HomeMy WebLinkAboutPermit Plumbing 2014-10-02SPRINGFIELD -
" CITY OF SPRINGFIELD
t i
Building / Residential Permit
PERMIT NO: 811-SPR2014-02137
v .springfield-or.gov
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: 1 010 2/2 01 4 EXPIRES: 03/31/2015
STATUS DATE: 10/02/2014 APPLIED: 1010212014
SITE ADDRESS: 546 5TH ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703352405500
PROJECT DESCRIPTION: Replacing water line from home to meter.
OWNER: BESWICKJULIA ANN RRICHARD
ADDRESS: 546 N 5TH ST
SCOPE: Plumbing Only
TYPE OF STRUCTURE: Residential
Phone Number:
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
Plumbing Contractor JOHN THE PLUMBER INC CCB 107810 07/24/2015 541-6864888
INSPECTIONS REQUIRED
Inspections
3315 Water Line
By signature, 1 stale 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 perm; on of the Community Services Division, Building Safety. I further
certify that only contractors and employees who an
'n pliance with ORS 701.005 will be used on this project. I further agree
to ensure that all required inspections are re sled a proper time, that each address is readable from the street, that the
permit card is located at the frgfit of the pro , a e approved set of plans will remain on the site at all times during
construction. /
or Contractor Signature
to Ovv uTION; Or
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TICE:
i1S PERMIT SHALL EXPIRE IF THE WORK
i NORI7_ED UNDER FFiIS PERMIT IS NOT
i 1ENUO OR IS ABANDONED FOR
0 DAY PERIOD.
Springfield Building Permit 10/2/2014 11:09:41AM Page 1 of 1
SPRINGFIELD ----- CITY OF SPRINGFIELD
225 Fah St
TRANSACTION RECEIPT 8pdngfie1d,0R97477
OREGON 541-726-3753
811-SPR2014-02137
w .spdngfieldor.gov 546 5TH ST permitcenter@spdngrield-or.gov
RECEIPT NO: 2014002179 RECORD NO: 811-SPR2014-02137 DATE: 1 0/0212 01 4
Continuing Education Fee 224-00000-425606 2.50
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
Water Line 224-00000-425603 1005 85.00
8930
TOTAL DUE: 101.95
TOTAL PAID: '101.95
Plumbing Permit Application SPRINGFIELD DEPARTMENT USE ONLY
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Permit no.:
225 Fifth Street Springfield, OR 97477 PH(541)726-3753 ♦ FAX(541)726-3689 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
Sanitation approval verified? ❑ Yes ❑ No
CATEGORY OF CONSTRUCTION
esidential I ❑ Government
❑ Commercial
JOB SITE INFORMATION AND LOCATION:-
Job site address:%
City: ;,
State: (J
ZIP: v( 74
Reference:
Taxlot.: f`
DESCRIPTION OF WORK"
3,601 to 7,200 square feet $196.00 $
7,201 square feet and greater $261.00 $
PROP TY :OWNER
Name: &7C62rd e W(Lk
Address: i T
City:
State: d
(9' �1
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: O A r e M k JA
Address:r2 23- 'o
City: I
State: G
1 ZIP: 9 ?�D
Phone:5 00
Fax:
E-mail: lOLtvt �ot� Co/tG�l T.!?Q
CCB license no.: t /
BCD license no.:
Plumbing license no.:
Print name: &, (.4' ( yh
Signature:
I v
440-2500-J (5/21/2014/COM)
FEE SCHEDULE
Description
Qty
cost
cost!'
New residential
1 bathroom/1 kitchen (includes: first
100feet of water/sewer lines, !rose $268.00 $
bibs, ice maker, underfloor low point
drains and rain -drain packages)
2 bathrooms/1 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 pfan 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 -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
$
Each fixture
$21.00
$
Miscellaneous fees
100' storm, sewer, water line
$86.00
$
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
$21.00
$
Specialty fixtures
$21.00
$
Reinspection (no. of his. x fee per hr.)
$82.00
$
Special requested inspections (no. of
firs. x fee per hr.)
$82,00
$
Each additional inspection: (1)
$82.00
$
Medical gas piping
Minimum fee
$
and equipment $
Enter value of installation a
Enter fee based on installation and equipment value. $
APPLICANT'USE
(A) Enter subtotal of above fees Q
(Minimum PermitFee$82.00) $ u�0
(B) Investigative fee (equal to [Al) $
(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): $. LI-)\
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