HomeMy WebLinkAboutPermit Plumbing 2014-08-15L
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Nv r .spmtgfield-or.gov
PROJECT STATUS: Issued
CITY OF SPRINGFIELD
Building / Commercial Permit
PERMIT NO: 811-SPR2014-01784
STATUS DATE: 08/15/2014
SITE ADDRESS: 235 Q ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703263102105
OWNER: HERON BAY PARTNERS LLC
ADDRESS: 8141 SE 44TH ST
225 Fifth Sl
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 641-726-3676
pe rmitcenler@spri ngfield-or.gov
ISSUED: 08/15/2014 EXPIRES: 02/10/2015
APPLIED: 08/15/2014
SCOPE: Plumbing Only
TYPE OF STRUCTURE: Commercial
Phone Number:
MERCER ISLAND WA 98040
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor BERNARD PETERSEN INC CCB 93126 08/23/2015 541-343-9339
Inspections
3200 Sanitary Sewer
INSPECTIONS REQUIRED
Sanitary Sewer Line: Prior to filling trench and including required testing.
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.
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800.332-2344).
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Springfield Building Permit 8/15/2014 4:37:06PM Page 1 of 1
SPRI�OR
CITY OF SPRINGFIELD
1225 Fifth Sl
TRANSACTION RECEIPTSp ng eId,OR87477
541-726-3753
ecor+ 811-SPR2014-01784
wenv.springfield-or.gov 235 Q ST permilcenter@spdngrield-or.gov
RECEIPT NO: 2014001793 RECORD NO: 811-SPR2014.01784 DATE: 08/15/2014
DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE
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
Credit Card Bernard Peterson
05072C
101.95
TOTAL PAID: 101.95
Plumbing Permit Application
TFIELDkQREGON
DEPARTMENT USE ONLY
Permit no.:}j I I - L - ZAP (-(
Date:,Z1S 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 war]( is not started within 180 days of issuance or if work is suspended for 180 days. aoi1 IRVI rf)tltiil you to
lit
LOCAL GOVERNMENT APPROVAL locth
440-2500-1 (5/21/2014/COM)
New rdi''d S eta - obtain (;'P v., . ' ,r lone
I00feeroJS��e �u &sji on l tllily tdotificati n
tniPF' Tiro ,y$ 68.00 $
bibs, ice nib54M )V _ aor l 1 2-2
drains and rain-drd' ct�a��s)
Zoning approval verified? ❑ Yes ❑ No
Sanitation approval verified? ❑ Yes ❑ No
CATEGORY OF CONSTRUCTION
❑ Residential
❑ Government
❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address:]
City:
State: 2
ZIP:
Reference:
Taxlot.:
DESCRIPTION OF WORK
I a �C
$196.00 $
PROPERTY OWNER z
Name:
Addres
City:
State
ZIP, -
Phone:
x. awl S
E-mail: 1� S
This installation is being madi on residential or farm property
owned by me or a member ?fftny immediate family, and isq2���
exempt from licensing requir bnts under OAR 918-695-0.O2j i
Signature: WR -
CONTRACTOR INSTALLATION
Business a e: [ 2 j r 411
Address:
City: 2 I
State:(
ZIP:'g-?C
Phone:
Fax:
E-mail:
CCB license no.: 0 1
BCD license no.:
Plumbing license no.:
Print name:
Signature:
440-2500-1 (5/21/2014/COM)
New rdi''d S eta - obtain (;'P v., . ' ,r lone
I00feeroJS��e �u &sji on l tllily tdotificati n
tniPF' Tiro ,y$ 68.00 $
bibs, ice nib54M )V _ aor l 1 2-2
drains and rain-drd' ct�a��s)
2 bathrooms/1 kitchen
$420.00 $
3 bathrooms/1 kitchen
$494.00 $
Each additional bathroom (over 3)
$107.00 $
Each additional kitchen (over t)
$107.00 $
Residential firesprinklers includes pilan
review
0 to 2,000 square feet
$82.00 $
2,001 to 3,600 square feet
$131.00 $
3,601 to 7,200 square feet
$196.00 $
ar
7,201 sque feet and greater
$261.00 $
t;onnecnons to buuamg sewer ana
water supply
$
$82.00
$
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee
(D) Technology Fee (5% of [A])
$82.00
$
Each fixture
TOTAL fees and surcharges (A through E):
$21.00
$
Miscellaneous fees
100' storm, sewer, water line
$85.00
$
Each fixture, appurtenance, and piping
$21.00
$
Storm water retention/detention facility
$21.00
$
Piping or private storm drainage' I $21.00 I $
vefrmc rVbAbl lhmf 1. nrcf inn rcpt
his.xfeaper'k/:)'J NrCED OR IS f RIADONEi9`P13a a
Each additionallap elIor{? 0)101), $82.00 $
Medical gas piping Minimum fee $
Enter value of installation and equipment $ _.
Enter fee based on installation and equipment value. $
(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])
$ C
(D) Technology Fee (5% of [A])
$
(E) Continuing Education Fee $2.50
$2.50
TOTAL fees and surcharges (A through E):
$ %