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HomeMy WebLinkAboutPermit Plumbing 2014-4-17 SPRINGFIELD 225 Fifth St '` ` CITY OF SPRINGFIELD Springfield,OR 97477 l.,441 Phone: 541-726-3753 `='-� OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00844 • www.springfield-or.gov pe rmitcenter @springfield-or.goy PROJECT STATUS: Issued ISSUED: 04/17/2014 EXPIRES: 10/14/2014 STATUS DATE: 04/17/2014 APPLIED: 04/17/2014 SITE ADDRESS: 3850 E 21ST AVE,Eugene,OR 97403 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1803031201300 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Sewer cap-Demo fire damaged house OWNER: THORIN RICHARD B TE Phone Number: ADDRESS: PO BOX 25558 EUGENE OR 97402 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OWNER CCB 000000 08/01/2025 General Contractor OWNER CCB 000000 08/01/2025 • INSPECTIONS REQUIRED 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. n • wner or Contractor Signature Date ATTENTION: Oregon law requires you to NOTICE: foiiow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK in 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 • oallin0 the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center Is 1.800.332.2344). • Springfield Building Permit 4117/2014 2:45.28PM Page 1-of 1 Plumbing Permit Application DEPARTMENT USE ONLY I • �+ c SPRINGFIELD--r+ GCS al: Ct' �7.P , �Q 'S .E , O .( ;ohs Permit no.: S/Li ' 0 /Z/ • _ i r / / , 225 Fifth Street • Springfield,OR 97477 • PIR54I)726-3753 • FAX(541)726-3689 a xA0 EGAN Date: C/j /7 /47 f I This permit is issued tinder 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/1 kitchen(includes:first ( 100 feet ofiratertsewer lines,hose 1 • Residential ❑Government ❑Commercial bibs. ice maker, underfloor low-point $262.00 $ JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) ] Job site address: eS /S6 C -2,e S% 2 bathrooms/1 kitchen $411.00 S i .3 bathrooms/I kitchen $483.00 $ °• City: r Stater-ZIP: 5 7 v� i Each additional bathroom(over 3) $104.50 $ Reference: Taxiot.: Each additional kitchen(over 1) $104.50 $ DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) ,N-- e411-1.— 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 $ /// 7.201 square feet and greater $255.00 $ Name: .f 4O / &0i n/ ; / Manufactured dwelling or pre-fah(circle one) i Address:47G/i3 y cl/cc— Connections to building sewer and I $80.00 $ i City: C=UG State supply r ZIP97y o t Commercial,industrial,and dwellings other than one-or Phones .2/F 75-5-�� / Fax: - - two-family j r E-mail: /2c tWorzi nJ ( I 4/1',� , ayfr— Minimum fez I $80.00 S This installation is being made on residential or farm property Each tisane I $21.00 S owned by me or 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 $ I CONTRACTOR'INSTALLATION Storm water retention/detention facility $21.00 I $ ! Business name: 77. iiJ ,4-tt r �NC irrigation systems I $21.00 $ r7-° `- Piping or private storm drainage $21,00 S Address: . 0 , , x 2 32 systems exceeding the first 100 feet City: �(J 6 State:.- Z1P:fine2 Specialty fi xtures $21.00 $ Reinspection(no of hrs.x fee per hr.) $80.00 S I Phone: /- %-7.9�yXf Fax: - - Special requested inspections(no.of $80.00 S t hrs.x fee per r.) E-mail: /lets-e._-e._ f h i CCB license no.: 7;-"-71 BCD license no.: Each additional inspection:(I)56v• $80.00 $7/5 Plumbing license no.: . Medical gas piping Minimum fee $ Print name: // k-,, .�.--,1��L C:, value of installation and equipment$_ [ �" ''`�1, Enter fee based on installation and equipment value. $ Signatue: \, APPLICANT USE F G/ (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) 2{-A i (B)Investigative fee(equal to[Al) $ U' ! (C)Enter 12%surcharge(.12 x[A+B]) S -!�O (DJ Technology Fee(5%of[A]) $ , ( per TOTAL fees and surcharges(A.through D): $ i , 1 440-2500){4 112013/COM) SPRINGFIELD - 1 CITY OF SPRINGFIELD 225 Fifth St • \-OREGON TRANSACTION RECEIPT Springfield,OR 97477 541-726-3753 811-S P R2014-00844 www.springfield-or.gov 3850 E 21ST AVE permitcenter©springfield-or.gov RECEIPT NO: 2014000846 RECORD NO: 811-SPR2014-00844 - DATE:04/17/2014 `DESCRIPTION _ _.,ACCOUNT CODE/TRANS CODE _. ......_,.AMOUNT;DUE 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 PAYMENT TYPE 1 PAYOR, CASHIER:CCARPENTER COMMENTS- AMOUNT PAID Credit Card THORIN RICHARD B TE 93.60 030269 TOTAL PAID: 93.60