HomeMy WebLinkAboutPermit Plumbing 2014-6-5 •
SPIUNGFIELD 225 Fifth St
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CITY OF SPRINGFIELD Springfield,OR 97477
' Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01228
www.springfeld-or.gov . permitcenter@springfield-or.gov
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PROJECT STATUS: Issued ISSUED: 06/05/2014 EXPIRES: 12/01/2014
STATUS DATE: 06/05/2014 APPLIED: 06/05/2014
SITE ADDRESS: 4340 ASTER ST,Springfield,OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702323105100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: replace 75'sewer pipe.-Private Side only •
OWNER: HOUSING AUTHORITY&URBAN Phone Number:
ADDRESS: 177 DAY ISLAND RD •
. EUGENE OR 97401
OWNER: L C COMMUNITY ACTION Phone Number:
ADDRESS: 177 DAY ISLAND RD
EUGENE OR 97401
OWNER: RENEWAL AGENCY OF LN COUNTY Phone Number:
ADDRESS: 177 DAY ISLAND RD .
_ EUGENE OR 97401
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor EMERALD EXCAVATING INC CCB 14173 07/14/2014 541-345-1505
• INSPECTIONS REQUIRED 1 '
Inspections
3200 Sanitary Sewer. Sanitary Sewer Line: Prior to filling trench and including required testing. .
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3999 Final Plumbing - Final Plumbing: When all plumbing work is complete.
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
gon 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.
?r1 c . krr.CC.. w��� 6/5 by • fo„,,,EN��t0 adoregon law requires• .
Owner or Cont ae!ef 6ignature " Date. in OA Cation Centert Thosehe Ore set forth
Utility .
THIS PERMIT SHALL EXPIRE IF THE WORK R .952-OOf-0010 throw are
. AUTHORIZED UNDER THIS PERMIT IS NOT 00a?in You may obtain •Copiesof OAR 952.0n,
COMMENCED OR IS ABANDONED FOR number foetCCenter. (Note: the telephone by
ANY 180 DAY PERIOD. Center is-1-Oregon Utility Notification •
800-332-2344),
Springfield Building Permit 6/5/2014 10:39:01AM. Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
- 225 Fifth St
`o E�oN • TRANSACTION RECEIPT Spnngfield,OR 97477 •
541-726-3753
811-SPR2014-01228
www.springfield-or.gcv 4340 ASTER ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2014001234 RECORD NO: 811SPR2014-01228 DATE:06/05/2014
DESCRIPTION i"r PM1 S4KeLr i LPL `fl:- _OACCOUNT;CODE/TRANSiCODE
,;� ; ,�;}iAMOU NT DUE t_;
Continuing Education Fee 224-00000-425606 2.50
Sanitary sewer 224-00000-425603 1005 85.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 - 10.20
Technology fee(5%of permit total) 100-00000-425605 2099 4.25
� TOTAL DUE: 101.95
PAYMEarlrYPE 'RAY.OR cases'Ea=d RsoR a �COMMENTB '"�� i ___ - AMOUNT PAID? . ' El
Credit Card EMERALD EXCAVATING INC 101.95
215073
TOTAL PAID: 101.95
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Plumbing Permit Application DEPARTMENT. USE ONLY:.
SPRINGFIELD * t v
", ^'.-6 174,g.4::9; 5-a r1 9 4 _.,.a ,+ t5. 9t:' €
DEITY OF SPRINGFIEL1-!..;`OREG.ON 1 Permit no.:5/ifZc Cl- ZZ°v
.i s::::,. 44 i".,:rr;sc ,.ik -,.--sr$ . ..• c. ,. aOEr' >'�fib.r' `.t r.+;v 'v:i:; r W. /
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 •FAX(541)726-3689 Date: G/ ' ' /y
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.
t:'L'OCAL't`GOVERNMENT _AP,PROVAL,' F ;;L F i W.! r fiF,EEtSCHEDULE, , , ;,!3 `.,
Zoning approval verified? 0 Yes ❑ No %Description , V'' �r}s° ' ,;. .c1(.4?' t ^Cost Total
.. a:. .,. a. .t Qty. 1`'`ea _r ` cost 0-:
Sanitation approval verified? ❑ Yes ❑No New residential
,;.CATEGORY OF.CONSTRUCTION to":;1 t e' 1 bathroom/1 kitchen(includes:first •
Residential ❑Government ❑ Commercial 100 feet of water/sewer lines, hose $268.00 $
bibs, ice maker, underfloor low-point
,JOBffSITEINFORMATION AND,:LOCATION`::. C.(1. drains and rain-drain packages)
Job site address: 434c As,--_,,e_ Sr 2 bathrooms/1 kitchen $420.00 $
City: e ',./32 I&(¢'i t<L/. State: ZIP: 3 bathrooms/I kitchen $494.00 $
It Each additional bathroom(over 3) $107.00 $
Reference: Taxlot.: Each additional kitchen(over 1) $107.00 $ ,
ri' // 1.,.; %: ��DESCRIPTIONt OFAW,ORKS t ";i;_1' 'W4.!. Residential fire sprinklers(includes plan review)
J G},.7 r•reyo-\ T'�.I,_-Z -IFE?u AC-C"C' I • 0 to 2,000 square feet $82.00 $
2,001 to 3,600 square feet $131.00 $
' ∎WS. `;m PROP,ERT.YgOWNER! Y,,:';;ye Iry , 3,601 to 7,200 square feet $196.00 $
1 1 C s A 7,201 square feet and greater $261.00 $ '
S
Name: V
FA Manufactured dwelling or pre-fab(circle one)
Address: 3 c0 , FA 12V t E`rJ - Connections to building sewer and
water supply $82.00 $
City:SPR I (rF (] State: o(z ZIP: q-PI 77 Commercial,industrial,and dwellings other than one-or
Phone:90-W.- 2S 2 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
exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line $85.00 $
Signature: Each fixture,appurtenance,and piping $21.00 $
' .. iS.CONTRACTOR4INSTALLATION . t't �,z`_,, Storm water retention/detention facility ty $21.00 $
Irrigation systems $21.00 $name: ;•rl' -L-i c .c Av/+n 4-/fr ruc .
Piping or private storm drainage
Address: '175 E "Al , S rn AVE. • systems exceeding the first 100 feet $21.00 $
City: ale-ENE State: t7C ZIP: 1.7y0 Z Specialty fixtures $21.00 $
ale-ENE
Reinspection(no.of hrs.x fee per hr.) $82.00 $
Phone:94 L 3t/' I So S- Fax: /} JgS_I BifcJ . Special requested inspections(no.of $82.00 $
E-mail: To de) .er@ c-7, ere-, lei exe . co--"-‘, hrs.x fee per hr.)
CCB license no.: ]•-1 I"13 • BCD license no.: Each additional inspection:(1) $82.00 $
iMedical'`as 1 m ';- t � 'r ,.. Minimum fee $
Plumbing license no.: (� t� / /7 g P P g r zar, .
Print name: 0.01e. ,.� t. 1- ..t 1 Enter value of installation and equipment$
/ •Enter fee based on installation and equipment value. $
Signature: d% ei /� . Kna ho-/ ' .1.4. .a` -'wA. PPLICANTtUSE;:.. ';t4i, i-7 , s
(A) Enter subtotal of above fees $
(Minimum Permit Fee$82.00)
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Technology Fee(5%of[A]) $
(E)Continuing Education Fee$2.50 $2.50
TOTAL fees and surcharges(A through E): $ /p/ 9 s
440-2500-1(5/212014/COM)