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Home My WebLink AboutPermit Plumbing 2014-08-21SPRINGFIELD -. 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 Phone: 541-726-3753 ORSGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01823 wmapdngfeld-acgov permitcenter@springrteld-or.gov PROJECT STATUS: Issued ISSUED: 0812112014 EXPIRES: 02/1612015 STATUS DATE: 08/21/2014 APPLIED: 08/2112014 SITE ADDRESS: 787 66TH ST, Springfield, OR 97478 SCOPE: Backflow Device ASSESOR'S PARCEL NO: 1702341102909 TYPE OF STRUCTURE: Residential -PROJEGT-DESCRIPTION,1nstatf-backflow-devic OWNER: BARTON RICHARD G Phone Number: ADDRESS: 787 66TH ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone FOUR SEASONS YARD MAINTENANCE LLC Landscape Contra 9178 05/31/2014 541-895-5242 INSPECTIONS REQUIRED Inspections 3620 Backflow Device Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. 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. Z1 COn r or Contracor Signature Date ATTr--NTION: Oregon law requires you to follow rules adopted by the Oregon Utility Nn Center. NotificatioThose rules are set forth OAR 952 001-0010 through OAR 952-001- 0090. You may obtain Copies of the rules by calling the center. (Note: the telephone nurnber for the Oregon Utility Notification Center is 1-800-332-2344), IIS PERMIT SHALL EXPIRE IF THE WORK I;ORIZED UNDER THIS PERMIT IS NOT FNCED OR IS ABANDONED FOR �0 DAY PERIOD. Springfield Building Permit 8/21/2014 1:18:47PM Page 1 of 1 SPRINGFIELD - CITY OF SPRINGFIELD �.. - 225 Fifth Sl �,, TRANSACTION RECEIPT Spdngfield,OR97477 �' OREGON 541-726-3753 L 811-SPR2014-01823 mm.springfeld-orgov 787 66TH ST permitcenter@spdngfield-ocgov RECEIPT NO: 2014001842 RECORD NO: 811-SPR2014-01823 DATE: 08/21/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Backflow preventer 224-00000-425603 1005 21.00 Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 61.00 Continuing Education Fee 224-00000-425606 2.50 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 9.84 Technology fee (5% of permit total) 100-00000-425605 2099 4.10 TOTAL DUE: 98.44 DAVA=MT.TVDP 1DAVr1D nASHIGD• nnnwl CRV r.nMMFIJTR AMOUNT-MD— Credit Card four seasons yard 98.44 09793G TOTAL PAID: 98.44 'k W2 Plumbing Permit Application 225 Fink Street ♦ Springfield, OR 97477 9PRINaFIELO DEPARTMENT USE ONLY 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 clays of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? ❑ Yes ❑ No Sanitation approval verified? ❑ Yes ❑ No CATEGORY OF :CONSTRUCTION ' Residential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION Job site address: $ +1_ S City: I _L State:� 7,201 square feet and greater Reference: 2— 3 (tt Taxlot.: 6'2,,90'3 DESCRIPTION OF WORK U (� Connections to building sewer and water supply PROPERTY TOWNER Name: $ Address: -h S' City:1e( State: ZIP:q'7 q,7 Phone I- Fax: E-mail: ---- — This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature: CONTRACTOR INSTALLATION Business name. $ Address: Q City: ft State: ZIP: t-/Zlo Phonal -26 I Fax: E-mail: Setrd t fYc icense no.: g BCD license no.: Plumbing license no.: Print name: Signature: 440-2500-J(5l21t20t4/COM) FEE SCHEDULE . Description Qty Cost Total ea. cost New residential I bathroom/I kitchen (includes: first I00jeet ofwater/sewer lines, hose §268.OD $ bibs, ice maker, underfloor low point drains and rain -drain oackaees) Each additional bathroom (over 3) $107.00 1 $ ch ad Eaditional kitchen (over t) 5107.00 $ 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 $ 7,201 square feet and greater $261.00 $ Manufactured dwelling or pre fab (circle one) Connections to building sewer and water supply $ $82.00 $ Commercial, industrial, and dwellings other than one- or two-family __ _ Minimum fee Each additional inspection: (1) $82.00 $ Each fixture 1 1 $21.00 1 $ 100' storm, sewer, water line $85.00 $ Each fixture, appurtenance, and piping—F $21.00 $ ' - Irrigation systesn3 $21.00 $ 'ping or private storm drainage "� s stems exceedin the first 100 feet $21.00 $ Specialty fixtures $21.00 $ Reinspection (no, of his. x fee per hr.) $82.00 $ Special requested inspections (no. of - hrs. x fee per hr.) $82.00 $ Each additional inspection: (1) $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 a yve, e $ (Minimum Permit ee$82.90) (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): 1 $ C e3yu