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Home My WebLink AboutPermit Plumbing 2014-09-19SPRINGFIELD # r _F < 4 OREGON www. spri ngfield-ovgov CITY OF SPRINGFIELD Building / Commercial Permit PERMIT NO: 811-SPR2014-02041 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perm itcenter@spdngfield-or.gov PROJECT STATUS: Issued ISSUED: 09/19/2014 EXPIRES: 03/18/2015 STATUS DATE: 09/19/2014 APPLIED: 09/19/2014 SITE ADDRESS: 610 S 2ND ST, Springfield, OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703353300500 TYPE OF STRUCTURE: Industrial PROJECT DESCRIPTION: Sewer line- 250' OWNER: MOMENTIVE SPECIALTY CHEMICALS INC ADDRESS: 180 E BROAD ST Phone Number: COLUMBUS OH 43215 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor H & J CONSTRUCTION INC CCB 88084 12/31/2015 541-689-5863 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). PER�t4iT SI-IAI_L EXPIRE IF THE WORT( r)RIZED UNDER THIS PERMIT ISNOT ENCEO OR IS ABANDONED FOR it PERIOD- Springfield Building Permit 9/19/2014 1:36:17PM Page 1 of 1 SPRINGFIELD -' CITY OF SPRINGFIELD t ---- TRANSACTION RECEIPT 225 Pfllh St Spdngfield,OR97477 -"' OREGON 811 -SP R2014-02041 541-726-3753 www.springfield-ocgov 610 S 2ND ST permits nler@springfield-ocgov RECEIPT NO: 2014002090 RECORD NO: 811-SPR2014.02041 DATE: 09/19/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE' " Continuing Education Fee 224-00000-425606 2.50 Sanitary sewer 224-00000-425603 1005 85.00 Sanitary sewer - each additional 100 feet or portion of 224-00000-425603 1005 42.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 15.24 Technology fee (5% of permit total) 100-00000-425605 2099 6.35 TOTAL DUE: 151.09 'PAYMENT TYPE PAYOR CASHIER: CCAPPENTER - COMMENTS AMOUNT PAID Credit Card MOMENTIVE SPECIALTY CHEMICAL 151.09 043430 INC TOTAL PAID: 151.09 r) Plumbing Permit Application SPRINGFIELD I n Em 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 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 I tqCommercial JOB SITE INFORMATION AND LOCATION: Job site address: (el b 5- ZbiO City:t P t�C� State: QIZ, ZIP:�� Reference: Taxlot.: DESCRIPTION OF l(ttWORK 7` 1 O -F - CC. -1- Int S\TE- Connections to building sewer and water supply PROPERTY OWNER Name: Ai I C/M 5 Address: 11,:5 Pj - D I City: State:0 (Z ZIPF114Tq PhonedF } FaxS - l —3cqfo E-mail: fy\2&_.e_1,i4iiJ2. u>en This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt fro i ing requ, en ts un er OAR 918.695-0020. Signature: CONTRACTOR INSTALLATION Business name:) o t Address:2 O t City: State: oft I ZIP: ? Phone: Fax: E-mail: CCB license no.: BCD license no.: Plumbing license no.: Print name: L Signature: 440-2500-J (5/21 /2014/COM) FEE SCHEDULE Description Qty east Total st New residential. I bathroom/l kitchen (includes: first 100feet ofwaler/sewer lines, hose $266.00 $ bibs, ice maker, underfloor low point drains and rain -drain packages) 2 bathrooms/1 kitchen $420.00 $ 3 bathrooms/1 kitchen $494.00 S Each additional bathroom (over 3) $107.00 -$ Each additional kitchen (over 1) $107.00 $ Residential tiresprinklers includes pian review 0 to 2,000 square feet $62.00 $ 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.OD $ Manufactured dwelling or pre -tab (circle one) Connections to building sewer and water supply $82.00 $ Commercial, industrial, and dwellings other than one. or two-family Minimum fee $82.00 1 $ Each fixture 1 1 $21.00 $ Miscellaneous fees Alt 100' storm, sewer, water line $86.00 $ 5 �"- Each fixture, appurtenance, and piping $21.00 $ Storm water retention/detention facility $21.00 $ Irrigation systems $21.00 $ Piping or private storm drainage systems exceedingthe first 100 feet $21.OD $ Specialty fixtures $21.00 $ Reinspection (no. of hrs. x fee per hr.) $82.00 $ Special requested inspections (no. of hrs. x fee per hr.) $g2,00 $ 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. $ APALICANT, USE (A) Enter subtotal of above fees $ (Minimum Permit Fee $82.00) 7 (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ (D) Technology Fee (50/o of [A]) $ (E) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through E): $ UY