HomeMy WebLinkAboutPermit Plumbing 2004-3-25
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00332
ISSUED: 03/25/2004
APPLIED: 03/25/2004
EXPIRES: 09/25/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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SITE ADDRESS: 6090 MICA ST
ASSESSOR'S PARCEL NO.: 1802033400147
TYPE OF WORK: Backflow Device
PROJECT DESCRIPTION: Backflow device
TYPE OF USE:
Residential
Owner: TINA NAULT
Address: 6090 MICA ST SPRINGFIELD OR 97478
# of Units: # of Stories:
Primary Occupancy Group: R-3 Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VN Water Type:
Secondary Construction Type: Range Type: to
..JW,hw rmniJlreS you
# of Bedrooms: T'ON'oregUft.t<Jl.gfl~H'. UtTt
ATTEN . d by the Oregon II y
&~lIn.\A' rilles adopte .... .1-.... orUet fort
'J~tification CD I'j'f."!"'.- -~A~ON
10 OAR 952-0 ;.;. ih1fOpies 0
0090. Yoy may obta 'FJMl.telephone
calling the center~'tt\i~~Nm.i dication
number;~~~~~;?~ J?m~v'2~' .
Contractor Type
Landscape
SETBACKS
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
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Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
I CONTRACTOR INFORMATION I
Contractor
MEDALLION LANDSCAPE SERVICE INC
License
7118
I BUILDING INFORMATION I
% of Lot Coverage:
New
Phone Number: 541-746-9172
Expiration Date
02/28/2005
Phone
541-933-2745
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
NOTICE: Sidewalk Type:
THIS PERMIT SHALL EXPIRE IF THE WOR~ownspouts/Drains:
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
'{~
Total Value of Project
Paee 1 of2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2004-00332
ISSUED: 03/25/2004
APPLIED: 03/25/2004
EXPIRES: 09/25/2004
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
"k Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$4.50
$3.15
$14.00
$31.00
3/25/04
3/25/04
3/25/04
3/25/04
Receipt Number
1200400000000000387
1200400000000000387
1200400000000000387
1200400000000000387
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 Insnections ,
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 of the property, and the approved set of plans will remain on the site at all
times during construction.
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Owner or Contractors Signature
Date
..
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00332
COM2004-00332
COM2004-00332
COM2004-00332
Payments:
Type of Payment
Check
Receipt#: 1200400000000000387
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum! Adjustment Plumbing
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
MEDALLION LANDSCAPE
5052
City of dpringfield Official Receipt.
Development Services Department
Public Works Department .
Date: 03/25/2004 11:58:00AM
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
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ZZ5 FWrI-I STREET. SFRINGFIELD, OR 97477 . FH:(541)726-3753 0 FAX: (541)726-3689
Cify Job NumberCOn-tZ004- 003"3 Z-
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Job Locatiop
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Tax Lot
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Assessors M(lr
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BACKFLO\V PERMIT IS $52.65 (includes Permit Fee, State~~'4\l~.ge & Administrative Fee)
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Contractor Informatiol1
Construction Contractors Registration #
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Expires ,;< -=-< 8" - 6$
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Y sIgmng t IS penll1t app IcatIOn, agree 1{\V~?r an ~ti<m ,~r>a ~f1ow preventIOn
devise has been installed and is visible fo~l~'\"!!1t\il~~~J)\t;Wtll~ at all information on
this pennit/application is correct. . "~\,\Q~\tt: 0" \$ f:\\)
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Datf' 3 '- 2 S ,. 0 y
For Office Use
Date of Application
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Checked for Delinquencit'''
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Checked for Historical Status
Shared Drive (T:)/Building FonllS/BackOow Prevention I-03.doc