HomeMy WebLinkAboutPermit Plumbing 2014-4-15 •
SPRINGFIELD.._
:A,1 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
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s.. Phone: 541-726-3753
OREGON • Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00811
www.springfield-or.gov permitcenter @springfield-or.gm,
PROJECT STATUS: Issued ISSUED: 04/15/2014 EXPIRES: 10/12/2014
STATUS DATE: 04/15/2014 APPLIED: 04/15/2014
SITE ADDRESS: 1455 S 58TH ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1802033200900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Fire Damage-Replacing two tubs and washer box
OWNER: WHITNEY MICHAEL M JR&SAREN L Phone Number:
ADDRESS: 1455 S 58TH ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
L INSPECTIONS REQUIRED
Inspections
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'f the property, and the approved set of plans will remain on the site at all times during
co r lion.
�yt /
\ evice / "" fI C
Owner or Contractor Signature Da -
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility NOTICE;
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
copies
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone S COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 4/15/2014 1:58:12PM Page 1 of 1
SFIRING FIELD CITY OF SPRINGFIELD
it .:rr. 225 Fifth St
«; TRANSACTION RECEIPT Springfield,OR 97477
',_ 541-726-3753
OREGON 811-SPR2014-00811
www.springfield-cr.gov 1455 S 58TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000818 RECORD NO: 811-SPR2014-00811 DATE:04/15/2014
. [DESCRIPTION ACCOUNT CODE/TRANS CODE _:. AMOUNT DUE; 1,tr.
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 17.00
Fixture 224-00000-425603 1005 21.00
Shower/Shower pan 224-00000-425603 1005 42.00
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_JIaRSON , ' ,a', . COMMENTS -r ' I. 'd'AMOUNT'PAID I
Check Roto Rooter 93.60
1386
TOTAL PAID: 93.60
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Plumbing Permit Application DEPARTMENT USE ONLY I
` 'M; �\ •. .W +. SPRINGFIELD=ar•
,.a O t SFitiNG EEL4 QR ( ® . :- Permit no �/�Zo( Y -O '�[
225 Filh Street • Springfield,OR 97477• PHto41)726-3750 •FAX(541)726-J689
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loAEGON Date: i /�5 //Y
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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.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Description Qty. Cost Total
ea. cost
Sanitation approval verified? ❑Yes ❑No New residential
CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first q
Residential ❑Government El Commercial 100 feet oju•cren'se,rertines, hose. $252 50 $ e
bibs, ice nicker, undery7oor low-point
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) }e
Job site address: \If SS s SI I"l S+ . 2 bathrooms/I kitchen - $411.00 $ f
City: 5' (. ed State: 0 ZIP: 9 �3 3 bathrooms/1 kitchen $483.00 $
P' Each additional bathroom(over 3) $104.50 $ 9
Reference: Taxlot.: Each additional kitchen(over I) - $104.50 $
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
:14447-k[�0.�i
DESCRIPTION
(y1" 2 , • • '�{ f,(,6 rjpN, 0 to 2,000 square feet $80.00 $ t
. 2,001 to 3.600 square feet $128.00 $
PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $ j
Name: �. K� W A AviA 7,201 square fez,and greater $255.00 $
Manufactured dwelling or pre-fab(circle one) t
Address: y S S Sri Sf I Connections to building sewer and )
Q water supply $80.00 $ . I
City: 5 rl t atc1 State: D� ZIP:C1"Ie 4
Commercial,industrial,and dwellings other than one-or 1
Phone: - - Fax: - - two-family
E-mail: j
Minimum fee $80.00 $ t
This installation is being made on residential or farm property Each fixture $21.00 $ E
owned by me or a member of my immediate family,and is Miscellaneous fees t
exempt from licensing requirements under OAR 9(8-695-0020. 100'stoma,sewer.water line $83.50 I $
Signature: Each fixture,appurtenance,and piping 5 $21.00 $
CONTRACTOR 1 STALLATION Storm water retention/detention facility $21.00 $ I
Business name: I u/ 1V '/A litigation systems $21.00 $
L Piping or private stonn drainage $21.00 S
Address: k21{g W I'7*1 systems exceeding the first 100 feet
City: E -L�-etc State:6c. . ZIP:ci'700?-- Specialty fixtures $21.00 $ I
Reinspection(no.of hrs,x fee per hr.) $80.00 S
Phone:)-ta449- /9/ Fax: - - l
I Special requested inspections(no.of $80.00 $ i
E-mail: hrs.x fee per hr.)
i
/ Each 5 r Each additional inspection: (I) $80.00 $
CCB license no.: 0 1 BCD license no.:
Plumbing license no.: y� Medical gas piping Minimum fee $
• �ate6 ' I g• P 1 g
Enter value of installation and equipment$
Print name: �.. -�, . - . - I
`'i .. er Enter fee based on installation and equipment value. $
Signatue: _ APPLICANT USE
(A) Enter subtotal of above fees j
(Minimum Permit Fee$80.00) $ I
(B)Investigative fee(equal to[A]) .S l
(C)Enter 12%surcharge(.12 x[A+B)) S
(U)Technology Fee(5%of(AI) 1 $
TOTAL fees and surcharges(A through D): I $ '',7?e=
I
440-2500-J(4/1/2013/CON1)