HomeMy WebLinkAboutPermit Plumbing 2007-9-20
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ZZ5FIITHSTREET _ SPRINGFlELD,OR97477. PH:(541)7Z6-3753 -FAX:: (541)726-3689
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~' For Offi9tl"i!1\mON~ Ore.gnn raw 'Aq'Ift'- y~
O ~ follow rules adopted by the Oregon Utility
. I ~ Notification Center. Those rules are set forth
r,'ll Date of Application 9 Z u 6 1ft OAR 952-001-0010 throuah OAR 952-001.
Y OU90. YOU may obtain copies of the rul~
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~ THIS PERMIT SHAll EXPIRE IF THE WORK
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COMMENCED OR IS ABANDONED fOR
ANY 180 DAY PERIOD.
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BACKFLO'V PREVENTION DEVICE PERMIT FEE: $61.50
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By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been installed and is visible for inspection (726-3769). I also state that all information on this
permit/application is correct.
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Shared Drive (T:)/Building Fonns/Backflow Prevention 7.07.doc
I CONTRACTOR INFORMA nON I
AITENTlON: Oregon law requires you to .
Co~~es adopted by the Oregon Utility License
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# of Units: number for the Orego 'Ot if f' . ~p o~e
Primary Occupancy Group: <ftnlter is 1-80 _ ~_ YUPNl-QfI
Secondary Occupancy Group: Type 0 e t:
Primary Construction Type VB Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: Energy Path:
Sprinkled Building:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5750 MONTCLAIRE WAY
ASSESSOR'S PARCEL NO.: 1802030004600
Springfield
PROJECT DESCRIPTION: backflow device
Owner: HA YDEN ENTERPRISES
Address: 2622 SW GLACIER PL #110
REDMOND OR 97756
Contractor Type
Landscape
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01432
ISSUED: 09/20/2007
APPLIED: 09/20/2007
EXPIRES: 03/20/2008
VALUE:
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
Phone Number: 541-228-1081
Expiration Date
02/28/2008
Phone
541-998-2039
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMA nON,
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
NOT!rE:
THIS PERMIT S
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation Description I
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Paee 1 of2
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Value
Date Calculated
Status
Issued
CITY OF SPJ:{11~GFIELD '
Building/Combination Permit
PERMIT NO: COM2007-01432
ISSUED: 09/20/2007
APPLIED: 09/20/2007
EXPIRES: 03/2012008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
BackfIow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$5.00
$2.50
$4.00
$16,00
$34,00
9/20/07
9120/07
9120/07
9120/07
9/20/07
2200700000000001474
2200700000000001474
2200700000000001474
2200700000000001474
2200700000000001474
Total Amount Paid
$61.50
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Reouired Insoections I
--
BackfIow 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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7- ,;20-0 ?
Owner or Contractors Signature
Date
Paee 2 of 2
225 Fifth Str-eet
. .
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-01432
COM2007-0 1432
COM2007-01432
COM2007-01432
COM2007 -01432
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000001474
Date: 09/20/2007
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
HAYDEN ENT
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 099179 In Person
Payment Total:
Page 1 of 1
9:44:07 AM
Amount Due
16.00
34.00
2.50
4.00
5.00
$61.50
Amount Paid
$61.50
$61.50
9/20/2007