HomeMy WebLinkAboutPermit Plumbing 2014-6-13 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfeld,OR 97477
-tett _ Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01285
www.springfield-or.gov permitcenter @springfeld-or.gov
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PROJECT STATUS: Issued ISSUED: 06/13/2014 EXPIRES: 12/09/2014
STATUS DATE: 06/13/2014 APPLIED: 06/13/2014
SITE ADDRESS: 1460 G ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703362204601 " TYPE OF STRUCTURE: Commercial
.PROJECT DESCRIPTION: P- Fourth floor renovationReplace 15 tub showers
OWNER: MCKENZIE WILLAMETTE REGIONAL MEDICAL CTR Phone Number:
ADDRESS: 14400 METCALF AVE •
OVERLAND PARK KS 66223
CONTRACTOR INFORMATION
Contractor Type Contractor Name • Lic Type Lic No Lic Exp Phone
Plumbing Contractor OREGON CASCADE PLUMBING 8.HEATING INC COB 127 11/25/2014 503-588-0355
INSPECTIONS REQUIRED
Inspections • _
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing. r
3999 Final Plumbing Final Plumbing: When all plumbing work is complete.
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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
construn/ ''y t /gi
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Owne or ontractor Signature Date
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ATTENTION: Oregon law requires you to
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NOTICE: follow rules adopted by the Oregon Utility .
THIS PERMIT SHALL EXPIRE IF THE WORK• Notification Center. Those rules are set forth .
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone
ANY 180 DAY PERIOD. number for the Oregon Utility Notification
Center is 1-800-832-2344). •
Springfield Building Permit 6/13/2014 8.33:59AM Page 1 of 1
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SPRINGFIELD -- CITY OF SPRINGFIELD
itt-�'• --�ry�,...;,,_,,, , 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
OROREGON 541-726-3753
811-SPR2014-01285
www.springfield-or.goy 1460 G ST permitcenter @springkeld-ar.gov
RECEIPT NO: 2014001291 RECORD NO:811-SPR2014-01285 - DATE:06/13/2014
DESCRIPTION 2*22.t' ?,s`r`J""*�`._ 3 -E`k'47: a:. -sACCOUNTCODEITRANSrari]o} ;:F_sc_dC AAMOUNTRDUE far
Technology.fee(5%of permit total) 100-00000-425605 2099 2.50
TOTAL DUE 2.50
ESJ P.AYMENT TYPE P.AYOR cASNie' ': 'i!rn' COMMENTc'i) "0LI NTg'PAID
Cash Mike Harm 2.50
• TOTAL PAID: 2.50
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
OR I TRANSACTION RECEIPT Spnngfield,OR97477
'k. OREGON 541-726-3753
811-SPR2014-01285
•www.spnngfiefdor.gov 1460 G ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2014001290 RECORD NO:811SPR2014-01285. DATE:06/13/2014
DESCRIPTION 7.r.W? ra~ ,-7: •,rr_iN-,■ri +�'_`'�a'e ACCOUNT:CODERR/CNSTCODE rtii=n2. AMOUNT
Bathtub 224-00000-425603 1005 315.00
Continuing Education Fee 224-00000-425606 2.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 37.80
Technology fee(5%of permit total) 100-00000-425605 2099 13.25
,. TOTAL DUE: 368.55
lei l AY,MENTI/RfliE.- B,AY,OR ISweRTNtal COMMENTS AMO.INT_P.;41D +" ""tar it
Check OREGON CASCADE PLUMBING & 368.55
052956 HEATING INC
TOTAL PAID: 368.55
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(RI d12 - 4/ 2L.
• Plumbing Permit Application DEPARTMENT USE ONLY
n-,. ;; .. • SPRINGFIELD r I
CITY OF SPRINGFIELD; OREGON „. t Permit no 5feZ0(N-/Z 85--- i
225 Fifth Street•Springfield,OR 97477 • PH(541)726-3733 • FAX(541)726-3689 r . OREGON Dale: 6// 3//y
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This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits 7
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 f
Sanitation approval verified? ❑Yes ❑No New residential
CATEGORY OF CONSTRUCTION 1 hathroom+t kitchen(includes:firs)
100 feet of o aler sewer lines,hose
❑ Residential El Government El Commercial bibs, ice maker, underfloor low-point $262.00 $
JOB SITE INFORMATION AND LOCATION drains and rain-drain packages)
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Job site address:
I y60 6-4 54-^e-e...-+ 2 bathrooms/I kitchen $411.00 S
City: fPJri sn FICa l State: OR.. p ZIP: 7 977 3 bathroons/I kitchen $483.00 $ r
/ Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over 1) $104.50 $ I
DESCRIPTION OF WORK Residential fire sprinklers(includes plan review)
Re,P/aie- /5 4-u6 3'loLlu5 0 to 2,000 square feet $80.00 $ j
2,001 to 3,600 square feet $128.00 $
PROPERTY OWNER gel / 3,601 to 7,200 square feet 5192.00 $
Name: /14&14 Zit L.i I I/G f�-'F - gel S/�I Tti / 7,201 square feet and greater 5255.00 $ [
Manufactured dwelling or pre-tab(circle one)
Address: /t x` Connections to building sewer and t
water supply $80.00 $ ?
City: rl `- State: Ii `- ZIP: h " rcia
Commercial,industrial,and dwellings other than one-or
Phone: - - Fax: - - two-family j
E-mail: Minimum fee $80.00 $ t
Each fixture , 1 5 $21.00 $315 i
'Fhis installation is being made on residential or farm property
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 $83.50 $ I
Signature: Each fixture,appurtenance.and piping $21.00 $ i
CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $
Irrigation systems $21.00 $
Business name: °re o� (4s-C4 is (oi„, ,„ E is
J' 7 '71 / Piping or private storm drainage $21.00 $
Address: ]7aQ 27h L 54-, 5E systems exceeding the first 100 feet
City: SA I,e_h State: 0 ZIP: q.-)30,2_ Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $80.00 $
Phone:56 J-5'¢g- a 3 ss Fax: - - Special requested inspections(no.of
E-mail: hrs.x fee per hr.) $80.00 $
�rahK . oyc_mart. e, orejah tsrAL•com
CCB license no.: 121 BCD license no.: Zit- 33 Pa Each additional inspection:(I) $80.00 $
Plumbing license no.: 50 I 3-P Medical gas piping Minimum fee $
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Print name: Enter value of installation and equipment$ 1
k eU l M 1(�Pir Enter lee based on installation and equipment value. $
Signature: �� G� --,
APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00) 316
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ 37, yG '
(D)Technology Fee(5%of[A]) $ Ka 71
TOTAL fees and surcharges(A through D): $ 3 60. Sf
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440-2500-1(411/2013/COM)