HomeMy WebLinkAboutPermit Plumbing 2016-07-14ffiffi CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR201 6-01772
shall remain at the
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
IVR Phone: 1 -888-299-2821
Message Phone: 54 1 -7 26-3769
permitcenter@springf ield-or. govwww. springfi eld-or. gov
This Perm or
lssued
07t14t2416
ISSUED:
APPLIED:
07t1412016
07t14t20'16
until final i
EXPIRES:
IVR REF #:
01t09t2017
81 1020567634
n
SITE ADDRESS: 1375 30TH ST, Springfield, OR 97478 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702303402100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: P - Rerouting 80 lineal feet of sanitary line to new connection point at the front of the
property (all work on private property).
OWNER:
ADDRESS:
CLEVENGER GLEN
609 CASCADE DR
SPRINGFIELD OR 97478
Phone Number:
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor JOHN PHILLIP DECKER 1 63938 0312912017 541-726-6124
INSPECTIONS REQUIRED
IVR Code / lnspection Type
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
3999 Final Plumbing Final Plumbing: When all plumbing work is complete
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 Current Development Department, Building Safety. I
further certify that only contractors and employees who are in compliance with ORS Chapter 70'1 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 n
or copy thereof, shall remain at the7-l\iobsite until final inspection
-)6
Owner or Contractor Srgnature
NOTICE:
irui prdrtnrT sHALL BtpIRE lF THE woRK
AiliHbCEio uruorn THls PEBMIT ls-NoT
CoururrucED oR ls ABANDoNED FoB
ANY 180 DAY PERIOD.
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Date
Springfield Building Permit 7/1412016 3:26:35PM
PROJECT STATUS:
STATUS DATE:
Page 1 of 1
SPRt
TRANSACTION RECEIPT
811-SPR2016-01772
1375 30TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-37s3
www. sprin gfield{r. gov permitcenter@springf ield-or. gov
RECEIPT NO: 201600i844 RECORD NO: 81 1 -SPR2016-0172 2 DATE:07114t2Q16
Continuing Education Fee
Sanitary sewer
State of Oregon Surcharge (12o/o of applicable fees)
Technology 'fee (Sok of permit total)
224-00000-42s606
224-00000-425603
821 -00000-21 5004
1 00-00000-425605
1 005
1 099
2099
2.50
92.00
11 04
4.60
TOTAL DUE:110.14
Check
4269
Glen Clevenger 110.14
TOTAL PAID:110.14
PAIDTSMITH
Crry or SpnrNGFrELo, OREGox
Plumbing Permit Application
*P$it*ldi'inkl{)
Permit no.
125 Fifth Street . Springfield,,OR9'1477 ) PH(541)72G3153 . FAX(541)726-3689 Date:
This permit is issued under OAR 9f 8-780-0060. 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.
ffi +
t
Zorung approva.l verified? ! Ves E t'to
Sanitation approval verified? I yes fl t'io
OFCAT roN
p'Residential ! Government E Commercial
AN ,CATION
Job site address: l7)< .? O ,t
City: 5nnn S.lr/State: f fr ztP:Q 7V78
Reference:v A Taxlot.
DESCRIPTION OF WORK€t o
PROP OWNER
r
5
Name:
Address
City: g ptru€rlr)State: @ (zw: f /!)p
Phone:f4l !2il'Zl> O Fax: UA 4
i lof
This instaliation 1S
by me
from
ora
made on resi ial or farm property
of immediate family, and is
E-mai1:oD tCoFT
oAR 918-695-0020
owned
exempt
p'w €/ExBusiness name:
Address
City: r State:ZP
Phone:sl/ -.sv3 (dEt Fax
E-maii:
CCB license no.BCD license no.
Plumbing license no
Print name:
Signature:
New residential
1 bathroom/l kitcha (includes: frstl00feet of water/sewer lines, hose
bibs, ice maker, underfloor low-point
drains and rain-drain packages)
s290.00 S
2 bathroomVl kitchen s4s4.00 s
3 bathroomsrl kitchen s534.00 s
Each additional bathroom (over 3)s115.00 S
Each additional kitchen (over I )s115"00 S
Residential fire sprinklers (includes plan review)
0 to 2,000 square feet s89.00 s
2,001 to 3,600 square leet s't 42.00 S
3,601 to 7,200 square feet s21 2.00 s
7,201 square feet and greater s283.00 S
Manufactured dwelUng or pre-fab (circle one)
Comections to building sewer and
water supply s89.00 $
Commercial, industrial, and dwellings other tian one- or
two-family
Minimum fee s89.00 S
Each fixture s22.00 S
Miscellaneous fees
100' storm, sewer, water line i s92.00 S9Z
Each fixture, appurtenance, and piping $22.00 $
Storm water retention /detention facility $92.00 $
lrri gation systems,iBackllo w $22.00 $
Piping or private storm drainage
svstems exceedins the first 100 feet $22.00 $
Specialty fixtures $22.00 $
Reinspection (no. of hrs. x Ge per hr.)s89.00 $
Special requested inspections (no. of
hrs. x fee per hr.)s89.00 S
Each additional inspection: (l)s89.00 $
Medical gas piping Minimum fee s
Enter value of installation and equipment S _
Enter fee based on installation and equipment value.$
USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $89.00)n?--$
(B) lnvestigative fee (equal to [A])$
(C) Enter l2oZ surcharge (.12 x [A+B])$ llor
(D) Techrology Fee (s% of [A])$A?
(E) Continuing Education Fee 52.50 $2.50
TOTAL fees and surcharges (A through E)$il.} lg
440-2500-J (4/r/20 l 6/CoM)
DEPARTMENT USE ONLY
LOCAL GOVERNMENT APPROVAL
1pwtl t)o o#Jt
FEE SCHEDULE
Description Qty.Cost
ea.