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HomeMy WebLinkAboutPermit Plumbing 2014-4-30 A —a—. - 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 OREGON Building I Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00940 • www.springfield-ocgav permitcenter @springfield-or.gav • PROJECT STATUS: Issued ISSUED: 04/30/2014 EXPIRES: 10/27/2014 STATUS DATE: 04/30/2014 APPLIED: 04/29/2014 SITE ADDRESS: 1369 L ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703253306100 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace water line OWNER: LOWELL RUTH ELLEN Phone Number: - ADDRESS: 1369 L ST SPRINGFIELD OR 97477 • L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone • INSPECTIONS REQUIRED • Inspections 3315 Water Line 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. Owner or Contractor Signature Date • ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: • Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK 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 4/30/2014 8:02,43AM Page 1 of 1 • >PRINGFIELD -° CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 'r OREGON 541-726-3753 811-SPR2014-00940 • www 6pr9ngfie1CVr.gov 1369 L ST permitcenter @springfield-or.gov RECEIPT NO: 2014000951 RECORD NO:811-SPR2014-00940 DATE:04/30/2014 DESCRIPTION ACCOUNT CODEITRANS CODE. " AMOUNT DUE ' State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.02 Technology fee(5%of permit total) 100-00000-425605 2099. 4.18 Water Line 224-00000-425603 1005 83.50 TOTAL DUE: 97.70 LPAYMENT TYPE . i� PAYOR 'CASHIER:CCARPENTER-',,- COMMENTS :' >. .+ _ 'AMOUNTPAID'. :�' .:.j Credit Card DEBORAH STROCHLIC 97.70 01222P TOTAL PAID: 97.70 , Plumbing Permit Application DEPARTMENT USE ONLY " c it er u 4 d " rro % m'4g.-yy 7r :.rmtn SPRIN GFiaD 14 l ),4a r OA tPntp� " ") D' T . 'd S n S,e 1 ..+tie.: _' rl'eunnto._CN - 9 ({(9 k v rst"'.L '?'v +. Hof _} ..e,,,,t ` x twee 'mtp-t s r4:.: ,� I _..������� L Fifth Suva• Spn, ficid,OR 9747; • Pli(571)726-3:+ ♦ F\(i4l}_63689 .. ,OaeGON _ gale If 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 I Zoning approval verified? ❑ Yes ❑No i Description Q I COSI I Total ]— r -1- C,.- CnI — —Sanitation approval verified? ❑ Yes ❑ No ptvv residential JOB SITE CATEGORY OF CONSTRUCTION I ruhrodnrl kitchen g; hl lvs fi yr Residential Government tOD jeel ofS aler s we lines,lose $2620 3 ❑ ❑Commercial Vbs re maker. of io I oar o•; leTu 0 r _ INFORMATION AND LOCATION draim(ndrr-,r-rb iu packages') 1 Job site address: ' ;69 L 2_b throonts?I kitchen 41I 00 $ 1 5 City — State © ZIP: Q � 69thnoom>.t kitchen j S483.00 S -t ' — -- `-- Mach udivamaibathroom(over 3) I 3 Retc enCc �riJot —_-- ._._.. - Each a:Mid omit kitchen(over I) _ : $104.50 S _.. 1 DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) _...tri ( ( ?% 0 to 2 000 quare feel Sumo I S I 2.001 to 3,600 square feet i128.00 I S PROPERTY OWNER 3,601 10 7,200 square feet I $192.00 S I Name: �-;� t, 4 '01 square feet and wit greater I-. 5255.00 S ;�-t.{1{h� //C�a� '�Ll ll '<� Q�.SJy.11 G _-_ 11;unlf ietm ed dwelling nr p1'e-iab{circle one) Addass _ 1' 1_ c I W Z � I tT�� f t'onntthOns tit bolding �arcr and —__ City: �� � State Oe_ I Z1f c :1hOc at i supply S80.00 oe r S — - I Commercial,industrial,and dwellings other than one-or This s�1 5� 3_3c,3_�(i_fz„ ,Yn r,mil - -1 - -lit mum tee i J$0A0 3 i e�, (::tent fixture $29.00 r 5 installation is being made on residential or farm properly - I owned by me or a member of my immediate family, and is 1 Piisu II uuoas fees --- ._...----_...... _ exempt from licensing requirements under OAR 918-895-0020. 100 storm seamen :cater line /p 583.50 1 g' I Sig nature: Each fixture appurtenun e,and piping $21.00 $ F. CONTRACTOR INSTALLATION sunm water r retentiunki lentdm facility I 521,00 S I Business name Veer {t � G i::--- � tsins ---L �—• g21.0o b � �f - -'- 1 Smog or private storm drainage Address. t 090 g ct s stem sxc (ding the fist 100 feet 521.00 b AYSA Pr ? - ry—__ Phone: � S1 ate 1 ZIT' 9350({ `.r'twr d- fixture,: $21.00 a _ Iv:insmecucn{no of hS z tee per In.) � $80.00 s I 5q.— — - Special requested inspections(no.01' 580.00 S E-mail: (/r� hr>_s lee per hr.) _C_P,\- _ (Packed 2.eA u+rr —._ . It'.t,E' license nn I 2_ 113(D a cn..c nos Each edditnsmd inspection:IJ) SOO.00 $ Plumbing license n0_: - �'Og Medical gas piping Minimum fee $ IPrint n net. SS - Emu value.of installation omi equipment$ . ":>4)ea_cx --..S--�a. 1, ._ _.— .--- //''.T��/-) 6nhi lit t is d on insr dl lion and equipment eatne, I 5 Signature: l� — --— -------- 1 APPLICANT USE (A) Filler subtotal of troy lase i (rxiinunm t Permit t u$80.(10) 13)Investigative fee(equal to[A]) I S I 1 (C)Enter 12%surcharge(.12 x lA Rfl : /� — 1 rD) I chn lee∎ Fee (5 , of IA]) 5ef 1 j LI TOTAL fees and surcharges(A through (4): I $ • •