HomeMy WebLinkAboutPermit Plumbing 2014-11-28 •
SPRINGFIELD - - 1
.t 225 Fifth St
{ CITY OF SPRINGFIELD 225 Fi th St R 97477
*`OdEGON Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01188
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/02/2014 EXPIRES: 11/28/2014
STATUS DATE: 06/02/2014 APPLIED: 06/02/2014
SITE ADDRESS: 1977 BONNIE LN,Springfield,OR 97477 SCOPE: Backflow Device
ASSESOR'S PARCEL NO: 1703251211300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Backflow device
OWNER: ' HUFFMAN GARY D&JOLENE Phone Number:
ADDRESS: 1977 BONNIE LN
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
II
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
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 property, and the approved set of plans will remain on the site at all times during
construction.
1 - a skid 4 — o� 96 /','
Owner or Contractor Signature Date
• ATTENTION: Oregon law requires you to
NOTICE' follow rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set 0
; iin OAR 952-001-0010 through OAR 952-001 01-
-
AUTHORIZED UNDER THIS PERMIT IS NOT , :0090. You may obtain copies of the rules by
COMMENCED OR IS ABANDONED FOR i. . (calling the center, (Note:the telephone
ANY 180 DAY PERIOD. a• snumber for the Oregon Utility Notification
•
Center is 1-800-332-2344).
Springfield Building Permit 6/2/2014 11:09:35AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
A
kx,,a, „..,sg., s' 225 Fifth St
TRANSACTION RECEIPT 225 Fifiel d,OR97477
OREGON 541-726-3753
811-SPR2014-01188
www.springfield-or.gov 1977 BONNIE LN permitcenter@springfield-or.gov
RECEIPT NO: 2014001194 RECORD NO: 811-SPR2014-01188 DATE:06/02/2014
DESCRIPTION_`w__ '., _ ;ACCOUNT CODE/TRANS CODE. ;`_L. AMOUNT DUE
Continuing Education Fee 224-00000-425E 2.50
Minimum Plumbing Fee(Three or Fewer Fixtures) 224-00000-425603 1057 82.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
L,.PAYMENTlYPE____PAY,OR__CASHIER.SCARPENTER__ r COMMENTS - ' AMOUNT PAID
Credit Card _ HUFFMAN GARY D&JOLENE 98.44
312090
TOTAL PAID: 98.44
•
•
Plumbing Permit Application " DEPARTMENT'USE'ONLY '- ',
4 y� w 44 y� +n SPNING-IELO Ott '
'5 fi+ ; f ✓.f'a •".$1 MF a1�P aA :}MY.S tJPt Ptt it tJ
z CliTYOF SPRINGFIELD OREGON,, w L,t` ` Permit no.: r IY— /
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: (/L
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.
i', LOCALuGOYERNMENT LAPP ROVAL , „ `r mot”„ . " L FEEiSCHEDULE', *,1 , . r '
Zoning approval verified? 111 Yes ❑ No n,. 3 ' �s'' y =Cost Total "s Deserlptlo ` ' Qt { •
... . ._,,,,_ .., rsi.0 ,-4. . ea _, . :,cost
::.
Sanitation approval verified? ❑ Yes ❑No New residential
":CATEGORY;OF'UCONSTRUCTION a° ;_”, I bathroom/I kitchen(includes:first
.�71 Residential ❑Government ❑Commercial
100 bibs, ice maker,water/sewer lines, hose $268.00 $
S�' _ bibs, ice maker, underfloor low point
7 JOB':+SITE-':INFORMATION AND, LOCATION' + ,' drains and rain-drain packages)
Job site address:/ q 7'7 e NA// . LN. 2 bathrooms/1 kitchen $420.00 $
3 bathrooms/1 kitchen $494.00 $
City:9A r)✓n e
/ (J State:Qt ZIP:r 7Y7 7
rr r Each additional bathroom(over 3) $107.00 $
Reference: Taxlot.: -Each additional kitchen(over 1) $107.00 $
t° r';�SDESCRIPTION,=OF ,WORK r„- 47IY ; , Residential fire sprinklers(includes plan review)
v A<- l'.P(.— LAW 1 L�.J A /-P fJ 0 to 2,000 square feet $82.00 $
r-eJ G /�s 2,001 to 3,600 square feet $131.00 $
is, 't.. ;,f(PROPERTY,' OWNER '_e;-t"`s i,:'rm-,'5' : 3,601 to 7,200 square feet $196.00 $
Name:atR p, duiFM A 7,201'square feet and greater $261.00 $
Manufactured dwelling or pre-tab(circle one)
Address: igri 7 7 L?o..ui_"�, i-x/, Connections to building sewer and $82.00 $
CitY: r,v fie) State:^nn ZIP:97s 77 water supply
(lP !/ (l'` Commercial,industrial,and dwellings other than one-or
Phone.5 -'( it 47o gigs Fax: - - two-family
E-mail: 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
—1 exempt from nsing requirements un er OAR 918-695-0020. 100' storm,sewer,water line $85.00 $
Signs ��J .(5. l2 Each fixture,appurtenance,and piping $21.00 $
e xCONT1yR�ACTOR'.IN TALL ION , , y; Storm water retention/detention facility $21.00 $
Business name: CLCJ,A.' j C--- 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.) $82.00 $
Phone: - - Fax. - - Special requested inspections(no.of
E-mail: hrs x fee per hr.) $82.00 $
CCB license no.: BCD license no.: Each additional inspection:(I) $82.00 $
Plumbing license no.: :-Medial gas piping"1-'a.,•11 r re. rp Minimum fee $
Print name:
Enter value of installation and equipment$
Enter fee based on installation and equipment value. $
Signature: 4 i 'A r _ ` `galitLICAN USE (;' `i. ,k'± v
(A) Enter subtotal of above fees $w p0
(Minimum Permit Fee$82.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ C/ s+.0
(D)Technology Fee(5%of[A]) $ N ro
(E)Continuing Education Fee$2.50 $2.50
TOTAL fees and surcharges(A through E): $ if ti LIL
440-2500-1(5/21/2014/C0M)