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Home My WebLink AboutPermit Plumbing 2007-6-15 " ZZ5f1ITHSTREET 0 SPRINGf1ELD,OR97477 0 PH:(54])7Z6-3753 o FAX: (541)7Z6-3689 ~: . '_ Cg-tf Z e; City Job Number. CP M 'Z <:> C 7 0 O'~4' ,}""-6 L - , l~ Job Location J v <;..... ..., /'f &< C..... ~j ~ Assessors Mop I7D 3~ 52.. 7- ~.~I~ ~ '. ~~ I 0 f17 v".,"-J c., ~~ ~'0' i wner ...... ~ ~'\' ~,.'0'X- <(~ Il' ~ Address l!J ~ 6 ~~ '-Q.s?I:4ttx.e . I ,,- ~v ~,., /' ;....~\; 'X- '" ~<;:j t...'. City ~~.t~fl. ,(\<':: ,,~~ ~ T;,"'{,'J,,-~' '\),- ,\'?' '~i ~~' _ QX-"" .'Ix-'V _ '0'X- _,'0'V' o ~~ . ~'J ~~' X-V <:i'c-" ~: '<\ ~'\~ ~~~OW PREVENTION DEVICE PERMIT FEE: $55.35 :-.- i ' IV~~ ,'b~ ~ r- "---$-' -- ..' 'm _ -,-... "" ,-- -"-",, -, ","' ,-, -_.. ~~ , COli tractor IlIformatioll '" ~ fJ4, 'f /.:/c..,clr L./c.-7\ ~ Contractor, o.~.::.; t:tl<.M fi ~ Addres~ (5 (Il 16 ~ (Ql ~~ ~~ e; -ol'f!!!l4. I~ ~~ ~4 ~ '~ ~ ~~ ~\ ~~ ~ e; r"iJ: ' 'r~ It)) ~ ~l , Tax Lo' j>honp Statp OIL [. VI'//c:,"'(1i;:.~ 2Vr-sYi/r , Ph"rp 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. ~,o~ 4,0 ~ i:S' Fo '~ ,0 ..,: ~({, 0<:- rf;- \:)1::> .\ . c>: Q) c; X '0" <..<tJ O~({, ~0 O:l~ '0<0 :-;:, _ v /' "-.0 ,",,0- ~v ~ca"'~" '\ 0'" ~... ~ ~<..-SO'&o0:>:,~0 0& >.'04, ~0 ~ r}~ i?J.0'1fs.Y'll' O~0VOO,s!'o '-.l~ . ....~ A.'\:' ( 0.0'. ._<0 ...0 ~. OV' :>-"'1'\,<<" .\" t>-Y .f.:P ,'" 'll' ,0.~~9.~K~JilS~"'9c;J <<l .:s-- v- ,--> '"'V ~ ~':f,v ~~ & ~. ",0 ?> '?- ~o, '1>4, ~({, ~0'" \:)<::l b ~_~~Q,y~,^00~..,:'13 / "",,- I'Y y ..., &. &- v S). Q, ,0 ~ru ' .~ S)O) ~~~.-&<.-- 0~ I::l ~.,..v C; Cheeked for Historical Statu" .-.)' ~ ~ City /:::-.....~ t'-,f Construetion Contractors Registration # Lee.. Stat!' 0/2. h_ 7 'I., Signaturf"~~ Date of Application Checked for Delinquencif"" SPRINGFIELD' l-.f\~ <~ *'~ * bZ. '70<.> ^ 7/6 ~ 3//( Zip 97'177 7ip '5?Yc;- Expires' ~-y -:C7 Datp €--: /~- C ') ~ S~ Drive (f:)/Building Forms!Bacld1ow::-._ .....:_..3-06.doc . Status Issued 225 Fifth Street Springlield OR(1)1>8i:-i:88-00B-~ S! .I81U8~ 541-726-3753 Phone UU!180!J!ION iil!mn UOB8JO 841JO) J8qWI1U 541-726-3676 Fax 8U04d8181 841 :810N) 'J81U80 841 BU!IIeO 541-726-3769 InspectiBhl eille1J 841 JO S8!doo U!elqo iiew nOA '0600 -lnn-7C~U\..lf'\11Rn""'llnJ"'\I""^ ,__ ____ Il1rf"'lll.<:'1C"'~'''''^''',,,,,,,,,,,,,_'..~'.~:- .-....... ....-"...........vv~: _ . - -'.... --t"-...v ......~t...v~fHvl'4 SITE ADDRESS: 13S61Ii-A:WNRjD.Q"fA]~~ldope S8lnl'I1Bfll,lreld ASSESSOR'S PARCEICNrul\ s,q0.1~..2Z!!.~9Jl!lB8JO :NOI1N311'tf PROJECT DESCRIPTION: Backflow device Owner: SARA ORR Address: 1356 LA WNRIDGE AVE SPRINGFIELD OR 97477 . Lll i' VI< ~rJ(ll~~I<.I!.LD' Building/Combination Permit PERMIT NO: COM2007-00882 ISSUED: 06/15/2007 APPLIED: 06/15/2007 EXPIRES: 12/15/2007 VALUE: TYPE OF WORK: Backflow Device TYPE OF USE: New Residential I CONTRACTOR INFORMATION I Contractor Type Landscape Contractor DUCKSWORTH LANDSCAPE BUILDING INFORMATION I License 12795 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of ~tories: R 3 H ;r .!t"\f'S't~ wtn ng ~ ANV - elg.. 0 ruc ure: l:lO~ 03 NO 0 Nt}f'pe ofiileat::J3:JN3V1iVliO:J iON '3~ ilVlil:l3d Sm't"tErJ'P'~i 03Z1l:l0HlnV )ll:lOM 3Hl ~I 3l:l1~~J;~/~~:1IVlil:l3d SIHl Sprinkled Buildin"gl 311 0 N n/a I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Paee 1 of 2 Phone Number: 541-746-3116 Expiration Date 08/31/2007 Phone 541-345-5408 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: DownspoutslDrains: Value Date Calculated Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backnow Device Minimum/Adjnstment Plumhing Total Amount Paid . Total Value of Project l.F""",,, Pll\lLJ Amount Paid Date Paid . CITY OF ~rKll~\JN""LD Building/Combination Permit PERMIT NO: COM2007-00882 ISSUED: 06/15/2007 APPLIED: 06/15/2007 EXPIRES: 12/15/2007 VALUE: Receipt Numher 2200700000000000966 2200700000000000966 2200700000000000966 2200700000000000966 2200700000000000966 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. $4.50 $2.25 $3.60 $14.00 $31.00 6/15/07 6/15/07 6/15/07 6/15/07 6/15/07 Backnow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. $55.35 I Plan Reviews I 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 he 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 tbe property, and the approved set of plans will remain on the site at all timeshnction. /-/'0 -0 ? Owner or Contractors Signature Paee 2 of2 Date 225 Fifth Street . . Springfreld, Oregon 97477 541-726-3759 Phone . U;j:a~~ ~., <;;& of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journal Number COM2007-00882 COM2007-00882 COM2007-00882 COM2007-00882 COM2007-00882 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 2200700000000000966 Date: 06/15/2007 Description Backtlow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By PHIL DUCKWORTH Item Total: L:heck Number Authorization Received By Batch Number Number How Received djb 030306 In Person Payment Total: Page I of I II :02:58AM Amount Due 14.00 31.00 2.25 3.60 4.50 $55.35 Amount Paid $55.35 $55.35 6/1512007