HomeMy WebLinkAboutPermit Plumbing 2014-4-22 •
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-SPR2014-00868
www.springfeldor.gov - permitcenteraspdngfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/22/2014 EXPIRES: 10/19/2014
STATUS DATE: 04/22/2014 APPLIED: 04/22/2014
SITE ADDRESS: 542 33RD ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702312404900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION; Hot Water Heater
OWNER: LABORN TIMOTHY J Phone Number: •
ADDRESS: 542 33ND ST •
SPRINGFIELD OR 97478
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CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor BAXTER PLUMBING&ROOTER INC CCB 194034 06/14/2015 541-334-6696
INSPECTIONS REQUIRED I
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 of the property,and the approved set of plans will remain on the site at all times during
construction. J
1/ 07--.),- /47/
'owner or Gntra Signature Date
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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 0090. You may obtain copies of the rules by
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 4/22/2014 8:20:54AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spnngfield,OR 97477
OREGON 541-726-3753
811-SPR2014-00868
www.spnngfield-or.gov 542 33RD ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000877 RECORD NO:811-SPR2014-00868 DATE:04/22/2014
Iel �ol;ilatigk _E , s,;t, rr f,'. .. ` F " - r ACCOUNT CODER C-RANS CODE Y=';iAMOUNT€DUE .,
Minimum Plumbing Fee(Three or Fewer Fixtures) +� -) 224-00000-425603 1057 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
s..PAYMENTrTYPE 4' i AYOR`4..C ASHIER:JLARSON L,,.::;_"-t,' s=.COMMENTS A t, —=u.s,.�-:AMOUNT PAID-,
Credit Card BAXTER PLUMBING &ROOTER INC 93.60
012612
TOTAL PAID: 93.60
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Plumbing Permit Application DEPARTMENT USE ONLY i
SPRINGFIELD
5/2Za -a te
fO ,SPRLNGEIE ;.OREGO 1 r , '8x Peilnit no.: I
[ n JLZ� f.
223 Fifth Street • Springfield,OR 97477• P11(541)726-3753 •FA%(S41)726-7639 Date: / / Y s
OREGON
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This permit is issued ender 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. eat coal
Sanitation approval verified? ❑ Yes ❑No New residential
CATEGORY OF CONSTRUCTION I bathroom/1 kitchen(includes:first i
Residential I El ❑Commercial /00 feet oj,rarer,'seicer lines, hose $262.00 $ e
bibs. ice maker, a idetyloor Ion-point Si
JOB SITE INFORMATION`'AND LOCATION ‘ drains and rain-drain packages)
Job site address:9-7 73 2 bathrooms;1 kitchen $411.00 $
}� .Z St i1�J r,pt7 I7 .i bathrooms/) kitchen $483.00 $ I
Cit•. �� State: j-f�f "LI'
` Each additional bathroom(over 3) $104.50 $
Refere Ice: Taxlot.: Each additional kitchen(over I) i
( ) $104.50 $
�� DESCRIPTION OF WORK / ' Residential fire sprinklers(includes plan review)
LN 515(7 !"r"JT tdc7l a V- Al-Lec -i & 1/ 0 to 2,000 square feet $80.00 $
2.001 to 3.600 square feet $128.00 $
PROPERTY OWNER 3.601 to 7,200 square feet $192.00 $ ■
Name: !/� 7,201 square feet and greater $255.00 $
T�4'7 L B 5e� Pl Manufactured dwelling or pre-fab(circle one)
y
Address: -c( Connections to building sewer and {
City: State: ZIP: water supply $80.00 $ t
Commercial,industrial,and dwellings other than one-or i
Phone: - - Fax: - - two-family
Minimum fez $80.00 $ {
E-mail: i
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 i
exempt from licensing requirements under OAR 918-695-0020. 100' storm.sewer,water line $83.50 I $ 1
Signature: Each fixture,appurtenance,and piping $21.00 $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $
Business name: �-f.,Ir- riok,,, Fj y 6'I e, t (
ruination systems $21.00 $
�9 l Piping or private stonn drainage
Addressee g..c it / systems exceeding the first 100 feet $21.00 $
City/ym i Vic. State:OA ZIP:77,6 7 Specialty fixtures $21.00 S
c�/ Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone 6‘n S� t
��f C 7r; Fax: Special requested inspections(no.of $80.00 S I
E-mail: i/•(J Lvjyt a ,a At 4,--,_ hrs.x fee pet hr.) _ 1
CCB license no/7965C/ BCD license n•..: Each additional inspection:(1) 580.00 $
Plumbing license no.: p,' /ok3 Medical gas piping Minimum fee $ !
I
Print name/' c / 547-yo 1-c— Enter value of installation and equipment$— I
Enter fee based on installation and equipment value. $ f
Signatwe: APPLICANT USE V
(A) Enter subtotal of above fees $ ? g 4
(Minimum Permit Fee$80.00)
(6)Investigative fee(equal to[A)) S
(C)Enter 12%surcharge(.12 x[A+BJ) $ 4 i),
(D)Technology Fee(5%of[AD $ 4 p,
TOTAL fees and surcharges(A through D): $ 1j.i
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440-2500-3(4nrz013/M M)