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Permit Plumbing 2014-3-31
SPRINGFIELDwamy r t 225 Fifth St ' CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 'OREGON Building I Residential Permit Inspection Phone: 541-726-3769 , Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00682 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 03/31/2014 EXPIRES: 09/27/2014 STATUS DATE: 03/31/2014 • APPLIED: 03/31/2014 • SITE ADDRESS: 1103 55TH ST,Springfield,OR 97478 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702284300301 - TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 65'sewer line-Private OWNER: MAYS ANGELA R • Phone Number: ADDRESS: 1103 55TH ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone , Plumbing Contractor DRAIN RAIDER ROOTER SERVICE INC CCB 191218 06/29/2014 541-338-8848 INSPECTIONS REQUIRED Inspections , 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing. 3999 Final Plumbing Final Plumbing: When all plumbing work is complete. 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 constru _ins - -- ' 331/� Owner or Contractor Signature. Date • ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth NOTICE: • in OAR 952-001-0010 through OAR 952-001- . THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification Center is 1-800-332-2344). ANY 180 DAY PERIOD. Springfield Building Permit 3/31/2014 10:01:30AM Page 1 of 1 SPRINGFIELD — CITY OF SPRINGFIELD 225 Fifth St L OREGON TRANSACTION RECEIPT Springfield,OR 97477 541-726-3753 811-SPR2014-00682 www.springfieldor.gov 1103 55TH ST permitcenter©sphngfield-or.gov RECEIPT NO: 2014000689 RECORD NO: 811-SPR2014-00682 DATE:03/31/2014 DESCRIPTION_ ' `r'-` w 'i T 3a2i , ` US AC000NT6OODETFRANS CODE b ?€ 'AMOUNT o 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 grPAYMENT�IYPE P.AYOR c'araRi i garo COMMENTS AMOUNTAPAID t, h r =•-.G, Cash DRAIN RAIDER ROOTER SERVICE It 97.70 • 266218 TOTAL PAID: 97.70 • • • Plumbing Permit Application DEPARTMENT USE ONLY µ, ¢ ,¢Y; , , - ,, t SPRINGFIELD //���� - " CI�r7Y OF SPRING IECD, OREGO ' ' Permit no.:5/9/e 7-e%t y - oo1 B 225 Fifth Street • Springfield,OR 97477 • P14(541)726-3753 • FAX(541)726-3689- 3 \OREGON Date: 3 / 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. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Description Qty cast Total Sanitation approval verified? ❑ Yes ❑ No New residential CATEGORY OF CONSTRUCTION 1 hathroom/1 kitchen (includes:Jim /q0 leer u/-water/sewer lines. hose AResidential ❑Government ❑Commercial bibs. ice maker. undeo:lr of low-poini $262.00 $ JOB SITE INFORMATION AND LOCATION drains and min-drain packages) • Job site address: 103 5-16"—r SIC 2 bathrooms/1 kitchen $411.00 $_ Citvpc; 21 Slate. ZIP: �7�/ 3 bathrooms/I kitchen $483.00 $ +�`��^ O 9. / 2� Each additional bathroom(over 3) $104.50 $ • Reference: TUNIOt.: Each additional kitchen(over I) $104.50 $ DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) Riike. r 0 10 2.000 square feet —_-- $80.00 $ 7 (fret �Os iec.r�tr , ii.IL / // 2.001 to 3.600 square feel 5128.00 $ • PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $ /�AyS 7,201 square feet and greater $255.00 $ Name: 417 e"/4 Manufactured dwelling or pre-fah(circle one) Address: '� Connections to building sewer and ��03 �� wale supply I_ $80.00 $ City:cep ) ,�e if I State: p Z[1:Q 7� r 4 l �� Commercial,industrial,•aud dwellings other than one- or Phones2M-sq_aT.2'7/ Fax: - - Iwo-family _ E-mail, Minimum lee $80.00 S This installation is being made on residential or farm property Each fixture $21.00 S owned by me or a member of my immediate family, and is Miscellaneous Ices exempt from licensing requirements under OAR 918-695-0020. 100' stern a water line I $83.50 S Signature: Each lixture. appurtenance,and piping $21.00 S CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $ Business name:._A'.�_ Rn StJc 7ric Irrigation systems $21.00 S _ Piping or private storm drainage $21.00 $ Address: L a -- L.. # systems exceeding the nisi 100 feet t Specially fixtures $21.00 $ City: Smte:mT, zip: 973/4.24_ Reinspection(no. alms. N lee per hr.) ,$80.00 S it FaX::51#343_o�O/ Special requested inspeelinns tan. of 7 $80.00 S E-mall e4 ' O r Ce' ;Jet' hrs.x fie per hcl .- rt �n.. r.P rem tJ`� �J-1 CCB license no.: IrGf(,te BCD license no. Each additional inspection: (I) $80.00 Plumbing license no.: PB jr,'37 Medical gas piping Minimum fee $ Print name: I t Enter value of installation and equipment$ �Y�[w re_,,- Sja_ Enter fee based on installation and equipment value. $ Signature: _, i _ APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) (13) Investigative fee(equal to IAI) $ (C)Enter 12%surcharge(.12 x [A+BI) $ (I))Technology Pee(5%of IAl) .._...__ S ?Cr TOTAL fees and surcharges(A through 0): 5 7 2_ jl ,MBA 440-2500-I(4/1/2013/CONS