HomeMy WebLinkAboutPermit Plumbing 2008-5-19
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2008-00708
ISSUED: 05/19/2008
APPLIED: 05/19/2008
EXPIRES: 11/19/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 662 Laksonen Lp
ASSESSOR'S PARCEL NO.: 1702352302100
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Backflow prevention device
Owner: ROBERSON MARGARET E
Address: 662 LAKSONEN LOOP
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION.
Contractor Type
Use Initials
Contractor
SPECIALTY CONTRACTORS
BUILDING INFORMATION I
License
Expiration Date Phone
(541) 606-3306
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
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:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Sidewalk Type:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
ATTENTION. Oregon law requires you to
follow rules adopted by the Oregon Utility
NotifIcation Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001-
."U ..lIt: UU8U YOU may amain copies OT me rUll::lS oy
THIS PERMIT SHALL EXPIRE IF THE \NMallUation Description I calling the center. (Note: the telephone
AUTHORIZED UNDER THIS PERMIT IS NOT number for the, Oregon Utility Notification
.L:'.I!Lu:Ul:NCErtrt:\.o.I.O'I\'D.A4L!:\t:'.!lJJ:.n FO..$ Per Sq Ft Square Footage Center IS 1-800-332-2344).
De~vJlJ.llli~lIc UJ.U1f1F ro P'\lWt\YIloI\HtWLJ K It' I' B'd A t Value Date Calculated
ANY 180 DAY PERIOD. or mu Ip ler or I moun
Notes:
Pa2;e 1 of 2
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2008-00708
ISSUED: 05/19/2008
APPLIED: 05/19/2008
EXPIRES: 11/19/2008
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
+ 12% State Surcharge
+ 5% Technology Fee
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$5.00
$6.00
$2.50
$16.00
$34.00
5/19/08
5/19/08
5/19/08
5/19/08
5/19/08
2200800000000000694
2200800000000000694
2200800000000000694
2200800000000000694
2200800000000000694
Total Amount Paid
$63.50
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
Backflow 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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Owner or Contractors Signature
Date
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689
City Job Number Com2.6D~ /' OOt 0<6
Job Location {~G~ (0L Cr <:J'--\f>q
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Assessors Mar
Tax Lot
Owner l h 0.r-C"/r ( -f {L ~eJL ~j01
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Address (oG 1 (c:; "L f{ 5.)fA p~ Phone"
City c;~ rL .L-(/ (2L'e fP Statp () {L '- Zip q~7r
- ~
BACKFLOW PREVENTION DEVICE PERMIT FEE: $63.50
Contractor Information
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7~"0- v~: r t~ (j/ State V rL( Zip ~)v?7
Construction Contractors Registration # (( ftr C( / I) C; 0 Expires <6 -'J(....;f /1 c- 'P - rJ 6
/
Contractor
Address
City
By signing this permit/application, I agree to call for an inspection once the backtlow prevention device
has been installed and IS visible for inspection (726-3769). I also state that all information on thIs
permit/application is correct.
Signature
-2?C::--
L_(('_Df(
Datp /
For Office Use
Date of Application
Checked for Delinquencwl;
Checked for Historical Status
Shared Dnve (T )/BUlldmg FonnslBackflow PreventIon 1-08 doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-00708
COM2008-00708
COM2008-00708
COM2008-00708
COM2008-00708
Payments:
Type of Payment
Cash
cRecemtl
RECEIPT #:
2200800000000000694
Date: 05/19/2008
DescriptIOn
Backflow Device
Mlmmum/ AdJustment Plumbmg
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmmlstratIve Fee
Paid By
SPECIALTY CONTRACTORS
Item Total:
Check Number AuthorizatIOn
ReceIved By Batch Number Number How ReceIved
ddk
In Person
Payment Total:
Page I of I
12:13:47PM
Amount Due
1600
3400
250
600
500
$63.50
Amount PaId
$63 50
$63.50
5/19/2008