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Home My WebLink AboutPermit Plumbing 2014-09-26SPRINGFIELD -- EXPIRES: 03/2512015 225 Fifth St ' CITY OF SPRINGFIELD Springfield,OR 97477 ASSESOR'S PARCEL NO: 1703263300800 TYPE OF STRUCTURE: Commercial Phone: 541-726-3753 oR9coN Building / Commercial Permit Inspection Phone: 541-726-3769 ADDRESS: PO BOX 8798 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-02092 v m.spnngfield-orgov Lic No Lic Exp Phone permitcenter@spnngfield-orgov PROJECT STATUS: Issued ISSUED: 09/2612014 EXPIRES: 03/2512015 STATUS DATE: 09/26/2014 APPLIED: 0912612014 SITE ADDRESS: 1275 MILL ST, Springfield, OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703263300800 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Replace sewer line OWNER: SALVATION ARMY Phone Number: ADDRESS: PO BOX 8798 PORTLAND OR 97208 CONTRACTOR INFORMATION Contractor Typo Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor BERNARD PETERSEN INC CCB 93126 09/23/2015 541-343-9339 INSPECTIONS REQUIRED Inspections 3200 Sanitary Sewer 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. EJ �NV�IN� , 2 C� i) 2-6 ) t 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). PERMIT SHALL EXPIRE IF THE WORK 11ORIZED UNDER THIS PERMIT IS NOT jMENCED OR IS ABANDONED FOR Y 180 DAY PERIOD. Springfield Building Permit 9/2612914 11:39:13AM Page 1 of 1 -. DATE: 09/26/2014 CITY OF SPRINGFIELD LSPRINGFIELD TRANSACTION RECEIPT 225 Fifth St Spring(eld,OR 224-00000-425606 2.50 97477 OREGON 811-SPR2014-02092 541-726-3753 %w .springfield-or.gov 1275 MILL ST permits nler@spdngfield-or.gov RECEIPT NO: 2014002139 RECORD NO: 811-SPR2014-02092 DATE: 09/26/2014 DESCRIPTION ACCOUNT CODEITRANS CODE AMOUNT DUE 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 10.20 Technology fee (5% of permit total) 100-00000-425605 2099 4.25 TOTAL DUE: 101.95 `PAYMENTTYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID Credit Card BERNARD PETERSEN INC 101.95 04104c TOTAL PAID: 101.95 Plumbing Permit Application 225 Fifth Street ♦ Springfield, OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689 SPRINGFIELD I DEPARTMENT USE �ONLY ' Permit no.: S��G�/ J 2— Date: Date: 0- / 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 10 Government p Commercial JOB SITE INFORMATION AND LOCATION' Job site address: /* e-/� City: S Stater ZIP: Reference: Taxlot.: DESCRIPTION OF WORK' 7,201 square feet and greater $261.00 $ Manufactured dwelling or prefab (circle one) PROPERTY OWNER Name: 7 f1i TJ U 1 i Address: Q anx "3-/j' City: State: ZIP: `J 200 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: C N ec> Address: Z O City: rp State: O PI I ZIP. -7 O?., Phone:S'S9 FaxSq)-343 E-mail: ijp CCB license no.: � I BCD license no.: Plumbing license no.: '20--35 Pt Print name: Q'qv Ve 2,Y) Signature: g 440-2500-1(5/212014/COM) FEE SCHEDULE Description Qty. , Czeaost Totalcost.' New residential 1 bathroom/l kitchen (inchrdes: first 100feetofwatedsewerlines ,hose $268.00 $ bibs, ice maker, underfloor low paha 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.OD $ Residential firesprinklers includes pian 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 prefab (circle one) Connections to building sewer and water supply $82.00 $ Commercial, industrial, and dwellings other than one- or two-family Minimumfee Each fixture 1 1 $21.00 $ Miscellaneous fees 100' storm, sewer, waterline 7i- $85.00 $ Each fixture, appurtenance, and piping $21.00 $ Storm water retentiouddetention facility $21.00 $ Irrigation systems $21.00 $ Piping or private storm drainage systems exceedingthe first 100 feet $21.00 $ Specialty fixtures $21.00 $ Reinspection (no. of his. x fee per hr.) $82.00 $ Special requested inspections (no. of his. x fee per hr.) $82.00 $ Each additional inspection: (1) $82.00 $ Medical gas pi 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) $ �� (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): I $/ 0/ s