HomeMy WebLinkAboutPermit Plumbing 2014-09-17SPRINGFIELD __-
225 Fifth St
'
CITY OF SPRINGFIELD
Springfield,OR97477
1
Phone: 541-726-3753
r
oaeco"
Building / Commercial Permit
Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-02009
w .spdngfieldocgov
permitcenler@spdngfield- r.gov
PROJECT STATUS: Issued ISSUED: 0911712014 EXPIRES: 03/16/2015
STATUS DATE: 09/17/2014 APPLIED: 09/17/2014
SITE ADDRESS: 2163 SHADYLANE DR, Springfield, OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703262203861 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION: 20' water and waste lines, 1 backflow
OWNER: WILLAMALANE PARK & RECREATION DISTRICT Phone Number:
ADDRESS: 250 S 32ND ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lie No Lic Exp Phone
Plumbing Contractor HARVEY & PRICE CO CCB 77 10/31/2014 541-746-1621
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
3315 Water Line
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.
Owner or Contractor Signature
I I fIS NA/IIT SAI-L t -VINE IF'1-Ii[ WORK
1illlflONl/GD UNDER TI11S PERMIT IS NOT
f- ifl9Ef�ICED 01"I IS ABANDONED FON
Ai!1' 1 u0 DAY PERIOD.
CL X11
Date
Al- 1 NTION: Oregon law requires you to
fo':10W 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).
Spdngfeld Building Permit 9/17!2014 10:47:12AM Page 1 of 1
SPRINGFIELD- - CITY OF SPRINGFIELD
6
TRANSACTION RECEIPT Spd gfield,OR97477
-'^ OREGON 541-726-3753
811-SPR2014-02009
vrvnv.springfield�r.gov 2163 SHADYLANE DR permitcenler@spdngfield-ocgov
RECEIPT NO: 2014002052
RECORD NO: 811-SPR2014-02009
DATE: 09/17/2014
fi
Backflow preventer
224-00000-425603
1005
21.00
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
22.92
Technology fee (5% of permit total)
100-00000-425605
2099
9.55
Water Line
224-00000-425603
1005
85.00
TOTAL DUE: 225.97
036194
TOTAL PAID: 225.97
Plumbing Permit Application DEPARTMENT USE ONLY
;, _�.,. � tir.��.,ti� ,v;-��✓. c �- � •._... � SP1tINGPIELD
[� `�� °�-�[ [k � �f��"" ��§ e �+�� P •. Permit no.:
225 Fifth Street 4 Springfield, Olt 97477 e 1 H(541)726-3753 ♦ FA\(540726-3689 „.OREGON Date:
This permit is issued under OAR 918-780-0060. Permits are issued c oly to the person at, contractor doing tire work. Permits
expire if worl( 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
U60verliniclit
I ❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: Y i Ve.
City: rt State. (jam
I ZIP:
Reference: Taxlot.:
Each additional bathroom (over 3)
DESCRIPTION OF WORK
d 3
a
PROPERTY OWNER
Name: ! �,q
Address: 2 SCD 32!^rk
City:
Slate:CYY"
I ZIP. 71/77
Phone: �j — ax: - -
E-mail:
This installation is being made oil residential or farnn 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: Y✓ .{.,. Lp Co
Address: aoS N
City: Stale: ZIP: °� %�03
Phones -
E-mail• 5 0- 10 ut,h Ii0.tV PI Ce.ony
CCB license lie,: •#'7 7 1 BCD recuse no.:
Plumbing license no.: oZO —•30
_
Print name: 5
Signature:
Qto" ' 20 Wcje,,_ W (ticce {
- `w'3 q u ) 3/4,
FEE SCHEDULE
Descri tion
I
Qtv
Cost
ea.
Total
cost
New residential
I bathroondl kitchen (indndes: Jir•.si
IOQ(eet o%watersewer lines, Lose
bibs, ice maker. andedloo)- low -paint
drains mrcl rain -ronin packages)
5262,00 $
2 bathrooms/I kitchen
$411.00 S
3 bathroonrstl kitchen
$483.00 S
Each additional bathroom (over 3)
$104.60 $
Each additional kitchen (over 1)
$104.60 $
Residential Hre s nrinlders includes don review)
0 to 2,000 square feet
$80.00 $
2,001 to 3,600 squoc feet
5128.00 $
3,601 to 7,200 square feet
$102.00 $
7,201 square feet and greater
\]anufactured dwelling or pro -fab (chicle one)
Connections to building sewer and
water supply
$80.00
5
Conimereinl, todusu•Inl, and dwellings other than one- or
two-family
Mininuim lee
$80.00
$
Each fixture
Miscellaneous fees
100' stonnn, sewer, water line
. 0
S
Each fixture, appurtenance, and piping
$21.00
S
Storm water re(ention/detention lacility
$7.1.00
$
irrigation systems
$21.00
S
Piping or private storm drainage
Systems exceedingthe first 100 feet
821.00
$
Specialty fixtures
$21.00
S
Reinspection (no. of firs. x fee per hr.)
$80.00
S
Special requested inspections (no. of
firs. x fee per hr.)
$80,00
S
rich additional Inspection: (1)
$80.00
$
Medical gas piping
Minimum fee
$
Enter value of installation and equipment $ _.
Enter fee based on installation and equipment value. S
APPLICANT USE 5-0
(A) Enter subtotal of above fees S G
(ttlintmum Permit Fee $80.00)
(B) Investigative fee (equal to [r1]) 5
(C) Enter 12% surcharge (.12 x [A+e]) $ 22 y
(D) Technology Fee. (G°6 of [A])
TOTAL fees mrd surcharges (A lbrough D): 5
440-2;00-) (411120131COxO
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