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Home My WebLink AboutPermit Plumbing 2004-05-12Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00562ISSUED: 0511212004APPLIED: 05/1112004 EXPIRESz 1111212004 VALUE: SITE ADDRESS: 640 14TH ST ASSESSORTS PARCEL NO.: 1703362301100 TYPE OF USE: Repair PROJECT DESCRIPTION: Install sump pump in crawl space of building and pipe to street curb Springfield TYPE OF WORK: Plumbing Only Owner: Address: MATHIS MARY 1386 E ST SPRINGFIELD OR 97477 Expiration Date 10/31/2005 Residential Phone 541-688-3648 Contractor Type General Contractor WILLIAM A BRIGHAM CONST CO INC License s9618 CONTRACTOR INFORMATION ,RMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: # of Stories: Height of Structure Type of Heat: Water Type: ATTENTION:Range Type: Energy Path tollow rulos adopft Sprinkled overlay Dist:ouffib # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Compact: Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: ARIflNG 3:""'"[ifi Iltlltlufi ce:-r------ -- - THIS PER MIT SHALL EXPIRE IT THE WORK Notes:AUTHORIZEO UNDER THIS P ERMIT IS NOI MENCED OR IS ABANDON ED IOR ANY $ Per Sq Ft or multiplier PUBLIC IMPROVEMENTS Description Type of Construction Total Value of Project Value Date Calculated re Center le Valuation Description I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00562ISSUED: 0511212004APPLIED: 05/1112004 EXPIRESz llll2l2004 VALUE: Fees Paid Fee Description + l0o/o Administrative Fee + 7%o State Surcharge Fixture Storm Sewer - lst 50 Feet Total Amount Paid Amount Paid $5.90 $4.13 $14.00 $4s.00 $69.03 Date Paid sn2t04 5n2104 sn2t04 5lt2l04 Receipt Number 1200400000000000716 r200400000000000716 1200400000000000716 1200400000000000716 Plan Reviews To Request an inspection call the24 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 Storm Sewer Line: Prior to filling trench. Reouired Insnections 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. o Owner or Signature Date Pase? of2 *t, - Construction Contractors Board Permit *:(J)ut4@t*-r -oOSbZ Date: S.Z o Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us bqo tL( +-r S +Address: Issued by:\< A, fi2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. ft :.{. My general contractor is s76/g (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Constnrction Contractors Board. OR tr 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Owners about Construction Responsibilities on the reverse side of this form.I of permit applicant) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/l I /03 225 Fifth Street Springfield, Oregon 97 477 5+7-726-3759 Phone ntty of Springfield Official Receipt ,_ :velopment Services Department Public Works Department RECEIPT #: 1200400000000000716 Date: 0511212004 8:05:26AM Job/Journal Number coM2004-00562 coM2004-00562 coM2004-00562 coM2004-00562 Description Fixture Storm Sewer - 1st 50 Feet + 7o/o State Surcharge + l0% Administrative Fee Amount Due 14.00 45.00 4.13 5.90 Item Total:$69.03 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid CreditCard MARY MATHIS djb 00038 I 012150 In Person Payment Total: $69.03 -s6r5r 5/12t2004 Page 1 of I ED