HomeMy WebLinkAboutPermit Plumbing 2003-10-22
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. . CITY OF I)I"Kl)'\jljt<U,LD
Building/Combination Permit
PERMIT NO: COM2003-01075
ISSUED: 10/2212003
APPLIED: 10/2212003
EXPIRES: 04/22/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1595 RAMBLING DR
ASSESSOR'S PARCEL NO,: 1703252209400
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Replace 40ft water line
Owner: MYRON VAN ETTEN
Address: 1595 RAMBLING DR SPRINGFIELD OR 97477
Phone Number: 541-
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor
HOFFMAN NORTHWEST INC
License
71162
Expiration Date
01116/2005
Phone
949-380-4161
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
BUILDING INFORMATION I \0
"o~
leS 1 ~~'\'1
# of Stories: -I'Ile~~\ 01' U \ 8t'Size:
Height of Struc~llj:e \'3' :l\e oleg Ie se ~~t 1st Floor:
Type qf,t\,fii'(:e eO '0'1 ~ 1~\aS ~~ g'=>'S'q F~2nd Floor:
~~\l\1~'tYI!~:;)~~ i,\\ose ~9P 0 :l\e 1..sq>F.t Basement:
~\ ~ng~er'h>S:\\01. '\0\,\\10 iaS 0\ ~ ~a9~~,,~arage/Carport
\0\~~2g.(dP~l',:\ .00 a.il\ c09 "\,\\e \e ~\~ther:
\0\\\\ ~ 9'=>?; a.'! 0'0\ ,\~O\?;\i\\\'j ~OA,~mpervious Surface Area:
r\l' ." rl\ _'Al _ u _nA...,
I DEV,EooP,M.~\INEORMitl()Nll-~
l...... ;'\'~" t\....'
....'Oe ".<'
n~"" (",n
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
REQUIRED PARKING
Vlhr
SETBACKS
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I 'i\"-
Sidewa1kJ'.vl\r\~'t. ~~Q\
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I Valuation Descrfotion I
Notes:
Description
Type of Construction
"SPerSqFt
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paeelof2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01075
ISSUED: 10/2212003
APPLIED: 10/22/2003
EXPIRES: 04/22/2004
VALUE:
Status
Issued
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
Water Line - 1st 50 Feet
Amount Paid
Date Paid
Receipt Number
$4,50
$3,15
$45.00
10/22/03
10/22/03
10/22/03
1200200000000002358
1200200000000002358
1200200000000002358
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 TnsneetionsJ
I 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 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 witb 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
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Owner or ConlTactors Signature Date
J
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-OI075
COM2003-OI075
COM2003-0 1 075
Payments:
Type of Payment
Check
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Receipt #: 1200200000000002358
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Water Line - 1st 50 Feet
Paid By
HOFFMAN NORTHWEST
Received By
djb
f..:heck Number
Batch Number Authorization Number
City of Springfield Official ReCeipt-
Development Services Department
Public Works Department i
Date: 10/22/2003 1:06:01PM
Amount Paid
Item Total:
3.15
4.50
45.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52,65
.
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