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Permit Mechanical 2014-3-31
• SPRINGFIELD 225 Fifth St A .7 , CITY OF SPRINGFIELD springfield,oR 97477 t"co OREGON Phone: 541-726-3753 Building / Residential Permit Inspection Phone:541-726-3769 • Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00688 www.springfield-or.gov -permitcenter©spdngfield-or.gov PROJECT STATUS: Issued ISSUED: 03/31/2014 - EXPIRES: 09/27/2014 STATUS DATE: 03/31/2014 APPLIED: 03/31/2014 SITE ADDRESS: 281 S 71ST ST,Springfield,OR 97478 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1702353405804 - TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Piping LP tank to generator OWNER: LACLUYSE DAVID Phone Number: ADDRESS: 281 S 71ST ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION JI Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Mechanical Contractor AMERICAS PROPANE LP CCB 152826 11/06/2014 541-746-6531 — INSPECTIONS REQUIRED 6 Inspections 2250 Gas Piping . 2255 Gas Pressure Test 2995 Final Gas Final Gas: When all gas 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 construction. 3//yOwner or Contractor Signature Date ATTENTION: Oregon law requires§ y,Ru Ia - NOTICE: . follow rules adopted by the Oregon Uti,IYYy THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set TRk,! in OAR 952-001.0010 throughQAR'952-0�1 AUTHORIZED UNDER 'fHIS PERMIT IS NOT 0090. You may obtain copiesLof the rAley$. COMMENCED OR IS ABANDONED FOR calling the center. (Note:tha•telephpnce - ANY 180 DAY PERIOD. number for the Oregon Utility,Notificat 6n Center is 1-800-332-2344). • Springfield Building Permit 3/31/2014 2:03:17PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St 00A- OREGON TRANSACTION RECEIPT Springfield,OR 97477 541-726-3753 811-SPR2014-00688 www.springfield-or.gov 281 S 71ST ST permitcenter @springfield-or.gov RECEIPT NO: 2014000695 RECORD NO:811-SPR2014-00688 DATE:03/31/2014 �o�3e171CbtlCe1 F.+e ?v_"�Na Ez N3.3e<< ACCOUNTICODELTRANVOODE '` .,. .-T�;AMOUNT DUEII First Appliance Fee 224-00000-425604 1006 80.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 • 4.00 TOTAL DUE: 93.60 PAYMENT TYPE ,- PAYOR CASHiER:;D 3 1! _ -.=- -::61 60MMENTS dam'' ,::i?�c s?4;e AMOUNTiPAID,-_a etif Check chris steindorf 93.60 1141 TOTAL PAID: 93.60 • �E>Ei mg Permit Application DEPARTMENT USE ONLY • ertA- MObz WSPRI+fiN GFiF L D,IO°: EGO N e r r; SPR"IN GFIELD Permit no.:cf tzv( Le— 006esB, 225 Fifth Street • Springfield,OR 97477 • PH(541)726 3753 • FAX(541)726-3689 \OREGON Date: /3 / / ) C/ 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-l80 daysS...) LOCAL GOVERNMENT APPROVAL r/44 ea FEE—SCHEDULE Zoning approval verified? ❑ Yes ❑ No '7.e Cost TotaI Description g Qt?� ea I cost Sanitation approval verified? ❑ Yes ❑ No - v residential ONCE' .S CATEGORY OF CONSTRUCTION I bathroom/I kitchen (includes:first Residential ❑Government ❑ Commercial 100 feel ,nuke,er. iulerJ lines, hose $262.00 $ bibs, ice maker. uudedloor low-polar JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) Job site address: 2 bathrooms/I kitchen $411.00 $ City: Sh✓nh re/® State: Q((!� ZIP: 3 bathrooms/I kitchen $483.00 $ P c( u Each additional bathroom(over 3) $104.50 $ Reference: /701 3 TaxlotO,�gO f Each additional kitchen (over I) $104.50 $ DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) L it a-a-s Ah„..b iK7 {v✓ sfandbv 7enerS.r 0 to 2.000 square feet $80.00 $ 2.001 to 3.600 square feet 5128.00 $ PROPERTY OWNER 3,601 to 7.200 square feet $192.00 $ Name: been e( GC1 C/tic(rG 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-fab(circle one) Address: ,Zt/ f•, 7/_ 5r , ZIP: �7 Connections to building sewer and City: e //l� water supply $80.00 S Spew-71A /� Can ceiaHndGs• al,at •ih'e m s nfker t, I phone:$c/�-a P70 Fax: - - hvo-family ViiIa1 7'f3K(G /4"5'1/11' E-mail: Minimum fee /r $80.00 $ "Ibis 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 $83.50 $ Signature: Each fixture, appurtenance,and piping $21.00._...-$ CONTRACTOR INSTALLATION Storm water retention/detention facility. 521.00 $ Business name: A-Pri Coe(&$-. PioPAne Irrigation systems $21.00 $ Piping or private storm drainage $21.00 S Address: A 1c/j Main St. systems exceeding the first 100 feet Specialty limits $21.00 $ City: S peins i- e-4i State.uc. ZIP: Reinspect ion(no. of hrs s fee per hr.) $80.00 $ Pbone:SW-7Y o / Fax: - - Special requested inspections(no.of $80.00 E-mail: hrs. x fee per hr.) _ CCB license no.:/S2$16 BCD license no.: Each additional inspection: (I) $80.00 S Plumbing license no.: Medical gas piping Minimum fee $ Print name: ,11,J-g I affi{ Enter value of installation and equipment$ a Enter fee based on installation and equipment value. $ Signature: APPLICANT USE (A) Enter subtotal ofabovvJee, S a^� (M ``ininnnn Permit Focr58b.00,I Q LJ (13) Investigative fee(equal to(Al) $ (C) Enter 12%surcharge(.12 x [A+BI) S (D)Technology Fee(5%of(Al) $ 7 �yB� TOTAl, lees and surcharges (A through D): .._...936`5 440-2500-1(4/I/2013/CON-I)