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Home My WebLink AboutPermit Plumbing 2004-5-7 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00545 ISSUED: 05/07/2004 APPLIED: 05/07/2004 EXPIRES: 11/07/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4064 CAMELLIA ST ASSESSOR'S PARCEL NO.: 1702314400712 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Backtlow Permit Owner: OSTRANDER EVELYN B LIFE EST Address: 4064 CAMELLIA ST SPRINGFIELD OR 97478 Phone Number: 541-747-7722 I CONTRACTOR INFORMATION. Contractor Type Plumbing Contractor ABSOLUTE PLUMBING SERVICES INC License 67664 Expiration Date 07/1112005 Phone 541-345-3055 I BUILDING INFORMATION I . Lot Size: Sq Ft Ist Floor: ATTEN'- " _. S~Ft 2nd Floor: , 11()j\J'l8ifJ.}tiB~' fO!'?W rules ad~i<t16'~/e,t~~f'Ou to !'Jotlflcation CentSq ~~ ~~on Utility In OAR 952-00 1-~fMYoor~~Bl}.~I~~gf:forth 009n y",. ....-} Lt - r1H AN 9~1 . I DEVELOPMENT INFORMk11I~ .,~ -~e~te~I(~omP~es ofthe rules by f1U", er ror the Or~g 0 . ~~IBWRKING C on tJlity Notificatio Front yard Setback: Overlay Dist: enter is 1-800-~~~44). n Side 1 Setback: # Street Trees Rqd: Handicapped: Side 2 Setback: Paved Drive Rqd: Compact: RearyHgJtM;~k: L EXPIRE IF THE WO~ofLot Coverage:- Solar S:~~~~~6 ~!~~a i~I~PER~IT_ IS NOT COMMENCED OR IS ABANDO~EOI~LICIMPROVEMENTSI Street I~nJDtt)~'V PERIOD. Storm Sewer Available: Special Instruction: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: , Height of Structure Type of Heat: Water Type: Range Type: Energy Path: SETBACKS Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pa2e 1 of2 '~* CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00545 ISSUED: 05/07/2004 APPLIED: 05/07/2004 EXPIRES: 11/07/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $3.15 $14.00 $31.00 5/7/04 5/7/04 5/7/04 5/7/04 2200400000000000496 2200400000000000496 2200400000000000496 2200400000000000496 Total Amount Paid $52.65 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reouired Insnections I 1 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 of 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 ofthe property, and the approved set of plans will remain on the site at all times during constru~tion. ~ &4-___, /!IW, Date I 1/1JL; I Owner or Contractors Signature Paee 2 of 2 ~ o · ,..-....l ~ ~ u · ,..-....l , f'-~ 0'1 ~ ~ .~ S ~ C) ~ C) U .~ > Q) Q o o .~ ~ o Q) > Q) ~ ~.. ~ o ~+-l ~ ~ U ~ ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)7Z6-:n53 · FAX: (541)726-3689 City Job Number Corn-;)ODLj -(J~SY..5' . j .it)/" I' / /l ,'1 - /J [( (:.- Job Location.:- l# '-1" ~ Assessors MaT' //O~ 3 / 4'1 00 7 / ~ . Tax Lot Owner ;:[' vel "11J I Address. 10 b f{ /Je; .l-JI"C( '/Viev' (a rvt-P If A... Phon~ 7l./7 - 77 Z 2. Zip 97l/!'~ G:Tf}Ei'USr.N: ~~~I Jirp.!=; ynll to b!low rL;IJ'~dopted by the Oregon Utility t~;:'~:::C':.::0;1 C;:;;-'~V;. TI-,u';o lulCi) alC i)ol rUlll. Statp O/C. in m~Feij,~'E~~~il.~~Q1dudes Permit Fee, State Surcharge & Administrative Fee) 0090. You may obtain copies of the rules by calling the center. (Note: the telephone rn->m93E:!m. ~rRQBlb~tility Notification Center'is 1-800--332-2344). Contractor ;+/;( 011/1-< f I f/In tip! "1 j Addres~ r 5 qB B ,4-(}(}t Jre-< c.+ . . . Phonf' ,#0...~. ~. ;?~ '3</5"- 50 s-s State l)fL Zip Q7'105 City e,...jL, J? /.4e NOTiCE: I Coilistl&JtiiliMtb~dthr~1f~AFaJb!~Mj~~:~~(, 7 t.c:, 'I .'\~T~0~1?l=n IINnFR THb PERMI r IS-illu I COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. By sIgning tnis pennit/application, I agree to call for an inspection once the backflow prevention devise has been installed and is visible for inspection (726-3769). I also state that all infonnation on this pennit/application is correct. Expires J .A1 (J DY Signature 2-. ~L Datp S/'1gtH , For Office Use Date of Application 6/7/d07J<7 , . V Checked for Historical Status ~ Checked for Delinquencit"<:: Shared Drive (T: )/BuiJding FOlllls/Backllow Prevention I-OJ ,doc 225 Fifth Street. ~ Springfield, Oregon 97477 541-726-3759 Phone .:;:= iii wac. ~,Y of Springfield Official Receipt ~elopment Services Department Public Works Department Job/Journal Number COM2004-00545 COM2004-00545 COM2004-00545 COM2004-00545 Payments: Type of Payment CreditCard 5/7/2004 RECEIPT #: 2200400000000000496 Date: 05/07/2004 Description Minimum! Adjustment Plumbing Backflow Device + 7% State Surcharge + 10% Administrative Fee Paid By ERIC OSTRANDER Item Total: Check Number Authorization Received By Batch Number Number How Received NJM 000378 018536 In Person Payment Total: Page 1 of 1 11:56:46AM Amount Due 31.00 14.00 3.15 4.50 $52.65 Amount Paid $52.65 $52.65