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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: -Sffi t21t612004 Page I of I IEIT'D3.D b{-l.( t- ( t j ----''--I &s 225 ETN'H STREET . SPRJNGFIEI,D,ORgT4TZ t pH:(S4t)726-gZSg r I.AX (S41)726_9689 (1'1 Ft!{e C-o e( Zoo 4.D (54d--City Job Nu r Fiit+d.q8 ("), r - 'Pq(,. ?c rfr qLJob Assessors Tax Lot . ,5c. rrf;i&-.,t ytX Sq-)q7-I P 7U 77state ff zipS? [-tN (^ft a-DtyCi ['ee)State Surcharge & r\dministrativr.!'ec,Permitcludes(in.651r52ISR.PIIT'lr[]wI},AC'KIIT,O .lnJitrmationConlracktr /Contractor -/B{ 2 b7ZZx0o {rd,r plrn{ (*"t i.r{ *=taA hn*F{ ar), r 1al{:h(}'/al-q{ r-l?ry{f.\,\rlrfi{ {id"r"i?i"i(} ziptyCi ExpiresC>SzO\ €l/{(t)a1 ContrilctorstionConstmc #Registration u.g a4-o}-os once the backflow prevention I also state that all information on Dn'e llrb 4 +'12 tL, -\z€.xt to call for an inspection inspection (7 26 -37 69). L*I.,\DAAAPE- By signing this pennit/application, I agree devise has been installed and is visible for this (Je L{u For Olfice Use AhJd lffic e1.1Ye( \1,FqrlL}ffi bid Date of Application Checked for Delincluencies- Checlced for Historical Status 5z.bs Sharrd Drive (T:)/Buildiug Forrns/lJackfl ow Prevention l-1)3.doc -rf- /o*n, Address