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
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_ 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
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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
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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
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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
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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)