HomeMy WebLinkAboutPermit Plumbing 2014-7-11 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD
Springfield,OR 97477
___Lstdoi
�, Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01505
www.springfield-or.gov permitcenter @springfieldor.gov
PROJECT STATUS: Issued ISSUED: 07/11/2014 EXPIRES: 01/06/2015
STATUS DATE: 07/11/2014 APPLIED: 07/11/2014
SITE ADDRESS: 1360 MOHAWK BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703253310000 - TYPE OF STRUCTURE: Commercial
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PROJECT DESCRIPTION: Water lines •
OWNER: PRIME PROPERTY INVESTMENTS LLC ' .. Phone Number:
ADDRESS: 1360 MOHAWK BLVD
, , SPRINGFIELD OR 97477 ,
CONTRACTOR INFORMATION ` .
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor DRAIN RAIDER ROOTER SERVICE INC CCB 191218 06/29/2016 541-338-8848
• INSPECTIONS REQUIRED
Inspections
3315 Water Line
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 lo -ted at the front .; . e property, and the approved set of plans will remain on the site at all times during •
constructi� '
' Sad— _ -- 7// //I/
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•i r or Contractor Signature Date
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TTEN T ION Oregon law requires you to
NOTICE' toilor+ rules adopted by the Oregon Utility forth .
in OAR 952-00 nter. Those through OAR 9 set 001-
THIS PERMIT UNDER EXPIRE IF THE WORK in OAR 952 001-0010n copies of the rules by
AUTHORIZED UNDER THIS PERMIT IS NOT p090. •You may
COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone
number for the Oregon Utility Notification
ANY 180 DAY PERIOD. Center is 1 800 332 2344)•
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Springfield Building Permit 7/11/2014 2:38:50PM Page 1 of 1
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SPRINGFIELD"' CITY OF SPRINGFIELD
225 Fifth St
"`O EGON TRANSACTION RECEIPT Spnngfield,OR 97477
541-726-3753
811-SPR2014-01505
wvwspnngfield-or.gov 1360 MOHAWK BLVD permitcenter @spnngfield-or.gov
RECEIPT NO: 2014001505 • RECORD NO:811SPR2014-01505 DATE:07/11/2014
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jol�.�'H;71;Allre7 __v,-: m•�.�ACCOUNT CODE/TiRANS CODE F��`ri` (AMOUNT DUE':
Continuing Education Fee 224-00000-425606 2.50
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
Water Line 224-00000-425603 1005 85.00
TOTAL DUE: 101.95
TFAVMENTSTNRE P.AYORY cnsw so a. . COMMENTS _. 'AMOUNT PAIO
Credit Card DRAIN RAIDER ROOTER SERVICE It 101.95
948496
TOTAL PAID: 101.95
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Plumbing Permit Application DEPARTMENT USE ONLY
SPFIIIGPIELG
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rt- SRNGIELDEGON': CITY,OF F9 S U—/b S-0
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 7//l/f 47
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.
;:LOCAL GOVERNMENT APPROVAL;",. " ' '
r�FEE,SCHEDULE F � �
p r' ..' , j'Cost _Total
Zoning approval verified. 0 ❑ No � 'Descrlptlon�; � Y ? ;lv,= > Qty ? ea [ncost,°;
Sanitation approval verified? ❑ Yes ❑No New residential
' :CATEGORY"OF'.:CONSTRUCTION $,};-, L 1 bathroom/1 kitchen(includes:first
100 feet of water/sewer lines, hose
❑Residential ❑Government Commercial bibs, ice maker,"underfloor low point $268.00 $
• atJOB'SITE <INFORMATION AND LOCATION,, A- drains and rain-drain packages)
13 o li BI JA_ 2 bathrooms/I kitchen $420.00 $
Job site address: r-
/7 �-7 3 bathrooms/1 kitchen $494.00 $
city:SPrlril4r Ci State: OZ ZIP:92 / /
Each additional bathroom(over 3) $107.00 $
Reference: I Taxlot.: Each additional kitchen(over 1) $107.00 $
ntr` n:.IDESCRIPTION;:E:rWORK` ;r t ' i`
'` ) /� ', Residential fire sprinklers(includes plan review)
IRttd ganw?ei o✓c— I kr r ,�s 1)4 L 0 to 2,000 square feet $82.00 $
�/]j�' r 2,001 to 3,600 square feet $131.00 $
,`'• rJ :P O ERTY:!OWN ER:tj tiLR ,;3;' "K' ` 3,601 to 7,200 square feet $196.00 $
Name:
L 7,201 square feet and greater $261.00 $
�a c <'� - 4 Manufactured dwelling or pre-fab(circle one)
Address: 11/4360 µ,(o 11_U Connections to building sewer and $82.00 $
City: s---pc . q,707 water supply
Ci State: ���✓/// ZIP: Commercial,industrial,and dwellings other than one-or
Phone911 339 6o1/ 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 • .70 $85.00 $ 7-5"
Signature: Each fixture,appurtenance,and piping $21.00 $
CONTRACTOR]INSTALLATION;y1a„ .13x !'1, Storm water retention/detention facility $21.00 $
T,, v \ �cj�? �C ,rI Irrigation systems $21.00 $
Business name: lJ�f4tw1 S
> Piping or private storm drainage $21.00 $
Address:AS-'2V as p2 / systems exceeding the first 100 feet
City: "de State:0R 1 ZIP:9yl/o/ Specialty fixtures $21.00 $
Reinspection(no.of hrs.x fee per hr.) $82.00 $
Phone 3 g. DQ�qj�� Fax:sei/_ - Special requested inspections(no.of $82.00 $
E-mail: re 2.1 raiwde.r AO eon.Ca s, . /Jen— hrs.xfee per hr.)
CCB license no.: i9/�8 BCD license no.: Each additional inspection:(1) $82.00 $
Plumbing license no.: ?ain Medical gas pith- 4.-tt kkk s ' .` z,t Minimum fee $
t Enter value of installation and equipment$—
4
Print name: $/Z , -- ------
Enter fee based on installation and equipment value. $
Signature: -C• tee„i1 Z , €s°,�WA
_s,. .a„_� �6 �APP,LICANTtiUSES=t;rtntt,nSZ}A
(A) Enter subtotal of above fees y"�
(Minimum Permit Fee$82.00) $ 0 >
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ /0
(D)Technology Fee(5%of[A]) $ err L
(E)Continuing Education Fee$2.50 $2.50
-TOTAL fees and surcharges(A through E): $ V-
440-2500-1(5/21/2014/COM)
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