $411.00 $
City: 5 erm-f tl c9._. State: ag„ ZIP:at 70 7"7 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $
Reference 3 J�,3 / Taxlot7ct7
�� 1. Each additional kitchen(over I) $104.50 $
*-`. :. ! v,a ' DESCRIPTIO ft'OF WORKa ' arq♦ :Xe- ,2c"': Residential fire sprinklers(includes plan review) _
(A/414-C,-- 50-,/,'(t- 0 to 2,000 square feet $80.00 $
2,001 to 3,600 square feet $128.00 $
+`, LSt .x 'j' :PROP E RT,Y' OINN ER - •�+ s "+2; ri(u .y 3,601 to 7,200 square feet $192.00 $
, / 7,201 square feet and greater $255.00 $
Name: Do V tiv i WJM.�✓1 Manufactured dwelling or pre-fab(circle one)
Address: (7 10 / 1 j 47 iF Connections to building sewer and $80.00 $
water supply
City: 5� �/, � State:U' ZIP: `i � 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 I $83.50 S
Signature: r � Each fixture,appurtenance,and piping $21.00 $
`: ..'CONTRACTOR' INSTALLATION ''LL'%zk`.''*xL "x . - Storm water retention/detention facility $21.00 $
Business name: Rig 10 Ftpllk--t4--- Irrigation systems $21.00 $
Piping or private storm drainage
Address: 6/U 1-14 f(Ai 1 � systems exceeding the first 100 feet $21.00 $
City: Ce..5{4....t State: (DCZ ZIP:di74t' -- Specialty fixtures $21.00 $
Reinspection(no of hrs.x fee per hr.) $80.00 $
Phone:9-/A 6`S - /'it/ Fax: - - Special requested inspections(no.of
E-mail: . hrs.x fee per hr.) $80.00 $
CC-B license no.: I(05---5 I BCD license no.: Each additional inspection:(1) $80.00 $
Plumbing license no 1 ,, Medical gas pipmg4 „}t .. F f/ .Minimum fee $
Print name: 'K Enter value e b se of installation installation aon and emept$
Enter fee based st oration and and equipment value. $
Signature: t?Z; '+, S`APPL"ICANT; USEe; a„ar4`°r-a„ '"
(A) Enter subtotal of above fees $ c-,�JCi
(Minimum Permit Fee$80.00)• 6,S
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ /c)
(D)Technology Fee(5%of[A]) $ q /T
7 7u
TOTAL fees and surcharges (A through D): $//
440-2500-J(4/12013/COM) .