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Home My WebLink AboutPermit Plumbing 2014-4-21 ,SPRINGFIELD • 225 Fifth St - 6"kCITY OF SPRINGFIELD Springfield,OR 97477 EGa Phone: 541-726-3753 ORON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00861 vmw.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued . ISSUED: 04/21/2014 EXPIRES: 10/18/2014 STATUS DATE: 04/21/2014 APPLIED: 04/21/2014 SITE ADDRESS: 4390 SMITH WAY,Springfield,OR 97478 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702322401400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 3 Fixutures • • OWNER: LONG DAVID F Phone Number: ADDRESS: 4390.SMITH WAY SPRINGFIELD OR 97478 CONTRACTOR INFORMATION - Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER CCB 000000 , 08/01/2025 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 of the property,and the approved set of plans will remain on the site at all times during construction. . • Q.,. ..gaik_ 30.„.„j. Owner or Contractor Signature Date. • • ATTENTION: Oregon law requires you to . follow rules adopted by the Oregon Utility ' THIS T IPERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone number for the Oregon Utility Notification ANY 180 DAY PERIOD. Center is 1-800-332-2344). Springfield Building Permit • 4/21/2014 10:03:33AM Page 1 of 1 • SPRINGFIELD - CITY OF SPRINGFIELD 225 Fifth St � ' . TRANSACTION RECEIPT Spnnggeld,OR97477 ETA‘".OREGON 541-726-3753 811-SPR2014-00861 www.springfleld-ar.gov 4390 SMITH WAY permitcentergspringfield-ar.gov RECEIPT NO: 2014000869 RECORD NO:811-SPR2014.00861 DATE:04/21/2014 O E_=e', t-"„ etea-,t,.;a :gait_`!.7-...' t •CCOUNTCODELTRANSICODE ,aAMOUNTDUE;.`..: 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 €' p.AY,MET PME PAYOR cgswER::ccARP riFF COIAMENTS `nnAMOUNT--PAID . Credit Card LONG DAVID F 93.60 722067 TOTAL PAID: 93.60 • Plumbing Permit Application DEPARTMENT USE ONLY SPRINGFIELD CUM Off acj3I OZTI [w.�B0 0ItED®N g � Permit no.:20.4a y — '-�-(J-� / _ 1lx `/ [ 225 Fifth Street •Spnngfield,OR 97477• PH(541)726-3713 • FAX(541)726-3689 OREGON Date: / Z�//G/ 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 Sanitation approval verified? (0 Yes residential Yes ❑No ea. cost CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes:first 100 feet ofwater/sewer litres.lose EResidentiai ❑Government ❑Commercial Gibs, ice ranker, underfloor/ow-point $262.00 $ JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) 2 bathrooms/I kitchen $411.00 $ �' ) Job site address: 14,351,0 , �(, tilt 3 bathrooms/1 kitchen $483.00 $ City: ,1"," fie, State: ZIP: 17'i /V // J Each additional bathroom(over 3) $104.50 $ Reference: Taxlot.: Each additional kitchen(over I) $104.50 $ DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) 1` ee AO�f - f-ii h a U�Nr5 0 to 2,000 square feet $80.00 $ e/Pa Cr 0 bit Ale S 09 A2 Z ,('pa k 2,001 to 3,600 square feet $128.00 $ a-E PROPERTY OWNER 3,601 to 7,200 square feet $192.00 $ Name: Y�7UrC� �Z 7.201 square feet and greater $255.00 $ r ,.c/, Manufactured dwelling or pre-fab(circle one) Address: G/3ya ,S/4,/4 &eel Connections to building sewer and $80.00 $ /�� / water supply City: sh,/ `-y, a State:/7c ZIP:979i7f Commercial,industrial,and dwellings other than one-or Phone:51/4 - - 7$Y two-family 3 Fax: - - Y E-mail: Minimum fee $80.00 $ >P[oa,y 6�6-Y-Hu , corv, 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 exempt from licen ing requirements under OAR 918-695-0020. 100' storm,sewer,water line $83.50 $ l Signature: °Ltd. Each fixture.appurtenance,and piping 3 $21.00 ' $ CONTRACTOR INST CATION Storm water retention/detention facility $21.00 $ Business name: Irrigation systems $21.00 $ Piping or private storm drainage $21.00 $ Address: systems exceeding the first 100 feet City: State: ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of E-mail: hrs.x fee per hr.) $80.00 $ CCB license no.: BCD license no.: Each additional inspection:(I) $80.00 $ Plumbing license no.: Medical gas piping Minimum fee $ Print name: Enter value of installation and equipment$ Enter fee based on installation and equipment value. $ Signature: APPLICANT USE •(A) Enter subtotal of above fees • (Minimum Permit Fee$80.00) $ (B)Investigative fee(equal to IA]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ (D)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through D): $ 9' 1 440-2500-1(4/1/2013/C0M) Property Owner Statement • Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: III own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. - • I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. >O4 G-CwG- Print Name of Permit Applicant #I it L-/ 2l— /c Signature of Permit Applicant Date • • • Permit#: o Address: ;f x -7 €;: a l.. Yar r.• • Issued by: Date: $59 • This Copy for Permit Offices