HomeMy WebLinkAboutPermit Plumbing 2004-8-9
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-00975
ISSUED: 08/09/2004
APPLIED: 08/09/2004
EXPIRES: 02/09/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1116 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703264410700
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: Backflow device
Owner: OPEN BIBLE STANDARD CHURCH
Address: 1116 K ST SPRINGFIELD OR 97477
Contractor Type
Landscape
Contractor
KEVIN PRIDGEN
I CONTRACTOR INFORMA~~OU.\~'1
got' \av.J~'.... regon \,)\\\x rt\'\
.-4!'!.~\O\I\~ ore ~d b'1 \~i ~!fe se\~lration Date Phone
"'1 ~~~\e$ ad~9.. 't"os.ln~~ 902'" \"\Q6/15/2005 541-741-6096
~~~~!F~Uo,\"e '~~e
~\:,-6!. - e:' obtal"~ o\e.. \'('\e \e\e~\ca\\on
~fi:'1~~~e~ ntet. l~ \,)\\~\W Not Lot Size:
~gl1J lf0J6lgon ~~~2'344). Sq Ft 1st Floor:
rf\1ft :, \& ,\_&00' Sq Ft 2nd Floor:
ater ~ Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
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I PUBLIC IMPROVEMENTS I \~t \f "~~ \S ~O\
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\~\S ~~~\tt.\) \}~~~s~~tS/Drains:
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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
Pae:e 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00975
ISSUED: 08/09/2004
APPLIED: 08/09/2004
EXPIRES: 02/09/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backflow Device
Minimum/ Adj ustment Plumbing
Amount Paid
Date Paid
Receipt Number
$4.50
$3.15
$14,00
$31.00
8/9/04
8/9/04
8/9/04
8/9/04
2200400000000001020
2200400000000001020
2200400000000001020
2200400000000001020
Total Amount Paid
$52.65
I Plan Reviews ~
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
Bacld10w Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
t~ .,_
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 of the property, and the approved set of plans will remain on the site at all
tim;:furing construction,
o ~.J ;r--J:It ~ f' Lr / __ ro L /J
l 1 - 'Vl--r- l
Owner or Contractor Ignatbre Date (
Pal.!:e 2 of2
225 Fifth Street
Springfi~ld, Oregon 97477
541-726-3759 Phone
Job/Journal Number
!<~, COM2004-00975
COM2004-00975
COM2004-00975
COM2004-00975
Payments:
Type of Payment
Check
j>,.,
:,.".
8/9/2004
RECEIPT #:
ii:4'I
r:ty of Springfield Official Receipt
/elopment Services Department
Public Works Department
2200400000000001020
Date: 08/09/2004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum! Adjustment Plumbing
Paid By
PRIDGEN LANDSCAPING
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
4154
In Person
Payment Total:
Page 1 of 1
9:54:52AM
Amount Due
3.15
4.50
14.00
31.00
$52,65
Amount Paid
$52.65
$52.65
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225 FIITH STREET . SPRINGFIELD, OR 97477 . PH:(541) 726-3753 . FAX: (541) 726-3689
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CO z..c.?O(/ 00 975
City Job Number . M "1 .-
Job Location 11/6 ~ ~U;1/(,/ ,!5~t/'/
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Assessors Mar 17 D3 2b L( L(
,TaxLot 10700
Owner ~.!//1//l/V CJ j),o, r/J~, ,.~, ,r r h /~ ~ ~~ f M L
- ~ ,. -7'-1' rd t( - ~r <..2'" \. '-'/-
Address 1/ /6 ~C ~~~~ I ~~_~~.. ~.:~!:'~hone h"53 ~/~"9' f5
City 4~'Y"'v.J ,.. "" ~.. _ '~J~'f' ,-'~.., Zip 9~"'7
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BACKFLO\V PERlVIIT ~. ii _(Mr~~i~.'<l~cbarge & Administrative Fee)
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Contractor Information ~::~'
Cnntractorj::;,r.dn /:.~c1~ /1<:( .~:{9.='" 0~=;~
Addres'/t"'9'7 7J~->:>,rA?~" A/to Phone /'"4-/- ?: c5)?-c'
City rf r7~;'/''f=> State oR Zip 97~C?-==-
Construction Contractors Registration # h5P'"p
Expires/5" _T?~~
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By signing this permit/application, I agree to call for an inspection once the bac ention
devise has been installed and is visible for inspection (726-3769). I also st~~g~~ onnation on
this permit/applic IOn is correWt. ;~ ~~ ~~~~ '<~
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For Office ~e
Date of Application
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Checked for Historical Status
Checked for Delinquencit'''
Shared Drive (T:)/Building Fonns/Backflow Preventionl-03,doc