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Home My WebLink AboutPermit Plumbing 2014-10-02SPRINGFIELD ' CITY OF SPRINGFIELD C OREGON Building / Residential Permit PERMIT NO: 811-SPR2014-02134 w .springfield-or.gov 225 Fifth St Spring0eld,OR 97477 Phone: 641-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@spdngfield-ongov PROJECT STATUS: Issued ISSUED: 10/02/2014 EXPIRES: 03/31/2015 STATUS DATE: 10/02/2014 APPLIED: 10/02/2014 SITE ADDRESS: 1258 CENTENNIAL BLVD, Springfield, OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703264411500 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replacing of a water line from house to meter. OWNER: VAN DYKE MICHELLE Phone Number: ADDRESS: 1258 CENTENNIAL BLVD SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lie No Lic Exp Phone Plumbing Contractor MICHAEL THOMAS DONAHUE CCB 194298 02/24/2016 541-5207225 INSPECTIONS REQUIRED Inspections 3315 Water Line 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 thatncontractors nd plo as who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure t t II r u red in ecti n e requested at the proper time, that each address is readable from the street, that the Perm caj I loc tecJ at t front th property, and the approved set of plans will remain on the site at all times during Owner or Contractor ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 052-001-0010 through OAR 952-001- 0090. You inay obtain Copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-600-332-2341). b2 / Date !'-J10r: I IIS PERMIT SI IALL EXPIRE IF THE WORK ,Iljj{ORI7_ED UNDER THIS PERMIT IS NOT n+iEMUD OR IS APIANDONED FOR o DAY PFP,IOD. Springfield Building Permit 70/2/2014 10:55:31AM Page 1 of 1 LSPRINGFIELD ---- CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spdngfield,OR97477 OREGON 641-726-3753 811-SPR2014-02134 mm.spnngfieldocgov 1258 CENTENNIAL BLVD permitoenter@spdngfield-or.gov RECEIPT NO: 2014002176 RECORD NO: 811-SPR2014-02134 DATE: 10/02/2014 N fi Continuing Education Fee 224-00000-425606 - 2.50 Slate of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Water Line 821-00000-215004 1099 100-00000-425605 2099 224-00000-425603 1005 10.20 4.25 85.00 TOTAL DUE: 101.95 — - Credit Card Michael Donahue / Green City Constrw 101.95 337671 TOTAL PAID: 101.95 Plumbing Permit Application SPRINGFIELD_ - I ' j t DEPARTMENT USE ONLY Permit no.: 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 Sa itation approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION Ej Residential I❑ Government I ❑ Commercial JOB SITE INFORMATION AND LOCATI N Job site address: D -�— City: iVIA , e 0 to 2,000 square feet $82.00 $ State: Q zip: 7 Y Reference: D15A 0" Taxlot.: DESCRIPTION 'OF WORK c w j -e - 001',/L PROPERTY OWNER Name: Address: 90 P1 4e,✓InI', City: S rti ,'d dl I State: ZIP: Phone: $21.00 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: Address: '1 i City: y (_ State: 4 ZIP: q7 t Phone - - ' Z Fax: 1 E-mail: 6Lo cc, v � CCB license no.: BCD ticense no.: Plumbing license no.: Print name: 1 Signature: 440-2500-J (5/21/2014/COM) FEE SCHEDULE Description Qty Cost ea.' Total cost New residential I bathroom/l kitchen (includes: first 100feet ofwater/sewer lines, hose $266.00 $ bibs, ice maker, undetJloor low point drains and rain -drain packages) 2 bathrooms/I 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 plan 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, water line $85.00 $VM Each fixture, appurtenance, and piping $21.00 $ Storm water retention/detention facility $21.00 $ Irrigation systems $21.00 $ Piping or private storm drainage systems exec din the firs[ 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: US.E (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]) Lid $ i (D) Technology Fee (5% of [A]) $ 11110*1 (E) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (A through E): 1 $ D 1I`)1t5'