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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. ~~ )'.- ,q - () K- c....--- Owner or Contractors Signature Date Pa2;e 2 of 2 ~ o · 'l""""'I ~, C\j u · 'l""""'I r--4 ~ ~ < ~ · 'l""""'I S Cl.) ~ Cl.) u · 'l""""'I ;>- Cl.) Q ~ o · 'l""""'I ~ ~ Cl) ;>- Cl.) ~ ~ ~ o r~ r~ U ~ en 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 ~(I'1 ' It /4'( {,If Oar 1 I ( () ~ 11 9-)y?gr Assessors Mar Tax Lot Owner l h 0.r-C"/r ( -f {L ~eJL ~j01 , '6 ~ - Lo~f fw -1069 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 9~eoJ fj Cv",- f({" <-{u/tJ Q-O (e>:x \. ~ <tq Phonf' CO G- }' ) () 6 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