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HomeMy WebLinkAboutPermit Plumbing 2014-5-23 SPRINGFIELD 225 Fifth St _........ ......ai CITY OF SPRINGFIELD Springfield,OR 97477 : .(\t Phone: 541-726-3753 '° OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01136 www.springfield-or.gov permitcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/23/2014 EXPIRES: 11/18/2014 STATUS DATE: 05/23/2014 APPLIED: 05/23/2014 SITE ADDRESS: 1750 MAIN ST,Springfield,OR 97477 SCOPE: Backflow Device ASSESOR'S PARCEL NO: 1703363101600 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Install backflow device OWNER: J&D FISHER LLC Phone Number: ADDRESS: 1249 S 41ST PL SPRINGFIELD OR 97478 _ CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor PACIFIC PLUMBING 8 ROOTER INC CCB 199420 03/26/2015 541-337-4701 INSPECTIONS REQUIRED - Inspections 3620 Backflow Device Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. 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 pro y, and the approved set of plans will remain on the site at all times during construction. /n Owner or Con actor Signature Date p11 t° cites Y pte9°n iaW <e Ote9p°Ut{o h (TE�O�: o tedaosth A wtolesad P etch o{�0�?e�by too C0e0 ikets 0ocou9 (}T10E M1t SHpL�ETH PE�M�S Npj ton$001952 iethetelePhOne F obtain°oP 1H\S Pt?'Z0 UNp 1S ABANDO EpR macente<. (NotUtilitY N°Ufication tyle p0nu bet to<the•O 800.332 23g4) coM EN PER M CE app. Cow o PTV 180 DA Springfield Building Permit i 5/23/2014 10:13:59AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD • l l J+.� 225 Fifth St E. ,,__`« TRANSACTION RECEIPT Springfield,OR 97477 't. r OREGON • 541-726-3753 811-SPR2014-01136 www.springfield-or.gov 1750 MAIN ST permitcenter©springfield-or.gov RECEIPT NO: 2014001134 RECORD NO:811-SPR2014-01136 DATE:05/23/2014 DESCRIPTION .__ _ : <_ _ _ _ _ . _ __ ______ ._ ___ .ACCOUNT_CODE/TRANS CODE:- _; _,AMOUNT DUE,:4 Backflow preventer 224-00000-425603 1005 21.00 Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00 Continuing Education Fee 224-00000-425E 2.50 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: 96.10 I PAYMENT TYPE ' PAYOR- CASHIER:DeowLsinic° • ` COMMENTS „ ' ' AMOUNT PAID _ Credit Card joshua edwards 96.10 06984c TOTAL PAID: 96.10 • • Plumbing Permit Application DEPARTMENT USE ONLY SPRINGFIELD ` CITY OF SPRINGFIELD, OREGON Permit no.: t�d S • alt 225 Fifth Street • Springfield.OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: /Z 1 f!/ 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 ea. ' .cost Sanitation approval verified? ❑ Yes ❑No New residential ' CATEGORY OF CONSTRUCTION_ I bathroom/I kitchen(includes:first El Residential LI Government p'Eommercial 100 feet ofworer/sewer lines, hose $268.00 $ bibs. ice maker, underfloor low point JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) Job site address: /7,j-a 44y2..d 5T- 2 bathrooms/I kitchen $420.00 $ City: S'P2h.GFieco State: 15t2. ZIP: 97v77 3 bathrooms/I kitchen $494.00 $ �7 Each additional bathroom(over 3) _ $107.00 $ Reference: ' /b33 6 1 Taxlot.: Q get, additional kitchen(over 1) $107.00 $ DESCRIPTION OF WORK Residential fire sprinklers(includes plan review) /A/STALL ,tf( J g//CKpcOa OE'ice 0 to 2,000 square feet $82.00 $ 2, 3. . $ PROPERTY OWNER 3,601 001 to to 7,200 600 square square feet feet $196$131.00 00 $ Name: 7.201 square feet and greater $261.00 $ Out( /r/CvCCLS r ISNE2 Manufactured dwelling or pre-fab(circle one) Address: /75-0 ,24A""1- Connections to building sewer and $82.00 $ water supply City: .5f71-t40(,P61.O State: ZIP: 97777 Commercial,industrial,and dwellings other than one-or Phone 5V-70- /2g0 Fax5i/( -7f/7- />t9-2 two-family E-mail: Ca✓T A 5j ,dilly, Minimum fee $82.00 $ 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 exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line $85.00 $ Signature: Each fixture,appurtenance,and piping $21.00 $ CONTRACTOR INSTALLATION . Storm water retention/detention facility $21.00 - $ Business name: Nf1 tC t C t�Ct/;+.,B�,.[c, etior � Irrigation systems $21.00 _ $ TT Piping or private storm drainage $21.00 $ Address: 77 612 EF.veurer/ 4 o6 systems exceeding the first 100 feet City: eil ocelve State: cR— ZIP: y�"ioy Specialty fixtures $21.00 $ Reinspection(no.of hrs.x fee per hr.) $82.00 $ Phone977-0s- 5 ',& Fax: - - Special requested inspections(no.of $82.00 $ E-mail: hrs.x fee per hr.) CCB license no.: /i 'c&o BCD license no.: Each additional inspection:(I) $82.00 $ Plumbing license no.: R,98-Z Medical gas piping . Minimum fee $ �. E �-dS Enter value of installation and equipment$ Print name: �5-/ Enter fee based on installation and equipment value. $ Signature: y.0°'".-P . Cf : APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee$82.00) (13) Investigative fee(equal to[A]) (C)Enter 12%surcharge(.12 x[A+B]) (D)Technology Fee(5%of[A]) l• $ (E)Continuing Education Fee$2.50 $2.50 TOTAL fees and surcharges(A through E): $ 7v G/ft 440-2500-J(5/21/2014/C0M)