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HomeMy WebLinkAboutPermit Plumbing 2014-3-12 ■ SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfeld,OR 97477 hir eco • Phone:.541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00530 www.springfield-or.gov , permitcenter @spnngfieid-orgov PROJECT STATUS: Issued ISSUED: 03/12/2014 • EXPIRES: 09/08/2014 STATUS DATE: 03/12/2014 APPLIED: 03/12/2014 • SITE ADDRESS: 1128 ISLAND ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703342100312 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Storm drain line OWNER: HOFFMAN JACOB J Phone Number: ADDRESS: . 6198 GRAYSTONE LOOP SPRINGFIELD OR 97478 CONTRACTOR INFORMATION - • Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER , CCB 000000 08/01/2025 INSPECTIONS REQUIRED • Inspections 3400 Storm Sewer Storm Sewer Line: Prior to filling trench. 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. : 7\ Owner or Con actor Signature Dat- • ATTENTION: Oregon law requires you to NOTICE: follow rules adopted by the Oregon Utility • 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 • COMMENCED OR IS ABANDONED FOR 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 3/12/2014 1:25:03PM Page 1 of 1 • • SPRINGFIELD-- CITY OF SPRINGFIELD TRANSACTION RECEIPT 225 Fifth St Spnngfield,OR97477 OREGON 541-726-3753 811-SPR2014-00530 www.spnngfield-ar.gov 1128 ISLAND ST permitcenter©sphngfield-ar.gov RECEIPT NO: 2014000541 RECORD NO:811-SPR2014.00530 DATE:03/12/2014 o C• •; O 16-0411211.C10:7' ..14:1:5k.2. 'ACCOUNT CODE/TRANS CODE-Ma+,.ai AMOUNT'DUE State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.02 Storm Sewer 224-00000-425603 1005 83.50 Technology fee(5%of permit total) 100-00000-425605 2099 4.18 TOTAL DUE: 97.70 rRAYMER TWE 'P.AYOR CASHIER CCARPENTER - COMMENTS' AVAMQUNT,{P.All arill. Cash HOFFMAN JACOB J 97.70 TOTAL PAID: 97.70 .Plumbing Permit Application DEPARTMEN T USE ONLY - etraiFJ g ^ -4 >Se SPRINGFIELD e GI nt O S INGFIEIb, OREGON I ' .s Permit no.: S7/ — S-3 62 225 Pillh Street • Springfield.OR 97477 • PH(5411726 3753 • FA\(541)726 3649 by -%=.OREGON Date: 7///2 7/ 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 clays. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑ No Description Qty east cost l Sanitation approval verified? ❑ Yes ❑ No New residential CATEGORY OF CONSTRUCTION I bathroom/1 kitchen(includes:first • MO feet(gueueCaewer lines. hose y-Itesidential ❑ Government ❑ Commercial bibs, ice maker. underfloor ton'-point $262.00 $ JOB SITE INFORMATION AND LOCATION ch• lu.s and rain-drain packages) Job site address: 4 8 9. 2 bathooms/I kitchen $411.00 $ ;� � 3 bathrooms/1 kitchen $463.00 $ City: 1'., h i State. lL ZIP: &/7� �i7 Each additional bathroom(over 3) $104.50 $ _ Re ferene : TaxloL: Each additional kitchen(over I) $104.50 $ DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) 0 to 2.000 square feet $80.00 $ 2.001 In 3.600 square feet $128.00 $ PROPERTY OWNER 3.601 to 7.200 square feet ' $192.00 S Name: 06 0 1.14.L., 7,201 square (eel and greater $255.00 $ Manufactured dwelling or pre-fah(circle one) Address: Gigs Gya` C6 h V Connections In building sewer and --_. $80.00 .�/ water supply City: c5 r.� item J I State: (j2 ZIP: ,7if ]� Commercial, industrial,and dwellings other than one-or Phones ( - $ -)S-7I Fax: - - two-family E-mail: I Minimum fee $80.00 I $ la '1-his ins-tallaticc��hhAAs being neon residential or farm property Each fixture _521.00 $ owned by me or a incatber of my immediate family,and is Miscellaneous fees q7 exempt from lice sing -:quirenlents under OAR 918-695-0020. IOU' storm.sewer. water line / $83.50 $ LEl S>� Signature: _�.ily Each fixture. appurtenance,and piping $21.00 $ - r0 ACT,�O/2R� INSTALLATION Storm water retention/detention Iitcilit $21.00 $ Business I ame: 9G'e(r✓p vs Irrigation systems $21.00 S V Piping or private storm drainage $21.00 $ sysi .__ - list I00 kel Address: a,m_exc�gdiiie thc_tir,. - —......_..--...S21.0_ _- City: State: ZIP: Specialty fixtures $21.00 $ Reinspeet ion(no. of hrs. x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of per f hrs. x fee hr.) $80.00 $ E-mail: • I _. CCB license no.: BCD license no.: Each additional inspection: (I) $80.00 $ Plumbing license no.: Medical gas piping Minimum tie $ Print name: Enter value of installation and equipment$— Enter fee based on installation and equipment value. $ Signature: APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee$80.00) r (13)Investigative fee(equal to Al)I $ . (C) Enter 12%surcharge(.12 x IA+B]) $/Q°- -- (D)Technology Fee(5%of)AI) . $ to TOTAL fees and surcharges(A through I)): $�/ 440-2500-i(-1/1/2013/CON)) •