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Home My WebLink AboutPermit Miscellaneous 2010-7-14 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00941 ISSUED: 07/14/2010 APPLIED: 07/14/2010 EXPIRES: 01/14/2011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 218 H ST ASSESSOR'S PARCEL NO.: 1703352212800 ;' ,i~:l. I . '. Springfield TYPE OF WORK: Backllow Device ,< TYPE OF USE: New Residential PROJECT DESCRIPTION: Backllow device Owner: JENSEN ROBERT C Address: 218 H ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License Expiration Date Phone ...... .. ~ -'.' BUILDING INFORMATION ~ # of Units: # of Stories: Primary Occupancy Group: R-3 __."......Height of Structure Secondary Occupancy Group: ~'" . Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: qu.\res......eM' Path: ENTION: Oregon \a~~: oregcfuii;}\i't&\~ Building: nla 101l0W r~ center. T\'1OS8 .. . INFORMATION Notilicatlon 001_0010tl1ro. 0 .. in OAR 952, a: obtain COpies e telep\'1One Front yard Setb"ll~O..'{oU m ~enter. tNote.t~ N~iWiIa""Dist: Side I Setback: calling the the Oregon Utlll.i34~)~treet Trees Rqd: Side 2 Setback: numb8rd~~ter is 1_800.332 Paved Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available:. Special Instruction: ::i!ir;'~ '. . ~'ft'P;;r' .' . . . :\".~\' '.,'j Sidewalk Type:. ." "'.i;;f,,;~ :~~;:~\.,1-.""'" . . Downspouts/Dra';'n~~ ~~ ;~c~O?-\\ . MO"\C~: WI\i S\'\T>.\.\. ~?m ?E?-Wlll \s N01; 1\-\lS ?E~2EO UNOER 1\-1~~OOl"~EO fOR c'>'." p..U1\-10 EO OR IS {>.'O . . Notes: Valuation Descri Descripti~n Type of Construction $ Per Sq.Ft Square Footage or multiplier"; AI' - 'lOr Bid Amount Value Date Calculated "..,.~.,:,.,.b ,........,..."... ""~ ... ,,' IT~p ~~';::-;1 - :, . ~'1;;t'Z;l~; '':' ~,:XN, 1:. Page I of2 Status Issued , CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00941 ISSUED: 07/14/2010 APPLIED: 07/14/2010 EXPIRES: 01/14/2011 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspectioo Line '.;:." J,':I.. , Total Value of Project Fees Paid ~ Fee Description + 12% State Surcharge + 5% Technology Fee Backnow Device Minimum/Adjustment Plumbing Amount Paidtlii?\ ". ~. u " " , Date Paid Receipt Nnmber '. '''I"'~: ',_<c'-" d" $6.9f:T!; , . $2.90'~ ',";".. , oJ.1: $19.00 $39.00 7/14/10 7/14/10 7/14/10 7/14/10 2201000000000000828 2201000000000000828 2201000000000000828 2201000000000000828 Total Amount Paid $67.86 Plan Reviews ~ To Request an inspection call the 24 hour recording lit.726-3769. All inspections requested before 7:00 i ., . ~ a.m. will be made the same working day, ins'jiections requested after 7:00 a.m. will be made the following work day. I Reauired InsDect~ Backnow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. .. 'l~"I'~L . i c.' . .' f By signature, I state and agree, that I have carefullY',examiried'the completed application and do hereby certify tbat all information hereon is true and correct, and I furt~e.r;;<:ertify IlJat any and all work performed shall be done in accordance with the Ordinances ofthe City of Springfield and the ~aws 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 011 this project. I further agree to ensure that all required inspections are requested at the propeitime, that each address is read:lble from the street, that the permit card is located at the front of the property, and the approved set of plans will rem:lin on the site :It :Ill times during construction. .j)}w--&. 7-/4-10 Owner or Contractors Signature Date (CL' l,''':', i1,'o.::' ,. Paee 2 of 2 . :'.: h'.,~, : H '," l'xa linc~J [if, ('I,' 225,Fift!1 Street Springfield, Oregon 97477 541-726-3759 Phone $J:~~:~. '.. Wic.... j . . ..;,...-'C. .' ,...~".~..,_...".,_..- City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000828 Date: 07/14/2010 9:25:26AM Job/Journal Number COM20 I 0-00941 COM20 I 0-00941 COM20 I 0-00941 COM20 10-0094 I Description Backflow Device Minimum/Adjustment Plumbing '- + 12% State Surcharge . , ".. ". + 5% Technology Fee '0, ._ Amount Due 19.00 39.00 6.96 2.90 $67.86 ,11 Payments: Type of Payment Check Paid By ROBERT JENSEN Item Total: Check Number Authorization Received By Batch Number . Number How Received Amount Paid djb 1728 In Person Payment Total: $67.86 $67.86 f-....... '. ':;;::.)h. I.if;:;,'...." ~ .\_;~t~ . .' :'J;;. I.f~\:t_ J':' cRcceintl Page I of I 7/14/2010 " '. ...,;.,. : J~.