HomeMy WebLinkAboutPermit Plumbing 2014-6-25 SPRINGFIELD - - 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
`�� Phone: 541-726-3753
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OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01369
www.springfield-or.gay permitcenter @ springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/25/2014 EXPIRES: 12/21/2014
STATUS DATE: 06/25/2014 APPLIED: 06/25/2014
SITE ADDRESS: 944 Q ST,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703261300101 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Connect to city SS and decommissioning tank
OWNER: ARCIGA JOSE I Phone Number:
ADDRESS: 944 Q ST
SPRINGFIELD OR 97477
OWNER: HUERTA FABIOLA Phone Number:
ADDRESS: 944 Q ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER GCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
7170 Septic Tank Abandonment
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.
ifill(Ael"
er or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility • •f OTI CE:
Notification Center. Those rules are set forth ;'HIS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- �,UTHORIZEDUNDERTHISPERMITISNOT
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone OMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 6/25/2014 2:59:40PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
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` i TRANSACTION RECEIPT 225 Fifth St
9pnng eld,OR 97477
541-726-3753
811-5 P R2014-01369 .
www.spnngfieldor.gav 944 Q ST permitcenter @springfield-or.gov
RECEIPT NO: 2014001374 RECORD NO:811-SPR2014-01369 DATE:06/25/2014
jel�aTo1;71uIdCol�i ;I i` A- d°i3- t,."fit ;TA-^ '4' `,ACCOUNT'CODEITRANS o o Ly; ,t--AMOUNT DUE- 'e •
Continuing Education Fee 224-00000-425606 2.50
Sanitary sewer . 224-00000-425603 1005 85.00
Sanitary sewer-each additional 100 feet or portion of 224-00000-425603 1005 21.00
Sewer cap/septic tank demolition 224-00000-425603 1005 82.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 22.56.
Technology fee(5%of permit total) 100-00000-425605 2099 9.40
TOTAL DUE: 222.46
PAYENTr.TYPE P.AYOR cashilrii,etIbN R `COMMENII AMOUNTdPAID
Check HUERTA FABIOLA 222.46
1439
TOTAL PAID: 222.46
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Plumbing Permit Application ypgryOR1ELC DEPARTMENTUSE ONLY
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'-. CITY OF SPRINGFIELD OREGON A' Pemitno.:$7 ti — 136, ?
M ` }.3^ rF,,,4;::A5..,:-`iN.x9./%±R ik:b? -.•'sfiM •. n' a4.' ."t'' + '.. - S ,
225 Fifth Street•Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3639 Date: 6"/2.-c / ( 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.
;'.`. ` '• '.:)'LOCALcGOVERNMENT,APPROVAL v . . , ‘, ��x;EEE"SCHEDULE `*'r
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Zoning approval verified? ❑ Yes ❑No Descnption ? u``.. rt+O, Qty . r- t r'.;_.t l
Sanitation approval verified? ❑ Yes ❑No New residential
r !,'CATEGORY OF,CONSTRUCTION a° _'f,„w , , I bathroom/1 kitchen(includes:first
❑
100 feet of water/sewer lines, hose
Residential 0
❑Commercial $268.00 $
bibs, ice maker, underfloor low-point
wr JOB iSITE"INFORMATION'AND;':LOCATIONx 'z,n drains and rain-drain packages)
Job site address: 2 bathrooms/1 kitchen $420.00 $
3 bathrooms/] kitchen $494.00 $City Q -I J /t•e/J State: OY ZIPq 2/ 7
Each additional bathroom(over 3) $107.00 $
Reference: Taxlot.: Each additional kitchen(over I) 5107.00 $
:f•;'r r r x y1DECRIPT.ION'N OFe+WORK„A'"'ii:t `fit;+? Residential fire sprinklers(includes plan review)
0 to 2,000 square feet $82.00 $
2,001 to 3,600 square feet $131.00 $
v. . k a„sp4 e:ZIP, OP.ERTYiOWNER'fc--'t'` e, Sr:r�;<ti 3,601 to 7,200 square feet $196.00 $
Name: Ed /0 �C( "I vE Y7Gf 7,201 square feet and greater $261.00 $
Manufactured dwelling or pre-tab(circle one)
Address: gip-7 Connections to building sewer and
water supply $82.00 $
City: /' y w! I l�e%/ State: 7y ZIP:op Commercial,industrial,and dwellings other than one-or
Phone: -Ili -/ 'i'(/-(, 'di( Fax: - = two-family
E-mail:ca- ,,,,g (ph{-1001(,t/0/R1 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 fro lic sin re. it men . under OAR 918-695-0020. 100' storm,sewer,water line kaU $85.00 3k,
—'9 Signature d Each fixture,appurtenance,and piping $21.00 $
”? ` e ,t; CONTRA Ii OR=INSTALLATION s ?' ,,,t., Storm water retention/detention facility $21.00 $
Business name: fa D /0/4 IS/e Yi „w 9• Irrigation systems $21.00 $q -_/7 4) systems exceeding g storm
the first drainage
Address: / t systems exceeding the first 100 feet $21.00 $
City: �h-(/'7 '(� State: ZIP:97 y7'7 Specialty fixtures $21.00 $
5 J/p Reinspection(no.of hrs.x fee per hr.) $82.00 $
Phone.S-t1 - 3tf/t�g`�1 Fax. - - Special requested inspections(no.of $82 00 $
E-mail: la a t//&aG4 40 A.cop,----- hrs.x fee per hr.) p j(. 777
CCB license no.: BCD license no.: Each additional inspection:(1�'`7”' / $82.00 $ Iry
Plumbing license no iMedieal'gas piping ,;-,,- ,„£,,, ,:o. Minimum fee $
Print name:
Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature: r :.` rAPPLICANT;,USE x z. 1 `,-q
(A) Enter subtotal of above fees
(Minimum Permit Fee$82.00) /2./
$
(B)Investigative fee(equal to[A]) $ t
Ste
(C)Enter 12%surcharge(.12 x[A+B]) $_12
(D)Technology Fee(5%of[Al) $9 yj
(E)Continuing Education Fee$2.50 $( 50
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TOTAL fees and surcharges(A through E): $277
440-2500-1(5/21/2014/COM)