HomeMy WebLinkAboutPermit Plumbing 2003-12-09Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-01228ISSUED: 1210912003APPLIEDz 1210912003
EXPIRESz 0610912004
VALUE:
SITE ADDRESS: 568 S 5TH ST
ASSESSOR'SPARCELNO.: 1703353405200
PROJECT DESCRIPTION: Replacing sanitary sewer, about 80'
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: Alteration Residential
Owner:
Address:
SAMPSON WENDY L
568 S sTH ST SPRINGFIELD OR 97477
Contractor Type
Plumbing
Contractor License
NEW HORIZONS HEALTH CARE SYSTEMS66681
Expiration Date
05fiSt2004
Phone
541-746-4224
CONTRACTOR INFORMATION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-1
SETBACKS
Frontyard Setback:
Side I Setback:
Side 2
Rearyard
Solar
Street
Storm Sewer Available:
Special Instruction:
Notes:
VN
# 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
Sidewalk Type:
Downspouts/Drains:
REQUIRED PARJ(NG
Total:
Handicapped:
Compact:
Total Value of Project
Pase I of 2
Description Type of Construction VaIue Date Calculated
ffi
D U ll-Irll\ (, rt\ r UX.IYrry..l
.,.i,'
i
5
o $+
Valuation Description I
Building/C ombination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-01228ISSUED: 1210912003APPLIEDz 1210912003
EXPIRESz 0610912004
VALUE:
Fees Paid
Fee Description
+ l0Yo Administrative Fee
+ 7o/o State Surcharge
Sanitary Sewer - lst 50 Feet
Sanitary Sewer Each Addtl 100r
Total Amount Paid
Amount Paid
$5.90
$4.13
$45.00
$14.00
$69.03
Date Paid
t2t9t03
t2t9t03
t2t9to3
t2t9t03
Receipt Number
220020000000000185r
22002000000000018sr
2200200000000001851
2200200000000001851
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.
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 Springlield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY witl 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 the property, and the approved set of plans will remain on the site at all
times during construction.
tZ/n/"
Owner re Date
Pase 2 of 2
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Receipt #: 220O2O000000000 I 85 I Date:12t09t2003 1:58:38PM
coM2003-01228
coM2003-01228
coM2003-01228
coM2003-01228
Sanitary Sewer - lst 50 Feet
Sanitary Sewer Each Addtl 100'
+ 7o/o State Surcharge
+ l0%o Administrative Fee
45.00
14.00
4.13
5.90
Item Total:$69.03
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Check THOMPSON SEPTIC & ROOTER jmp
SERVICE
18942 In Person
Payment Total:
$69.03
$69.03