HomeMy WebLinkAboutPermit Plumbing 2004-12-30
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01599
ISSUED: 12/30/2004
APPLIED: 12/30/2004
EXPIRES: 06/30/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4938 DAISY ST
ASSESSOR'S PARCEL NO.: 1702333301741
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Backflow device
Owner: BARBARA SHRAUGER
Address: 4938 DAISY ST SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Landscape
Contractor License Expiration Date
LANDMARK IRRIGATION CORP . _ 6~49 n \i:lVV I Q'1;.:'f.:~~~{~PP5
tlUILJJIl .Ill'!tIl'UJ<s"~:flrlN by the Oregon Utility
follow ru ru\es are set forth
# of 1\'i9(i\~ation Center. Those h ol\Yl ~t1&I001-
HeiglH ef~Q(bflO1-001? thrO~~s 0~\li8tl!ldfbJPr:
Type~~.atou may obtain cop. the ~INj~6~'loor:
Water ~flhg the center. (Note... i~gnent:
Range ~YJAAber for the Oregon Utlhty t Garage/Carport
Energy'pa'tn: Center \s 1-800-332-2 Other:
Sprinkled Building: n/a Occupant Load:
Phone
541-686-9493
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
VN
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive o'~R~:1 r. E' Co mPWacOt:RK
% of Lot Cover-age:J . 1 SHAll EXPIRE If 1HE
~~I~II~E!~\n I INnER 1HIS PERM\1I~rN01
I PUBLIC IMPROV~~~m~ED OR IS ABANUUNtU ru \
ANY 1'BU1JAY ~f~Wa9k Type:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
Notes:
I Valuation DescriPtion'
Description
Type of Construction
$ PerSq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
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.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01599
ISSUED: 12/30/2004
APPLIED: 12/30/2004
EXPIRES: 06/30/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fee~JaiU
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backtlow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$4.50
$3.15
$14.00
$31.00
12/30/04
12/30/04
12/30/04
12/30/04
Receipt Number
1200400000000001811
1200400000000001811
1200400000000001811
1200400000000001811
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 ReQuired In~eftiqnl~1I1
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 of the property, and the approved set of plans will remain on the site at all'
times during construction.
(yI/;...t1J..~ U) P L,l (./tt' no'"
S' O,J r' _
--vs,
/2- so, -D <...(
Owner or Contractors Signature
Date
Pal!e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541;726-3759 Phone,
.
Jiily of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001811
Date: 12/30/2004
11:21:34AM
Job/Journal Number
COM2004-01599
COM2004-01599
COM2004-0 1599
COM2004-01599
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum! Adjustment Plumbing
Payments:
Type of Payment
Check
Paid By
LANDMARK IRRIGA nON
CORP
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 1781 In Person
Amount Due
3.15
4.50
14.00
31.00
$52.65
Amount Paid
$52.65
Payment Total:
$52.65
12/30/2004
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