HomeMy WebLinkAboutPermit Plumbing 2014-5-12 SPRINGFIELD 225 Fifth,St
1, --- -:�r CITY OF SPRINGFIELD Springfield,OR 97477
-� ` i Phone: 541-726-3753
OREGON
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01045
www.springfield-or,gov perm itcenter @springtieltl-or.gov
PROJECT STATUS: Issued ISSUED: 05/12/2014 EXPIRES: 11/07/2014
STATUS DATE: 05/12/2014 APPLIED: 05/12/2014
SITE ADDRESS: 715 10TH ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703351106600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace sewer line .
OWNER: TENDICK SHIRLEY J&PERRY B Phone Number:
ADDRESS: 715 10TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor JENCOURT ENVIRONMENTAL SERVICES LLC COB 182531 06/11/2014 541-689-1711
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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 he property, and the approved set'of plans will remain on the site at all times during
construct
.L.....,____-------------3/ 51/ 2-A
Owner or Contractor Signature Date V
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK
rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
COMMENCED OR IS ABANDONED FOR in OAR 952-001-0010 through OAR 952.001-
•
AUTHORIZED UNDER THIS PERMIT IS NOT
ANY 180 DAY PERIOD. 0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
• Center is 1-800-332.2344),
Springfield Building Permit 5/12/2014 1:53.55PM • Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
OREGON TRANSACTION RECEIPT 225 Fifth St
SpringfielOR 97477
811-SPR2014-01045 541-726-3753
www 4pr-169641d-or goy 715 10TH ST pe-nitcenter@springfieFdar.gov
RECEIPT NO: 2014001030 RECORD NO: 811-SPR2014-01045 DATE:05/12/2014
,DESCRIPTION , ACCOUNTCODE/TRANS CODE:. AMOUNT DUE
Sanitary sewer 224-00000-425603 1005 83.50
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
TOTAL DUE: 97.70
PAYMENT TYPE PAYOR CASHIER:CCARPENTER COMMENTS-. . AMOUNT PAID
.
Credit Card David Cossey 97.70
08200d
TOTAL PAID: 97.70
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Plumbing Permit Application DEPARTMENT USE ONLY
t ,�. SPRINGFIEiD-i ]
II-TY{E3 `.� ING 1[EL: T;® I GQ> -- w� > Pennitno.: S/�/- /O�/S
225 Fifth Street • Springfield,DE 97477• PH(541)726-3733 •FAX(541)726-3689 08EGOH Date: 57/..2-/ I
t
. 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 riot started within 180 days of issuance or if work is suspended for 180 days. i
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 bathrooni/1 kitchen(includes:fins! I
100 Jeer of uater sewer lines, hose
❑.Residential ❑Government ❑Commercial $262.00 $ 1
bibs, ice maker. undeoloor lowponn
JOB SITE INFO ATION AND LOCATION dranuandrain-drain packages)
Job site ad�d(rless: �Y$ , S4- 2 bathrooms'I kitchen $411,00 ,f i
City: Sc State:QC 'ZIPq�i� 3 bathrooms/1 kitchen $483.00 $
Each additional bathroom(over 3) $104.50 $ i
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $ I
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
.IT"l yt 41.- 0 to 2,000 square feet $80.00 $
Pi e 2,001 to 3.600 square feet $126.00 $ i
-PROPERTY OWNER 3.601 to 7.200 square feet $192.00 $
i
Name: ,��„,. pppp -1-' 1,� 7.201 square feet and greater $256.00 S', �t-!� \e V�VC - ` Manufactured dwelling or pre-fab(circle one)
Address: Sa.tr Connections to building sewer and I i
City: State: ZIP:
water supply $80.00 $
Commercial,industrial,and dwellings other than one-or t
Phone: - - ) Fax: - - two-family
E-mail: Minimum fee $80.00 $
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 z
exempt from licensing requirements under OAR 918-695-0020. 100 storm,sewer,water line Ve I $83.50 I $�,.�
Signature: Each fixture,appurtenance,and piping $21.00 I $
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 I $
Business name: se, ooA-ems./ Irrigation systems i $21.00 $
N + t z Piping or private storm drainage $21.00 S
Address:t--�-*t2 � t S u kU ® `l�^� systems cxceedine the first 100 feet
City: �..T` Lt State '� ZIP:: N'AY� Specialty fixtures $21.00 S
Reinspection(no.of hrs.x fee per hr.) $80.00 $ I
Phones [{o — [ ( Fax: - - Special requested inspections(no.of t
E-mail: hrs.x fee per hr.) $80.00 $
I
CCB license no.:lSaS3 I BCD license no.: Each additional inspection:(I) $80.00 $
Plumbing license no.: y Medical gas piping Minimum fee S I
QA
Print name: (kis' 1>ned) Enter value of installation and equipment$ . [
Enter fee based on installation and equipment value. $
Signature._ .//e a _ - APPLICANT USE
- (A) Enter subtotal of above fees $ cr:1
(Minimum Permit Fee$80.00)
(B)Investigative fee(equal to[A]) S
(C)Enter 12%surcharge(.12 x[A+B]) $/'042
, (D)Technology Fee(5%of[A)) $ t(
TOTAL fees and surcharges(A through D): $ 1�s------- '
i
i
440-2500-J(4/1/2013/COM)
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