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HomeMy WebLinkAboutPermit Plumbing 2014-3-13 SPRINGFIELD 225 Fifth St ' CITY OF SPRINGFIELD Springfield,OR 97477 • ,''` Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 - Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00547 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 03/13/2014 EXPIRES: 09/09/2014 STATUS DATE: 03/13/2014 APPLIED: 03/13/2014 SITE ADDRESS: 2016 H ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703361203900 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace sewer line.less than 100If-shared line for duplex OWNER: ' BLAIN FAMILY REVOCABLE LIFETIME AB TRUST Phone Number: ADDRESS: 2022 H ST SPRINGFIELD OR 97477 • _ CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor 4CML CUSTOM HOME SERVICES LLC GCB 201505 12/09/2015 503-899-9322 INSPECTIONS REQUIRED 1 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 constr ruction. m , ,„,,,j i 131 lig Owner or Contract,-r signature Date • ORK • uires you to �F MST 1S NOT Oregon law leg on Utility .4F3TICE•NIIT SHpaE EXPIRE ATTENTION: ted by the Oreg •1,HIS PER UNDER I t- PER follow rules ante IZED ONEO FOR `'r h OAR 9s52-001- �,j1HOR OR IS ABAND Notification Centoe01T0 through are et forth COMMENCED in OAR 952-001'obtain copies of the rules ne Y Q DAY PERIOD. 0092. You may o Note: the telep the center. ( Notification p,NV 18 • calling on Utility • • number for the Ores tenter is 1-500 332"2344). Springfield Building Permit 3/13/2014 11:16:58AM Page 1 of 1 • • SPRINGFIELD--- CITY OF SPRINGFIELD 225 Fifth St Ito E�aN TRANSACTION RECEIPT Spnngfield,Oft 97477 541-726-3753 811-S PR2014-00547 www.spnngfieldor.gov 2016 H ST permitcenter @spnngfield-or.gov RECEIPT NO: 2014000558 RECORD NO: 811SPR2014-00547 DATE:03/13/2014 frig-411;4621) ,k;', { at„t. ,._* ' `-?" i " ;ACCOUNT CODE/TRANS CODEZar.c1JRIIAMOUNTIOUEN Sanitary sewer 224-00000-425603 - 1005 - 8150 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„AYMENKIWIEE„ IWORi .cgsin d-nix r sC'OMMENTS.i�al. : r WW 'WMA,MOUNT SID., , . Credit Card chloe lima 97.70 142678 TOTAL PAID: 97.70 • • Plumbing Permit Application DEPARTMENT USE ONLY -�.. ' . ; - . k ,f SHINGFIELD 0 S Lf7 51 ITY,I® SPRINGFIELD,®REGO, :r a4 4, i ' Permit no S�� 225 Fifth Street • Springfield OR 97477 • P11(541)726-3753 • I A\t541)72G 3689 "T T`rOREGON Date: / .• This permit is issued tinder 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 FEE SCHEDULE Zoning approval verified? ❑ Yes ❑ No Description . Qty.l Cost Total ca. cost Sanitation approval verified? ❑ Yes ❑ No New residential CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first .160 feet o/mater/setter lines, hose Residential ❑Government ❑ Commercial Gibs. ice nicker, under/lour lotr-point $262.00 $ JOB SITE r INFORMATION AND LOCATION drams mid rain-rrainpackage,$) Job site address:I Lo` . + ZO�-2- 4 56- 2 bathrooms/1 kitchen $411.00 $ City: j �n ktQ,ld State:: - ZIP: 3 bathrooms/I kitchen $483.00 $ P J �� �� Filch additional bathroom(over 3) $104.50 $ Rol"brence: F�6 33 g(Z Ta.xlot Each additional kitchen(over 1) $104.50 $ DESCRIPTION OF WORK Residential lire sprinlders(includes plan review) VD plAQL t�,c to I b- - CS�Q/ 0 to 2.000 square feet $80.00 $ ")' w. 2.001 to 3.600 square feel $128.00 $ PROPERTY OWNER 3.601 to 7.200 square feet _____ $192.00 Name: 5\rad lQ.t n 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-fah(circle one) Address: 2022 ki 5- . Connections to building sewer and S water supply $80.00 City: Spfl nry�y,,-Cie,lci State: b-- ZIP: — J ���., Commercial, industrial,and dwellings other than one-or Phone: sit- 2 ..y4 tJ q Fax: _ -c t.vo-family, E-mail: / Minimum lee $80.00 S 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 S3.74:3 Signature: Each fixture, appurtenance,and piping $21.00 $ CONTRACTOR INSTALLATION Lb e, Storm water retention/detention facility $21.00 Si • Business name:`iuml-C%\-I> \_Come.SPWM� LLL_ hiJulionsystems $21.00 S j p,, r-- Piping or private storm drainage $21.00 Address: p Y/UX U P,p '��i-!�i_s�'stcnu exceeding the first 100 feet City: sleEkrSfM I State: ZIP:9-7 7 Specialty fixtures $21.00 $ Reinspcction(no.of hrs. x fee per hr.) $80.00 $ DhoneSp'Jj bcfqr17j22. Fax: - - Special requested inspections(no. of 7�� �� lus. s fca act hi I $80.00 $ E-mail:Ov __c_,u a-rr -pI y YYI I�G ltd 1RI -- - - __.-- CCB license no.: 7,01 t."—(05 BCD license noTiLi Z Each additional inspection: (1) $80.00 $ Plumbing license no.: eVaaa3 Medical gas piping ,Minimum fee $ Print name: C)' i oe Lt f"�LY— Enter value of installation and equipment$_ Enter fee based On installation and equipment value. $ Signature: f �� � mC — APPLICANT USE (A) Enter subtotal of above fees yq� (Minimum uun Permit Fee$80.00) (.7 er (Ii),Investigative fee(equal to[Al) 5 CZ (C) Enter 12%surcharge(.12 x IA+B)) $i 4 (D)Technology Pee(5%of IA]) $ 4\e, TOTAL fees and surcharges(A through D): $ ��pt7 440-2500-3($/1/2013/COM)