HomeMy WebLinkAboutPermit Plumbing 2005-1-24
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CITY OF SPRINGFIELD
Status
Issued
, Building/Combination Permit
PERMIT NO: COM2005-00095
ISSUED: 01124/2005
APPLIED: 01124/2005
EXPIRES: 07/24/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1462 I ST
ASSESSOR'S PARCEL NO.: 1703362203700
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Approx 701fwater line, replace interior potable supply lines
Commercial
Owner: MCKENZIE ANESTHESIA GROUP PC
Address: 1462 I ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor ATTENTION: OregoJt&w~~uire~fdltion Date Phone
, KEVIN LEE KIKER fnllnw rlllp.~ <=lrlnntArl ~Oreaon Ut1M@0/2006 541-744-0700
BUW}I'JI1~(!PINF~A n~ules are set forth
In UAti ~O<:::-UU I-UU I U uHuJgh OAR 952-0010
0(f#9{)'.Si6t1dJlay obtain copies of the ruma ~~e:
IOOiJj;.~tlitI1JXentM. (Note: the telepl'ql't Ist Floor:
i{allntnf~ll1lt1e Oregon Utility Notific8ticm 2nd Floor:
Water 1lSeMer is 1-80D-332-.2344)o Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary ConstruCtion Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMENT INFORMATION I
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:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUB~H_1'J1>>'IUtOVEMENTS I
THIS PERMIT SHALL EXPIRSi~waik1tyv~K
AUTHORIZED UNDER THIS B~aMcroUlsJm.lins:
COMMENCED OR IS ABANDONEifFOR .
ANY 180 DAY PERIOD. '
Notes:
, I Valuation Description 'I
Description
Type of Construction
$ Per Sq Ft
or multiplier.
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e 1 of2
Status
Issued ,
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00095
ISSUED: 01124/2005
APPLIED: 01124/2005
EXPIRES: 07/24/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone,
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
LFees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Miscellaneous Plumbing
Water Line -1st 50 Feet
Water Line - Each Addtll00'
Amount Paid Date Paid Receipt Number
$10.40 1/24/05 3200500000000000030
$7.28 1/24/05 3200500000000000030
$45.00 1/24/05 3200500000000000030
$45.00 1/24/05 3200500000000000030
$14.00 1/24/05 3200500000000000030
Total Amount Paid
$121.68
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.
L Reauired Insoections I
Water Line: Prior to filling trench and including required testing.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
By signature, I state and agree, that I have c~refully 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. . /?
~ ' ". /e'"_,
~~~
O"(~.(~ctors Signature
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Date
Paee 2 of2
225 Fifth pStreet
Spfin'gfleld, Oregon 97477 "
541-726-3759 Phone
r1ty of Springfield Official Receipt
velopment Services Department,
Public Works Department
RECEIPT #:
3200500000000000030
Date: 01124/2005
11:43:53AM
Job/Journal Number
COM2005c00095
COM2005-00095
COM2005-00095
C.OM2005-00095
COM2005-00095
Description
Miscellaneous Plumbing
Water Line - 1st 50 Feet
Water Line - Each Addtl 100'
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
45,00
45,00
14.00
7.28
10.40
$121.68
Amount Paid
Check
PRICE RITE
djb
619
In Person
Payment Total:
$121.68
$121.68
1/24/2005
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