HomeMy WebLinkAboutPermit Plumbing 2003-12-10
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01234
ISSUED: 12/10/2003
APPLIED: 12/10/2003
EXPIRES: 06/10/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3315 AMBLESIDE DR
ASSESSOR'S PARCEL NO.: 1702193407200
TYPE OF WORK: Backflow Device
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Backflow device
Owner: SCOTT JORDAN
Address: 28235 CLEAR LAKE RD EUGENE OR 97402
Phone Number: 541-688-3998
I CONTRACTOR INFORMATION I
Contractor Type
Landscape
Contractor
GREGORY HAFFNER LAWN SERVICE
License
7192
Expiration Date
06/30/2004
Phone
541-935-5361
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other: .
Impervious Surface Area:
R-3
I DEVELOPMENT INFORMATION I
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\a.\N \@verlaycP.isf:\\ \ .J
O,,\.Q{egon \-.':/ tnft,Sff~Jt' T;te~'Rqa\
,,\\\ \..... 0 \J \ '" "l~ r. 0
I\.-,n::r'< oo?\e se ~!lveil Driv~~qif:
f"' {u\eS a t' \"\\0 n O~t"\ \AS \
Rearyard Setback: to\\o'J"J. n cen'l.e . '\ 0 \'{\t'09i6\of Lot\~ove'ra'ge:
S 1 S tb k . "\Cal\O 0-1 _00 . n\eS U' ?hO\\e
o ar e ac s: ~o::'" a 95'2.-0, '. r"\hta.\D ~o~",. t'ne te\~.~~~~t\on
\~~O. :oUt~\;~~nt~l,p-Q~~iOjlMrjQ~iMENf\~..nCE: PIRE IF THE WORK
Street Improvements: ca.\\\~;t' 10\ tn. e. ,U\~~OG-~,Y.jt-- ~ THISPES'IMlJa~~.\n~tTXHIS PERMIT IS NOT
nU't1\" ._~,to( If., AUTHOijJZED '(J"NtfEt\
Storm Sewer Available: r . Mt'~W~~kWDONED FOR
Special Instruction: ~~~ 180 DAY PERIOD.
SETBACKS
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Total:
Handicapped:
Compact:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Pal!e 1 of 2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01234
ISSUED: 12/10/2003
APPLIED: 12/10/2003
EXPIRES: 06/10/2004
VALUE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
.541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$4.50
$3.15
$14.00
$31.00
12/10/03
12/10/03
12/10/03
12/10/03
Receipt Number
1200200000000002578
1200200000000002578
1200200000000002578
1200200000000002578
Total Amount Paid
$52.65
I Plan Reviews I
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.
, I Reouired Insoections I
1 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 ofthe property, and the approved set of plans will remain on the site at all
times during construction. .
r/J~~
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Owner or Contractors Signature
/'L'I e..--o...l
Date
Page 2 of2
225 .fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-0 1234
COM2003-01234
COM2003-01234
COM2003-01234
Payments:
Type of Payment
CreditCard
.'
Receipt #: 1200200000000002578
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum! Adjustment Plumbing
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
GREGORY HAFFNER
000244 010949
City of Springfield OffIcial Receipt
Development Services Department
Public Works Department
Date: 12/10/2003
1:33:50PM .
Amount Paid
Item Total:
3.15
4.50
14.00
31.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65