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Permits expire if work is not started within I suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has final land -use approval. Signature: Date; This project has DEQ approval. Signature: Date: Zoning approval verified: ❑ Yes ❑ No Property is within flood plain: ❑ Yes ❑ No CATEGORY OF CONSTRUCTION -esidentiat ❑ Government ❑Commercial JOB SITE INFORMATION AND LOCATION Job site address: Ori 'eine r City: SI'fLD State: 042 ZIP: Subdivision: I Lot no.: Reference: 70Te-1711Taxlot: PROPERTY OWNER Name: 14pr74r2LH Address: 64M 2` - City: State: ZIP: Phone: Fax: - - E-mail: Building Owner or Owner's agent authorizing this application: Sign here: ❑ This installation is being made on residential orfaim property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. CONTRACTOR INSTALLATIONI Business name: PTG Address: 5GWozgG /-�-_+7 City: VL State: d/L ZIP:yy2 Phone_Yl( -57a- 92,V Fax: - - E-mail:Jry46T CCB license no.: �p p Print name: Signature: 3. Plan review fees SQB-CONTRACTOR INFORMATION Name CCBLicense N Phone Number Electrical (c) Subtotal of fees above (3a and 3b): S Plumbing (a) Seismic fee, 1%(.01 x permit fee [2a]): Mechanical (b) Technology fee, 5%(.05 x permit fee[2a]): $ I DEPARTMENT USE ONLY, Permit no.: 9,K / Date: if work is FEE SCHEDULE 1. Valuation information _..... �. (a) Job description: / Occupancy v Construction type: Square feet: -- Costper square foot: - - - - - Other information: Type of Heat: Energy Path: ❑ new ❑alteration ❑ addition 1*i (b) Foundation -only permit? ❑ Yes ❑ No Total valuation: $ �� 2..Building fees / (a) Permit fee (use valuation table): $ / (b) Investigative fee (equal to [2a]): $ (c) Reinspection ($ per hour): (number of hours x fee per hour) $ (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ (e) Subtotal of fees above (2a through 2d): $ 3. Plan review fees (a) Plan review (65%x permit fee [2a]): $ (b) Fire and life safety (40%x permit fee [2a]): $ (c) Subtotal of fees above (3a and 3b): S 4. Miscellaneous fees (a) Seismic fee, 1%(.01 x permit fee [2a]): $ (b) Technology fee, 5%(.05 x permit fee[2a]): $ (e) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (2e+3c+4a+4b+4c): $ 1% SPRINGFIELD - 225 Fifth St - CITY OF SPRINGFIELD Springfield,OR97477 Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 641-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01798 vww.spdngfield-or.gov permitcenter@springfield-orgov PROJECT STATUS: Issued ISSUED: 08/18/2014 EXPIRES: 02/13/2015 STATUS DATE: 08/18/2014 APPLIED: 08/18/2014 SITE ADDRESS: 908 KELLY BLVD, Springfield, OR 97477 SCOPE: Fire Damage ASSESOR'S PARCEL NO: 1703341104400 TYPE OF STRUCTURE: Residential - PROJECTDESCRIPTION: -P- Fire damage repairs - - - - - OWNER: LAMARCHE JOAN ELIZABETH Phone Number: ADDRESS: 908 KELLY BLVD SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone General Contractor PJ MARTINEZ INC CCB 108907 08/10/2016 541-510-8200 SURRETTS PLUMBING (PB) Plumbing Coi 20-321PB 07/01/2017 541-741-3553 INSPECTIONS REQUIRED Inspections 3170 Underfloor Plumbing Underfloor Plumbing: Prior to insulation or decking. . 3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing. 3999 Final Plumbing Final Plumbing: When all plumbing work is complete. 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 constructioK/ wner or Contractor Signature Date NOTICE: 1-1-I1S PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. 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). Springfield Building Permit 8/18/2014 1:37:08PM Page 1 0f 1 SPRINGFIELD.._-_. OREGON w .springfieldocgov TRANSACTION RECEIPT 811-SPR2014-01798 908 KELLY BLVD CITY OF SPRINGFIELD 225 Fifth St Springfeld,OR 97477 541-726-3753 permitcenter@spdngfield-or.gov RECEIPT NO: 2014001801 RECORD NO: 811-SPR2014.01798 DATE: 08/18/2014 Continuing Education Fee 224-00000-425606 2.50 Minimum Plumbing Fee (Three or Fewer Fixtures) 224-00000-425603 1057 82.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 9.84 Technology fee (6% of permit total) 100-00000-425605 2099 4.10 590129 TOTAL PAID: 98.44 Plumbing DEPARTMENT USE ONLY SPRINGFIELD t... .... 3 . 79� Y Permitno.: Date: 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 Zoning approval verified? ❑ Yes ❑ No Sanitation approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION Job site address: JWXcLL �//Q City: 5rAb State: e;< ZIP: jam/ Reference: %D3 `Jgf/ Taxlot.: yCpv DESCRIPTION. OF WORK 2,001 to 3,600 square feet $131.00 $ 3,601 to 7,200 square feet $196.00 $ PROPERTY OWNER Name: / 4nlAeeN£ Address: City: State: ZIP: Phone: 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: 9L bV6 Address: . e P6 City: eo 6e_ &-t IState: D/L ZIP: fn2 Phone:g4t-S70- BZoo Fax: E-mail: y L o Z—/ CCB license no.: /p fj r)� BCD license no.: Plumbing license no.: Print name: Signature: 440-2500-1 (5/21/2014/COM) FEE SCHEDULE Description Qty Cost ea. Total cost - New residential 1 bathroom/l kitchen (includes. -first 100feet ofwater/sewer lines, hose $268.00 $ bibs, ice maker, underfloor low point drains and rain -drain packages) 2 bathrooms/1 kitchen $420.00 $ 3 bathrooms/1 kitchen $494.00 $ Each additional bathroom (over 3) $107.00 $ Each additional kitchen (over 1) $107.00 $ Residential Tiresprinklers includes pillan 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 $ 7,201 square feet and greater $261.00 $ Manufactured dwelling or pre -fab circle one) Connections to building sewer and_FT water supply $82,00 $ Commercial, industrial, and dwellings other than one- or two-family Minimum fee $82.00 $ Each fixture $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 $ Irrigation systems $21.00 $ Piping or private storm drainage _Ustems exceedingthe first 100 feet $21.00 $ Specialty fixtures $21.00 $ Reinspection (no. of hrs. 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. $ °'APPLICANT 'USE (A) Enter subtotal of above fees $ (Minimum Permit Fee $82.00) 2— (13) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+13]) $ G% (D) Technology Fee (5% of [A]) $ Y (E) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through E): $ I