HomeMy WebLinkAboutPermit Plumbing 2007-6-18
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54 ])726.3753 . FAX: (54 ])726-3689
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Tax Lo'
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. BACKFLOW PREVENTION DEVICE PERMIT FEE: $55.35
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By signing this permit/application, I agree to call for an inspection once the ba~\t16~~-e<f~tf6~'(ie~!fe
has been installed and is visible for inspection (726-3769). I also state that ~q~foffi1~tj.6l~~~'" 'Q
permit/application is correct. . ~.O\e '!,.eo ~",e ~ ~"O ~ ~e ~ ~0<;>.0 ~
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. Date of Application
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Shared Drive (f:)fBuilding FonnsfBackflow PreventionS-06.doc
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00863
ISSUED: 06/13/2007
APPLIED: 06/13/2007
EXPIRES: 12/13/2007
VALUE:
.
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 948 DARLENE AVE
ASSESSOR'S PARCEL NO,: 1703272100700
Springfield
TYPE OF WORK: Backtlow Device
PROJECT DESCRIPTION: Backtlow device
TYPE OF USE: New
Residential
Overlay Dist:
# Street Trees Rqd:
Paved Drive R~dfes yOU to
ON' OY!'JgtibOtl~d'fa~~e'on Utility
ATiENT\ . ted by the Or 9 et lorth
, ,,_... ,"les adoP _' __ ,,,Ips are 5 ~.
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Notiticati(fPJ:jal,;JCJM,i>~OMlIMEI'iTS'.les by
in OAI\~; ~~y obtain COP'~~h~ telephoneSidewalk Type:
0090. ter (Note. T ation
calling the cen 0 . gon Utility Notl IC Downspouts/Drains:
number lor the. 1r~800_332.2344),
Centel IS
Owner: NORMAN FOX
Address: 948 DARLENE ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION.
Contractor Type
Landscape
Contractor
NEW MOON YARD CARE
License
7433
I BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: R-3 Heigbt of Struct,,'\(..
Secondary Occupancy Group: TYl!e {v.--\\,\~!-NO
Primary Construction Ty!\e''{\C~:. VB r-.\.\. t.Y-lwa~r T~.lW \S ~OI
Secondary Constructionq-Vp~:I't.?WI\"'i S\-\ ?1\~~ng~.IFYI>~e\:O\\
# of Bedrooms: 1\'\\'5 OIleD Ij\'.mt. ":Ij;Q~"a'ib:
r-.ljl\-\On r:f\ O? IS r-.tS~rinkled Building: nla
_...c.~\r.cu '"""
Vr-.~~"~~Q Dr-.'/ To"EVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
1 Valuation Descriotion ,
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Paee I of 2
Pbone Number: 541-653-8412
Expiration Date
05/31/2008
Phone
541-431-6616
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Otber:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Value
Date Calculated
-Wi
.
. LI1 t OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-00863
ISSUED: 06/13/2007
APPLIED: 06/13/2007
EXPIRES: 12113/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
Ff'f'S PfolillJ
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backnow Device
MinimumlAdjustment Plumbing
Amonnt Paid
Date Paid
$4.50
$2.25
$3.60
$14.00
$31.00
6/13/07
6/13/07
6/13/07
6/13107
6/13/07
Receipt Number
1200700000000000759
1200700000000000759
1200700000000000759
1200700000000000759
1200700000000000759
Total Amount Paid
$55.35
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.
IRf'~
Backnow 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 pertaini~g to the work described herein, and
that NO OCCUPANCY will be made ofony structure without permission ofthe 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
~d~ing constructionn
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6w~er or Contractor~ Signature Date
Paee 2 of2
225 F.iftb Street
Springfield, Oregon 97477
541-726-3759 Pbone
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1iiiY of Springfield Official Receipt
.elopment Services Department
Public Works Department
Job/Journal Number
COM2007-00863
COM2007-00863
COM2007-00863
COM2007-00863
COM2007-00863
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
1200700000000000759
Date: 06/13/2007
Description
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum/Adjustment Plumbing
Paid By
NORMAN FOX
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
2657
In Person
Payment Total:
Page I of I
1I:02:ISAM
Amount Due
2.25
3.60
4.50
14.00
31.00
$55.35
Amount Paid
$55.35
$55.35
6/13/2007