HomeMy WebLinkAboutPermit Miscellaneous 2005-9-6
. CITYOFSPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01212
ISSUED: 09/06/2005
APPLIED: 09/06/2005
EXPIRES: 03/06/2006
VALUE:
.
Status: Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 2719 Game Farm Rd
ASSESSOR'S PARCEL NO.: 1703224105700
Springfield TYPE OF
Site Work Only
PROJECT DESCRIPTION: InstaU water line to lot 3 Cline partition
TYPE OF USE: New
Residential
\l\ a'i'S,
,~C It I\\~ Ie, ",\II
IPUBLIC IMPROVEMENisj,~s 'i''i:.'''I~~ tCl?-
" ' "II - \:\1' I\\"~
t., '~~~I\~I \l'01't\) '1;)r\'\'SidewalkType:
'\ \,'.J 'I~\:. \'I IS "
'1\ t'.Cl\' "r'i:.\) Cl GICl\) , DownspoutslDrains
p>v '- I"v o\;:, II
\J\,,;.,I\- \)t'<'I'
C, . ~ 'I <Q\)
'"'~
Owner: CLINE RALPH G JR & BETTY A
Address: 1150 WmSTLERS LN
ROSEBURG OR 97470
I CONTRACTOR INFORMATION I
OU \0
Contractor nulle'=> 'l U\I\I\'l License
EMERY)lf,sdN~\(J~fisn\tJ)eVON INC 312
~IO~' Ole~~o. 'O'l \~~ule'(BUIL'}~G'INFORMA TIONI
:\'\:.~ Ie'=> ?J.o.o~ I ,'(Io'=> ouQ,'(I ~' \'(Ie I'-":'"a
# of Units: '" "101tl IU Ce<:'<W ;'.~\'(II ',n,=> 0\ .""o'f<Stor~s:
;" ,.,,<:,< .(lv' O~Q \e\t;. .,\10'
Primary Occu... \.\fy,\Gro~p~-()\ :0\-3.1<:'< C ~e'. \'(Ie \~!!ignr of
. Secondary Oc~ t3'!'ify9'.:> \<;\?J.'l 0 \el. ~o U\~I\'l "'T;~e of Heat:
Yrimary Const~cti~'<ryp.~e ce<:'< Ole9;O<:'< ?>?>~.'2.?>~ater Type:
Secondary cons~ltJ,.l1.nl9; ~ \01 \'(Ie. \-'O~~. Range Type:
# of Bedrooms: u\<;\'Oel c,e<:,<\al IS Energy Path:
~ Sprinkred
Contractor Type
Plumhing
nla
I DEVELOPMENT INFORMATION I
'. Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Street
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descrintion I
Descrintion
S Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
1 of 2
Expiration Date
11/24/2007
Phone
503-769-7751
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
,,~
REQUIRED P"~G
.J vt:':)
Total:
Handicapped:
Compact:
Value
Date Calculated
.
.
CITY OF SPRINGFIELD'
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01212
ISSUED: 09/06/2005
APPLIED: 09/06/2005
EXPIRES: 03/06/2006
VALUE:
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Water Line - 1st 50 Feet
Water Line - Each AddtllOO'
Amount Paid
Date Paid
57.30
55.11
545.00
528.00
9/6/05
9/6/05
9/6/05
9/6/05
Receipt Number
1200500000000001307
1200500000000001307
1200500000000001307
1200500000000001307
Total Amount
585.41
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.
Water Line: Prior to filling trench and including required testing.
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 certity 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 wiD be made of any structure without permission of the Community Services Division,
Building Safety. I further certity 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 ofthe property, and the approved set of plans wiD remain on the site
at all times during constructiolL
~/?..a/4-fl E ~tC7 9:: 9ItJ~/~s .,,-
Owner or Contractors Signature Date
2 of 2
225 Fifth Street
SP.ringf!tld, Oregon 97477
541-726-3759 Phone
.
.~'~-.~~,-,' ','.,'
~
~.):
~ty of Springfield Official Receipt
.evelopment Services Department
Public Works Department
Job/Journal Number
COM2005-01212
COM2005-01212
COM2005-01212
COM2005-01212
Payments:
T)1Ie of Payment
CreditCard
.'
-
"
.'
9/6/2005
RECEIPT #:
1200500000000001307
Date: 09/06/2005
Descrlptloo
+ 7% State Surcharge
+ 10% Administrative Fee
Water Line - 1st 50 Feet
Water Line - Each AddtllOO'
Paid By
RALPH CLINE
Item Total:
Lheck Number Authorization
Received By Batch Number Number How Received
DJB 086681 In Person
Payment Total:
I of 1
2:36:45PM
Amoont Due
5.11
7.30
45.00
28.00
$85.41
Amount Paid
$85.41
$85.41