HomeMy WebLinkAboutPermit Plumbing 2004-12-16sF.B[|rlcFtsr r\
Status 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: COM2004-01544ISSUED: 12116t2004APPLIEDz 12116t2004EXPIRESz 06t16t2005
VALUE:
SITE ADDRESS: 2412 20TH ST
ASSESSOR'S PARCEL NO.: 1703244302000
PROJECT DESCRIPTION: Installing a backflow device.
Springfield TYPE OF WORK: Singte Family Residence
TYPE OF USE: Alteration Residential
Owner:
Address:
SCOTT CAROL D
24I22OTHST SPRINGFIELD OR 97477
Contractor Type
Landscape
Contractor
GRANTS
Expiration Date
04t03t2005
Phone
541-342-1835
License
7216
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Water Type:
Range Type:
Energy Path:
Sprinkled Building
Overlay Dist:
# Street Trees
Paved Drive
oh of Lot
'\s
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Other:
Load:
10
tso
Type:
Downspouts/Drains:
\
SF
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street lmprovements:
Storm Sewer Available:
Special Instruction:
Notes:
g\'a Compact:
PARKING
$ Per Sq Ft
or multiplier
po
Square Footage
or Bid AmountDescription Type of Construction
Total Value of Project
Value Date Calculated
t
Stories:
of Structure
K.' ,
t\
rso
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: COM2004-01544ISSUED: 12116t2004APPLIEDz 12t16t2004EXPIRESz 06t16t2005
VALUE:
Fees
Fee Description
+ l0o/o Administrative Fee
+ loh State Surcharge
Backflow Device
Minimum/Adj ustment Plumbing
Total Amount Paid
Amount Paid
$4.s0
$3.15
$14.00
$31.00
$s2.6s
Date Paid
t2n6t04
t2n6t04
t2n6t04
t2n6t04
Receipt Number
2200400000000001s19
2200400000000001519
2200400000000001519
2200400000000001519
Plan Reviews
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street,that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times du
t2- lt, -oY
Owner or Contractors Signature Date
Pase 2 of 2
[equlreo lnsDectrons ]
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
rity of Springfield Official Receipt
__ jvelopment Services Department
Public Works Department
RECEIPT #: 2200400000000001519 Date: 1211612004 l1:35:46AM
Job/Journal Number
coM2004-0r 544
coM2004-01544
coM2004-01s44
coM2004-01544
Description
Backflow Device
Minimum/Adj ustment Plumbing
+ 1Yo State Surcharge
+ l0% Administrative Fee
Amount Due
14.00
3l.00
3. l5
4.50
Item Total:$s2.65
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number
Authorization
Number How Received Amount Paid
CreditCard TERRY L THORN Jmp 016153 In Person $52.65
PaymentTotal:
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I also state that all information on
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inspection (7 26 -37 69).
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By signing this pennit/application, I agree
devise has been installed and is visible for
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Date of Application
Checked for Delincluencies- Checlced for Historical Status
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