HomeMy WebLinkAboutPermit Miscellaneous 2008-12-3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
.. - '-'-'I.C_._~-._'_, '"O"",.o..,..t.rERMITNO: COM2008-01731
, ',l. ). ., - I ,~..'fSSUED: 12/03/2008
,', ' . .'~ .' .' , ,'. '_:'.'~I,),..1JijI~""! PLIED: 12/0312008
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SITE ADDRESS: 2575 Olympic St Center is 1-800':Sp'ft~gMl\I TYPE OF WORK: Commercial Miscellaneons
ASSESSOR'S PARCEL NO,: 1703254101001
PROJECT DESCRIPTION: Backtlow dev for KFC
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TYPE OF USE: Alteration
Commercial
Owner:
Address:
KFCfLJS
2575 OLYMPIC STREET
SPRINGFIELD OR 97477
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THIS PER~III<tON1I'RA&:'t6R.'m RMA'IlGU
AUTHORIZt.U \Ji\{JcF, r, ^~ fl. ". .'
Contrac~~JMMENCED OR IS ABANDONED FQ~ense
RIGHT-~~l\llJl;l,!:l~lWI~RIOD, '
I BUILDING INFORMATION I
Contractor Type
Applicant
# of Units:
Primary Occupancy Group:
Seeondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:'
# of Bedrooms:
Frontyard Sethack:
Side I Sethack:
Side 2 Sethack:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
, ,
Storm Sewer Available:
Special Instruction:
Notes:
Description
A2
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy P~th:
Sprinkled'Building:
nJa
VB
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Phone Number: 541-726-7725
,
Expiration Date Phone
Lot Size:
Sq Fl'lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
'Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspoutsmrains:
I, Valuation D~scriotion I
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page I of2
Value
Date Calcuhited
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Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01731
ISSUED: 12/03/2008
APPLIED: 12/03/2008
EXPIRES: 06/03/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Total Value of Project
Fees Paicl I
Fee Description
. + 10% Administrative Fee
+ 12% State Surcharge
'+ 5% Technology Fee
Backl10w Device
Minimum/Adjustment Plumbing
. Amolint Paid
Date Paid
Receipt Number
$5,20
$6.24
$2,60
$17,00
$35.00
1213108
1213108
, 12/3/08
1213108
12/3108
2200800000000001704
2200800000000001704
2200800000000001704
2200800000000001704
2200800000000001704
, Total Amount Paid
$66,04
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
, a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.'
. I, Reouirecl In~nections I
Backl10w Device: Prior to covering and provide a c,opy of the test report on site at the,time of inspection.
By signature, 1 state and agree, that I have,carefnlly examined' the completed application and do hereby certify that all
information hereon is true and correct, and I.further certify that any and all work performed shall be done in accordance with
the Ordinances'of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made ofany structure without permission of the Community Services Division, Building Safety,
I further certify that only contractors and employees who are in compliance' with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction. . ~ I
~~ 37\,c.o~
Owner or Contractors Signature
Date
, Pa!!e 2 of 2
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54I)'726-3753 . FAX: (541)726-3689
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~ Date of Applir~t;"n
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~ Checked for Delinquencip<
ai$
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CIty Job Number C. F -11 ) /
Job LocationJ-'5"Q7 <; D L,. '/
Tax Lot
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'2-30' \
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Phorp 7 2.~ - 772. 'S:
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Stotp ~
Zip '4 ') '-/ 7 ?
BACKFLOW PREVENTION DEVICE PERMIT FEE: $66.04
. '
Contractorl<~ \^ -\- -
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State..i:l:,o.... '
CI,'l Ll,0 I
Zip
Construction Contractors Registration #
'-\<i$'/""(
Expires
By'signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been installed and' is visible for inspection (726-3769). I also state that all information on this
permit/application is correct.
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Dotp ~ 1?J1rC.. tJ.-aof1
For Office Use
1:1- /0 J
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Checked for Historical Statu.<
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Shared Drive (T:)lBuilding Forms/Backflow Prevention 7-08.doc
225 Fifth Street
Springfield, Oregon 97477
54J~726-3759 Phone
Job/Journal Number
COM2008-0 1731
COM2008-0173 I
COM2008-0173 I
COM2008-0173 I
COM2008-0173 I
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #: . 2200800000000001704
Description
Backflow Device'
Minimum/Adjustment Plumbing
, + 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
RIGHT_WAY PLUM
Check Number
Received By, Batch Number
cJc
",
Page 1 of 1
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 12/03/2008
2:04:15PM
Item Total:
Authorization
Number How Received
Amount Due
17.00
35.00
2.60
,6.24
5.20
$66.04
Amount Paid
098283 In Person
Payment Total:
$66.04
$66.04
".
12/3/2008