HomeMy WebLinkAboutPermit Plumbing 2004-03-15FIELD
Building/Combination Permit
PERMIT NO: COM2004-00282ISSUED: 0311512004APPLIED: 03/1512004
EXPIRESz 0911512004
VALUE:
Status Issued
225 Ftfth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-726-37 69 Inspection Line
SITE ADDRESS: 1101 16TH ST
ASSESSOR'S PARCEL NO.: 1703253404800
PROJECT DESCRIPTION: Repair Sanitary Sewer Line
Springfield TYPE OF WORJ(: Plumbing Onty
TYPE OF USE: Repair Commercial
Owner:
Address:
VENTIS INYESTMENT PROPERTIES LLC
1742 DELROSE AVE SPRINGFIELD OR 97477
Contractor Type
Plumbing
Contractor License
BOHEMIA PLUMBING & CONSTRUCTION ]41468
Expiration Date
03/03/2005
Phone
541-942-8333
CONTRACTORINFORMATI(
BUILDING INF(
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
street illflibl&f,ent',
Storm Sd#&BEHAbJSHALL EXPIRE lF TUE W0RK
Specialfi[!]ffifHtED UNDER THIS PERMIT lS NOT
COMMENCED OR IS ABAI{DONED FOR
Notes:
ANY 1Bo DAY PERIoD
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
o/o of Lot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
REQUIRED PARIilNG
Total:
Handicapped:
Compact:
Total Value of Project
Paee 1 of2
INFORMATION
PUBLIC IMPROVEMENTS
Description Type of Construction Yalue Date Calculated
ryrI
Valuation Description I
Y
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/C ombination Permit
PERMIT NO: COM2004-00282ISSUED: 0311512004APPLIED: 03/1512004EXPIRES: 09/1512004
VALUE:
tr'ees Paid
Fee Description
+ lUoh Administrative Fee
+ 7o/o State Surcharge
Sanitary Sewer - lst 50 Feet
Sanitary Sewer Each Addtl 100'
Total Amount Paid
Amount Paid
$s.90
$4.13
$4s.00
$14.00
$69.03
Date Paid
3n5t04
3nst04
3nst04
3nst04
Receipt Number
1200400000000000321
1200400000000000321
1200400000000000321
1200400000000000321
Plan Reviews
To Request an inspection caII 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.
1 Sanitary Sewer Line: Prior to filling trench and including required testing.
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 construction.
/
Owner or Signature Date
Pase2 oI2
LII*5
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
t?City of Springfield Official Receipt
Development Services Department
Public Works Department
#: 1200400000000000321 Date: 0311512004 1:08:05PM
coM2004-00282
coM2004-00282
coM2004-00282
coM2004-00282
Sanitary Sewer - lst 50 Feet
Sanitary Sewer Each Addtl 100'
+ 7Yo State Surcharge
+ l0%o Administrative Fee
45.00
14.00
4.13
s.90
Item Total:$69.03
Type ofPayment Paid By Received By Batch Number Authorization Number [Iow Received Amount Paid
Check BOHEMIA PLUMBING AND
CONSTRUCTION INC
dlm 2456 In Person
Payment Total:
$69.03
$69.03