HomeMy WebLinkAboutPermit Plumbing 2009-7-7 (2)
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00990
ISSUED: 07/0712009
APPLIED: 07/0712009
EXPIRES: 01/0712010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Lioe
SITE ADDRESS: 1086 F ST
ASSESSOR'S PARCEL NO.: 1703351106000
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Replace water line
Owner:
Address:
TRENA JAYNE
1086 F ST
SPRINGFIELD OR 97477
Phone Number: 541-991-0924
I CONTRACTOR INFORMATION 1
Contractor Type
Plumbing
Contractor
BERNARD PETERSEN INC
License
93126
Expiration Date
08/23/2U 11
Phone
541-343-9339
"\ I, BUI~DING INFORMATION 1
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
VB
n/a
I DEVELOPMENT INFORMATION ,I
REQUIRED PARKING
Front yard' Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
#Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBUlmMPRPYEME~TS 1
'~'''.H' f.. ~~....d .,. "-V reouires \/,:,:\, ...
Nor ;-.0\.. ~'~" Opted by the CSidewalk-Type:
. . . ~,:::" Center. Thos ' "'!dun Utility:
,m ~A" ,oJ.2'001-001 0 thr e rdlemhvnsPP!!.\s,Wrains:
DO,,:!. \ou may obt. ough OAR 952-001
1/' ' am cop. -
(;f; !ng the center (N t 18S of the rules by
qlUmber for the Or~.g oue:. the telephone
Con tl/lty N t.f.
enter is 1-800_'<'<0 o^. ? Ilcation
Notes:
-- , .~J'
NOTICE: I Valuation DescriDtion I
THIS PERMIT SHALL EXPIRE IF THE VVUKK
D . AtI.lTHORIZ'fr:n 1111'f",!;R Ttl-lICt..Dt:RMIT$,Po~.s" Ft . Square Footage
escnp1lOn ype 0 -tons rue Ion Iv l'i1lJ,r . .
COMMENCED OR IS ABANDONED ~Or?ultlpher or BId Amount
ANY 180 DAY PERIOD.
Value
Date Calculated
,
Paee lof 2
-$~~~C!Il'I!f.~I..
it
y,
Status
Issued
225 Fifth Street, Springfield, OR .
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.J
Total Value of Project
Fees Pairl J
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Water Line - 1st 100'
+ 12% State Surcharge
+ 5% Technology Fee
Fixture
Amount Paid
Date Paid
$9.12
$3.80
$76.00
$6.84
$2.85
$57.00
7/7/09
7/7/09
7/7/09
7/9/09
7/9/09
7/9/09
Total Amount Paid
$155.61
I Plan Reviews ,
CITY OF SPRINl:iHli,LD
Building/Combination Permit
PERMIT NO: COM2009-00990
ISSUED: 07/0712009
APPLIED: 07/0712009
EXPIRES: 01107/2010
VALUE:
Receipt Number
2200900000000000763
2200900000000000763
2200900000000000763
2200900000000000772
2200900000000000772
2200900000000000772
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 Re/luirerllnsnecti/ln.s I
Water Line: Prior to tilling trench and including required testing.
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 descrihed 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 011 the site at all
times during construction.
Owner or Contractors Signature
Pa2e 2 of 2
Date
225 Fifth Str~et
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00990
COM2009-00990
COM2009-00990
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
Description
Fixture
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
TRENAJAYNE
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000772
Date: 07/09/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm
465065 In Person
Payment Total:
Page I of I
10:23:07AM
Amount Due
57.00
2.85
6.84
$66.69
Amount Paid
$66.69_
$66.69
7/9/2009