HomeMy WebLinkAboutPermit Plumbing 2014-4-14 •
SPRINGFIELD --• 225 Fifth St
' 'u& CITY OF SPRINGFIELD Springfield,OR 97477
t.,{ t v Phone: 541-726-3753 •
n--‘ OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00799
www.springfeld-or.gav - permitcenter @springfield-ar.gov
PROJECT STATUS: Issued ISSUED: 04/14/2014 EXPIRES: 10/11/2014
STATUS DATE: 04/14/2014 APPLIED: 04/14/2014
SITE ADDRESS: • 1839 E ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703362400100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Demo house and sewer cap
OWNER: TERREL RANDY J Phone Number:
ADDRESS: 1869 E ST
SPRINGFIELD OR 97477
CONTRACTOR jmoi MATION b
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone .
General Contractor OWNER COB 000000 08/01/2025
INSPECTIONS REQUIRED Y
Inspections
7160 Sewer/Septic Cap
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. /� / r
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Owner or Contractor Signature Date
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ATTENTION: Oregon law requires you to
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follow rules adopted by the Oregon Utility NOME:
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001-
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 ANY 180 DAY PERIOD. •
Center is 1-800-332-2344).
Springfield Building Permit 4/14/2014 2:33:12PM Page 1 of 1
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Plumbing Permit Application DEPARTMENT USE ONLY
r SPRINGFIELD-�
0299
*r ITN 1 a ::. - ELD_tQ G,d , - ;, ;,^n Permit no.: Sly_ O2
225 Fifth Street •Springfield,OR 97477 • PI1(541)726 3753 • FAX(541)726-3689 Di PiAoRjGo Date: /17/ (
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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, i
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Description Qty east cost)
Sanitation approval verified? ❑Yes ❑No New residential
CATEGORY OF CONSTRUCTION I bathraom/1 kitchen(includes:first
la-Residential
IOU fret ofwalerisereer lines, hose
❑Government I , ❑Commercial orbs, ice maker, underfloor low-point $262.00 $ i
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
Job site address: I D 1 Ft laze?7 2 bathrooms/I kitchen
pp $411.00 S
City: State:0,` ZIP:y7y 3 bathrooms/1 kitchen $483.00 $
} SY�I��a��'�'� z� Each additional bathroom((wet 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I
( I) $104.50 $
. DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) 1
j7 Jpr)._— C.:41--ea 6 7c (2)-e-.......9 0 to 2,000 square feet $80.00 $
2.001 to 3,600 square feet $128.00 $ i
PROPERTY OWNER 3.601 to 7.200 square feet $192.00 $
Name: lK L}, eR,2-e - 7,201 square feet and greater $255.00 $ y
J G u S /fie ../ Manufactured dwelling or pre-fab(circle one)
Address: / O 1 .1 / I Connections to building sewer and
water supply $80.00 $
City: Sr9 Qi2.%JtA'e / State: 02 ZIP: CJ7e/7 7
Commercial,industrial,and dwellings other than one-or
Phone:5Q 1 Ce 53 —27/ I Fax: - - two-family
E-mail:
Minimum fee $80.00 $ I
This installation is being made on residential or farm property Each fixture I $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 I $
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Signature: Each fixture,appurtenance,and piping $21.00 I $
CONTRACTOR INSTALLATION ' Storm water retention/detention facility $21.00 I $
Business name: ��,A51---_ irrigation systems I $21.00 $
Piping or private storm drainage I $21.00 $ t
Address: systems exceeding the first 100 feet
City: State: ZIP: Specialty fixtures $21.00 $
. Reinspection(no of hrs.x fee per hr.) $80.00 S
Phone: - - Fax: - -
Special requested inspections(no.of
E-mail: hrs.x-fee per hr.) $80.00 5 I
CCB license no.: BCD license no.: Each additional inspection:(1) $80.00 $ t
Plumbing license no.: Medical gas piping Minimum fee $
Print name: Enter value of installation and equipment$_. i
Enter fee based on installation and equipment value. $ I
Signature: APPLICANT USE f
I(A) Enter subtotal of above fees [
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x 1+B - S 9 6Dr
(D)Technology Fee 5%of[AB $ w
TOTAL fees and surcharges(A through D): $ 0/1C1.,...7.--
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440-2500-.I(4/1/2013/COM)
SPRINGFIELD CITY OF SPRINGFIELD
TRANSACTION RECEIPT
225 Fifth
97477
OREGON 541-726-3753
811-SPR2014-00799
www.spnngfield-or.gov 1839 E ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014000800 RECORD NO: 811-SPR2014-00799 DATE:04/14/2014
0 ESCRIPTIONeVA'`'�,r` " ' u?' a. : °_`- ES, i RAGCOUIWCODEIT,RANS CODE ,!failAMOUNVD'UE.`:r
Sewer cap/septic tank demolition 224-00000-425603 1005 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
-P -$i ... c 66, 4a. T,�- :, 1 / .;rIllig... yz _1F rt,, r. } - .AMOUNTVPAID"� ,.. -
.AYMENT�TYPE 4!�"PAYOR ' casrftea:'ccgRaesree,I� . ';COMMENTS' - �: r. -r�-. . _ a
Cash TERREL RANDY J 93.60
TOTAL PAID: 93.60
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