HomeMy WebLinkAboutPermit Plumbing 2001-10-13
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01269
ISSUED: 10/13/2004
APPLIED: 10/13/2004
EXPIRES: 04/13/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2220 SHADYLANE DR
ASSESSOR'S PARCEL NO.: 1703262203868
Springfield TYPE OF WORK: Duplex
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Backflow device
Owner: SHEPARD CHARLES N TE
Address: PO BOX 8516 COBURG OR 97401
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W
I CONTRACTOR INFORMATION.
Contractor Type
Plumbing
Contractor
UMBRELLA PROPERTIES
BUILDING INFORMATION.
License
Expiration Date Phone
484-6595
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# 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:
n/a
I DEVELOPMENT INFORMATION.
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
ATTENTION: Oregon law requires you to
NOTH::r2: follow rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRF IF THF WORK Notification Center. Those rules are set forth
AUTHORIZED UNDER THIS P-iiivlIl- I;) '~Ub I OAR 952-001-0010 througn UAH ~b~-UU1-
COMMENCED OR IS ABAND ~Vf n escri tion 090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
Type of Construction $ Per Sq Ft Squ~re FWU~er for the ~ilm;>n Utility fJ!1aWi~ated
or multiplier or Bid Amount Center is 1-800-332-2344). "
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Total Value of Project
Pae:e 1 of2
,
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backflow Device
Minimum/Adjustment Piumbing
Total Amount Paid
I Fees Paid I
Amount Paid'
$4.50
$3.15
$14.00
$31.00
$52.65
I Plan Reviews I
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004~01269
ISSUED: 10/13/2004
APPLIED: 10/13/2004
EXPIRES: 04/13/2005
VALUE:
Date Paid
Receipt Number
10/13/04
10/13/04
10/13/04
10/13/04
3200400000000000288
3200400000000000288
3200400000000000288
3200400000000000288
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 Reauired Insnections I
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 of the property, and the approved set of plims will remain on the site at all
times during construction.
" L---'
Owner or Contractors Signature
~
Pal!e 2 of 2
foisw
/ I'
Date"
~25 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-01269
COM2004-0 1269
GOM2004-01269
COM2004-01269
Payments:
Type of Payment
Check
10/13/2004
RECEIPT #:
""Uy of Springfield Official Receipt
evelopment Services Department
Public Works Department
3200400000000000288
Date: 10/13/2004
Description
Backflow Device
Minimum/Adjustment piumbing'
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
UMBRELLA PROPERTIES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
dIm
60518
In Person
Payment Total:
Page 1 of 1
3:08:28PM
Amount Due
14,00
31.00
3,15
4,50
$52.65
Amount Paid
$52,65
$52.65