HomeMy WebLinkAboutPermit Plumbing 2003-9-11
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00886
ISSUED: 09/11/2003
APPLIED: 09/11/2003
EXPIRES: 03/11/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-376?Jnsl!e~tiop'iLineregon law reqUires you to
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SITE ADD~~g.:ation ljQ:b~~~~bR~~THIA"'8~R~ 9~5-2-00 ~ Springfield
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ASSESSOR'S PAKCEL NO.: bt1802Qa~,g21Bq the rules l
0090. You may 0 am C fJ ::l
P' . " .1-,- ....:lnt"'r I~!otrnthe telephone
PROJECT DES<DRlr'l ItlN:' Batktlow .~YticN t'fication
number for the Oregon till Y 0 t
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Owner: LYTLE BRUCE
Address: 4394 FORSYTHIA ST SPRINGFIELD OR 97478
Owner: ALEXANDERLADELLE NOT~CE:
Address: 4394 FORSYTHIA ST SPRINGFIELD OR 974f'~IS PERMIT SHALL EXPIRE IF THE WORK
';U-:-IIDr.IZeE urW[;-', -:-lllD r[fU~lI~ (J IJG"i'
CONTRAC~lJJ(D~ BANDONED FOR
TYPE OF WORK: Backtlow Device
TYPE OF USE:
Contractor Type
Landscape
Contractor
GRANTS LANDSCAPE SERVICE
License
10250
Expiration Date
09/30/2004
Phone
541-746-8482
BUILDING INFORMATION I
# of Buildings:
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:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
Pa2e 1 of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00886
ISSUED: 09/1112003
APPLIED: 09/1112003
EXPIRES: 03/11/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backtlow Device
Miscellaneous Plumbing
Amount Paid
Date Paid
$4.50
$3.15
$14.00
$31.00
9/11/03
9/11/03
9/11/03
9/11/03
Receipt Number
1200200000000002101
1200200000000002101
1200200000000002101
1200200000000002101
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.
, Reouired Insnections I
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 arty 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 al..,equired inspections are requested at the proper time, that each address is readable from the
street, that th.~ permit1cat.d7iS 16'cated at the front of the property, and the approved set of plans will remain on the site at all
t. d' ! t II.t' I J
Imes urI~cons ruc lQn.
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i~ I (/ r
Owner \fr Contracto"fs Signature Date
Pa2e 2 of2
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o ~foll~::: :}1r-rtnrl hy tho ()ro~()n Iltility
· r?1,~..ificationcel~~E~ul~~fQ;' .
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Q'Q~O. You maYlql9}.~'l topi~ ,pf the rules i
~i cam~gl~~~ ~~~;I~l\1lr'1to~Sk1~~ be. (v€
~.. num~er forJl1e Oreg~ Utility Notification ,#
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d T~I~ ~~~~_n~T )~11'-.'-. EYPIQ~ If.: T~E 'M0Ql(
R.. '.... BACKFLO\V PERlVUT IS $52.65 (includes plllJJHQB.~~JW~c1ffiSo~O~'ll.S.NQt['ative Fee)
e.; COMMENtt[rC1f1S~A~ANt) Nclrrm
~1i ANY 180 DAY PERIOD.
n"'~i Contractor Information
<U 6-~TS LlrNf)SW~ S'~VICRS
U./ Contractor
oV"""""l1 'P. tJ . \SO().. 22, 7 ~
~. Address
(j). City @. )~~ ( tJt-. State d-
f"J Construction Contractors Registration # U 7)", / (.
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. U, Checked for Delinquenci~"
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Numbe~/Yl;J lJD:5 ~og~~
Job Location q 31 ~ tbiz-,5 VI n+ 14- Df0\ ~
-S?fu:> .
Tax Lot
Phon~
7Y/-/7Itj
Zip . 7'7/.17!"
Phonl'"
. ,
Zip r7t/ 02-
Expires c:J '-1/03/ () S-
By signing this pennit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible for inspection (726-3769). I also state that all infonnation on
this permiVapPlicat is cil/; ;J
Signature ~ r U- Date 1-1/-02-
For Office Use
Date of Application ~/ / ~/ 0"3
~,.
Checked for Historical Status
Shared Drive (T;)/Building FOllllS/Backflow Prevention I-03,doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00886
COM2003-00886
COM2003-00886
COM2003-00886
Payments:
Type of Payment
CreditCard
Receipt #: 1200200000000002101
Description
Backflow Device
Miscellaneous Plumbing
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
TERRY L THORN
Received By
nJm
Check Number
Batch Number Authorization Number
00165 011172
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 09/11/2003
10:26:14AM
Amount Paid
Item Total:
14.00
31.00
3.15
4.50
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65