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Home My WebLink AboutPermit Plumbing 2007-06-21F Building/Combination Permit Status: Issued 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2007-00920ISSUED: 0612112007 APPLIEDz 0612112007 EXPIRES: 1212112007 VALUE: SITE ADDRESS: 2753 3rd St ASSESSOR'SPARCELNO.: 1702193100510 PROJECT DESCRIPTION: Backflow device License Expiration Date TYPE OF WORK: Backflow Device TYPE OF USE: New Residential Phone Number: 541'746-3154 Phone Owner: Address: DALE KINLEY 2753 3RD ST SPRINGFIELD THIS PERMIT S Contractor Tvpe Plumbing AUTHt)RiZED Co00$!th&{'ICED oltAtpB1B0 DAY ORISA PERIOD # 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: A11ENTION:the oregdby Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/CarPort Sq Ft Other: Occupant Load: R-3 VB Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: in OA 0090 \\ing the o/o of center UtilitY nla to on Uti\ttY ru\es are set torth OAR 952-001- es ot the rules tly telePhoneote: the Notilication REQUIRED PARKING Total: Handicapped: Compact: Dist:to\ Notitic ca $ Per Sq Ft or multiplier Sidewalk Type: Downspouts/Drains: Square Footage or Bid Amount V Description TYPe of Construction Page I of2 Value Date Calculated x*Flry*s , Building/Combination Permit Status: Issued 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2007-00920ISSUED: 0612112007 APPLIED: 0612112007 EXPIRESz 1212112007 VALUE: Fee Description + l0oh Administrative Fee + 5olo Technology Fee + 87o State Surcharge Backflow Device Minimum/Adj ustment Plumbing Total Value of Project Date Paid 6t2u07 6t2u07 6t2y07 6t2u07 6t2|07 Receipt Number 2200700000000000994 2200700000000000994 2200700000000000994 2200700000000000994 2200700000000000994 inspections requested before 7:00 7:00 a.m. will be made the following Amount Paid $4.s0 s2.25 $3.60 $14.00 $31.00 Total Amount Paid $5s.35 To Request an inspection call the24 hour recording at 726'3769. All a.m. will be made the same working day, inspections requested after work day. 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 ,na "lt 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 aie in compliance with oRS 701.005 will be used on this project' I further agree to ensure that all required inspeciions 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 du ring construction. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection' Plan Owner or Signature Page2 of2 Date 6"?t- o1 F ees rald I ( Construction Contractors Board 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Permit #: C6i,nZt-,7- o o ?Lo 2253 3{''l --1-* Address Issued by:\<Date: ( Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: E h_ I I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. 2 + tr 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reYerse side of this form. C of permi @ate) permitfile, pink copy to applicant.)(lVhite copy to issuing agency Property_owner.doc 06-0 I -04 /2,i / -oa !*Ftrrl6FlSl-D ^ity of Springfield Official Receipt evelopment Services DePartment Public Works DePartment 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone RECEIPT #: 2200700000000000994 Date: 0612112007 ll:12:2eAM .lob/Journal Number coM2007-00920 coM2007-00920 coM2007-00920 coM2007-00920 coM2007-00920 Description + 5% Technology Fee + 8% State Surcharge + l0%o Administrative Fee Backflow Device M inimum/Adj ustment Plumbing Amount Due 2.25 3.60 4.50 14.00 3 1.00 Item Total:$5s.3s Check Number AuthorizationPayments: Type of Payment Paid By Received By Batch Number Number How Received Amount Paid djb 7785 In Person Payment Total:$ss.35 $55.35CheckARLENE KINLEY cReceintl Page I of I 6t212007 225FIYIH STREET . SPRINGFIELD, OR 97477 o PH:(541)726-3753 o FAX: (541)726-3689 (a*tz-oo7-o o 7Zr) City Job N 1 7,d 57 n-t €/ 'Ll7". 1l ) flrt tnt t-(cr p;{ {-)d () r 1;r{ tE{g Job Location Assessors 702I ) l Tax Lot c,Ot(\ Da le /1ln /"Owner(1t-t Address 'ri 4 -?'i nz 1r zip 4(, efu\l J tqle ( {q'7 a-2-,F-l CitY ) r)S BACKFLOW PRE\,'E]YTION DE\,'ICE PER\{IT FEE:$s5.3s f)t.-t',VFL e q-{ r-1 )-,{}{t-{ C)A -i() () o 1:{ C)n (.'1 ir( \Jrfi {-J,-1)-.{ C) () $-t Fr B \-/#q-.iul-rt C)d, m Contractor Addres City Construction Contractors Registration # Expires AITEI'JTION: Otegon law reqtrires you to fr,llorry rules aiici;tr:rl bV tlre Oicton UtilitV By signing this permit/application, I agree to i:dim['iful3i#itfeg'grf,f,&Akkfbnprevention device has been installed anO iJvisiUle for inspectipri (72Q-3r.€fu dsilgqffitq&q$r@tA{UE{9f-quulation on this S tqtc zip permit/application is correct.ain copies of the rules bY r. (Note: the telephone regon Utility Notification-. 7A \/'t7,^21 '7l* (€ For Office Use b/2.(/ Date of Application Shared Drive (T:)/Building Forms/Backflow Prcvention8-06.doc CITY OF SPRTNGFIELD, OREGON 77 l\r[ on (- P1'ron" 1t't'O'' i,'.,'' " C o ntrs cto r lnformation GE: TH1S P ER ANY 1 80 IT IS NOI Checked for Delinquencies L Checked for Historical Status E '