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Home My WebLink AboutPermit Plumbing 2014-09-30SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 Vv i Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-02108 v .spdngfieldocgov permitcenter@spdngfield-oc9ov PROJECT STATUS: Issued ISSUED: 09/30/2014 EXPIRES: 03/29/2015 STATUS DATE: 09/30/2014 APPLIED: 09/30/2014 SITE ADDRESS: 4061 MAIN ST, Springfield, OR 97478 SCOPE: Backflow Device ASSESOR'S PARCEL NO: 1702314104600 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Replace an existing backflow device. OWNER: KAISER-CALLISON FAMILY LLC Phone Number: ADDRESS: 1904 NW EAGLES RIDGE LN ALBANY OR 97321 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lie No Lie Exp Phone Plumbing Contractor BROTHERS PLUMBING INC CCB 198624 12/31/2014 541-937-2994 INSPECTIONS REQUIRED NOWNEVINNEUMMONOWMA 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. [f L-qm\ � a - 01awr q1010 O ner or Contractor i nature 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 952001- 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). f�°UTILE: 1-1118 PERMIT SHALL EXPIRE IF THE WORK /},UTHORIZED UNDER THIS PERMIT IS NOT (:Of:11MENCED OR IS ABANDONED FOR f 80 DAY PERIOD. Springfield Building Permit 9/30/2014 8:26:57AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD _ TRANSACTION RECEIPT 225 Fifth St Spdngfield,OR97477 811-SPR2014-02108 541-726-3753 w .spdngfieldor.gcv 4061 MAIN ST permitcenter@spdngfield-or.gov RECEIPT NO: 2014002153 RECORD NO: 811-SPR2014.02108 DATE: 09/30/2014 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 Richard J Lybarger / Brothers Plumbinc 010382 TOTAL DUE: 98.44 TOTAL PAID: 98.44 Plumbing Permit Application SPRINGFIELD i. ..... '% r DEPARTMENT USE ONLY Permit nnno.:(- CR Date: vl 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 I ❑ Government 1,Wommercial 1 balhroom/l kitchen (includes: first 100feetofivater/sewer lines, hose $266.00 $ bibs, ice maker, underfloor low point drains and rain -drain packages) JOB SITE INFORMATION AND LOCATION ' Job site address: y0 (4 /0A,4 City: 1 State: ® ZIP: Refere ce: l Taxlot.: OF WORK' DDESCRIPTION A156n ezS iA S PROPERTY OWNER Name: 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: Rce h er-S )/r4b1'4 Address: P0. &OX Z City: Zo iState: 0 P, I ZIP: % Phone: 5'#1 - 37-..Z99 y I Fax: ?@9 E-mail: t' �f0 %lP(S^ Vv✓1 I 1 •C vr1 CCB license no.: BCD license no.: Plumbing license no.: Print name: Signature: CC$i*- 440-2500-1(5/21/2014/COM) FEE SCHEDULE DescriptionQty -'1-1ca. Cast Total cost New residential 1 balhroom/l kitchen (includes: first 100feetofivater/sewer lines, hose $266.00 $ bibs, ice maker, underfloor low point drains and rain -drain packages) 2 bathrooms/) kitchen $420.00 $ 3 bathrooms/1 kitchen $494.00 $ Each additional bathroom (over 3) $107.00 $ Each additional kitchen (over 1) $107.00 $ Residential firesprinklers includes p111Ian 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 water supply $82.00 $ Commercial, industrial, and dwellings other than one- or two-family Minimum fee Each fixture $21.00 $ Miscellaneous fees 100' storm, sewer, waterline $85.00 $ Each fixture, appurtenance, and piping f $21.00 $ Storm water retention/detention facility $21.00 $ Irrigation systems $21.00 $ Piping or private storm drainage systems exceedin the 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.) $g2,OD $ 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,`rUSIE (A) Enter subtotal of above fees nn $ OJ (Minimum Permit Fee $82.00) (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ ' (D) Technology Fee (5% of [A]) $pf IV (E) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through E): $ i I-