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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— / /sf- 1 , "he .-&t.% �_xz ;.'ront ,..ns.t.il#W .,, 'm" i aw-s ,�.. .at ft . �� 7 225 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)