HomeMy WebLinkAboutPermit Plumbing 2005-09-13CITY OF
Buildin g/Co mbination Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-7264676Fax
541:1 26-37 69 I nspection Line
PERIVIIT NO: COM2005-01253ISSUED: 0911312005APPLIED: 09/1312005E)?IRES: 03/1312006
VALUE:
IMPROVEMENTS
INFORMATI
SITE ADDRESS: 280120TH ST
ASSESSOR'S PARCEL NO.: 1703244204900
PROJECT DESCRIPTION: Backllow permit
Springfield TYPE OF
TYPEOF USE:
Backllow Device
New Residential
Owner:
Address:
LA]VIBERTDONNAJ
2801 N 2OTH ST
SPRINGFIELD OR 97477
Contractor TYpe
Landscape
# of Bedrooms:
Frontyard Setbaclc
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
#of \on
Water Type:
Range Type:
Energy Path:
Sprinkled
Overlay Dist:
# Street Trees
Paved Drive Rqd:
%o ofLot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
law gono(e License
7216
ut\ilW
torth Expiration Date
10/31/2005
Phone
541-342-1835
,hon
$ Per Sq Ft
or muftiplier
nla
Sidewalk Type:
DownspoutVDrains
REQUIRED PARJ(NG
Total:
Handicapped:
Compact:
Square Footage
or Bftl Amount
Valuation Descrintion
Description Type of Construction
lof2
Value Date Calculated
# of Units:
Primary Occupancy
Secondary Occupancy
Primary Construction
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CITY F SPRIN
Building/Combination Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:7263753 Phone
541-7263676Fax
541:7 26-37 69 I nspe ction Line
PERMIT NO: COM2005-01253ISSUED: 0911312005APPLIED: 09/1312005E)GIRES: 03/1312006
VALUE:
Fee Description
+ l0Yo Administrative Fee
+ 77o State Surcharge
Backflow Device
Minimum/Adj ustment Plumbin g
Total Amount
Amount Paid
$4.s0
$3.15
$14.00
$31.00
$s2.6s
Total Value of Project
Date Paid
9n3tos
9n3tos
9n3t05
9n3t0s
Receipt Number
1200s0000000000134r
120050000000000134r
1200500000000001341
1200s0000000000r341
Plan Reviews
To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00
a.rn will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
ired fnsnpcfinnc
By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certi$ that any and all work performed shall be done in accondance
with the Ordinances of the City of SpringfieH and the Laws of the State of Oregon pertaining to the work described herein,.
and that NO OCCUPAhICY will be made of any sfructure without permission of the Community Services Division,
Building Safety. I further certi$ 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 stree{ that the permit card b located at the front of the property, and the approved set of plans will remain on the site
at all times construction
?-/ 3- o t-
Owner or Contractors Signature
2oI 2
Date
Iees raro l
225 Fifth Street
Springfield, Ore gon 97 477
541:72G3759 Phone
City of Springfield Official Receipt
:velopment Services Department
Public Works Department
RECEIPT#: 1200s00000000001341 Date: 09/13/2005 1:4e:11PM
Jnb/Journal Number
coM2005-01253
coM2005-01253
coM2005-01253
coM2005-01253
Description
+ 7o/o State Surcharge
+ lo%o Administrative Fee
Backflow Device
Minimum/Adj ustment Plumbing
Amount Due
3.15
4.50
14.00
31.00
Item Total:$52.65
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number
Authorization
Number How Received Amount Paid
CreditCard REXTUS FOREST BY PROD djb 513105 In Person $52.65
Payment Total:
-Sffi
'I
r
i'l
911312005 lofl
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