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Home My WebLink AboutPermit Backflow Test 2008-7-16 CITY VI' ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2008-01067 ISSUED: 07/16/2008 APPLIED. 07/16/2008 EXPIRES: 01/1612009 VALUE Status Issued 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 951 S 56TH ST ASSESSOR'S PARCEL NO 1802041108900 SPRINGFIETYPE OF WORK Backflow DevIce TYPE OF USE PROJECT DESCRIPTION Backflow devIce Owner Address MINIUM DENNIS R 8745 THURSTON RD SPRINGFIELD OR 97478 /- -~'\IT'("1 Orngon lau, ~"'!",I~IIO~. ~lOJJ tt"l , ' ; ~"t d by I"COlNTRAtlT.oR,INFORMA TlON I I It. ~ :t n..p e "[inr,. " , 01'0' - ller Those rules are set fortn Contractor Tvp~ l' <;Q'JtractoJJ10 through OAR 952-001- LIcense Ldndscape r 1 sqHEFE.fu~II'iQ~:St~N6f the rules by 8203 I' th ter (NO"''''''' '"'1Po 'J:-:'J;:l..ll..l.'H.'r./' C, Ir,g e cen ~-,Iiilli"j'\NG.I,N.i;:oRMA TION I number for the Oregon" J,' ( ! , , Cenler IS 1-800-332-2344), # of Stones HeIght of Structure Type of Heat Water Type Range Type Energy Path Spnnkled Bulldmg # of VUlts Pnmary Occupancy Group Secondary Occupancy Group Pnmary ConstructIOn Type Secondary Construchon Type # of Bedrooms R-3 VB I DEVELOPMENT I~FOR,MATION . Frontyard Setback SIde 1 Setback SIde 2 Setbdck Rearyard Setback Solar Setbdcks NOTICE: .Qy I .Jm.~ THIS PERMIT ~rs~t:lfi.~J~~E THE WORK AUTHORIZED ~~Fbtkl~lR f:1MIT IS NOT COMMENCED tlfbta,odl:MI ~D FOR ANY 180 DAY PERIOD I PVBLIC IMPROV~ME~TS I Street Improvements Storm Sewer A v dllable Special InstructIOn New Resldenhal ExpIratIon Date 03/31/2009 Phone 541-451-4946 n/a 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 Downspoutsffirams SIdewalk Type Notes I ValuatIon DescriotIon I DeSCriptIOn $ Per Sq Ft or mulhpher Square Footage or BId Amount Type 01 ConstructIOn Page 1 of2 Value Date Calculated -~~ CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO ISSUED, APPLIED EXPIRES. VALUE: COM2008-01067 07/16/2008 07/16/2008 01/16/2009 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme Total Value of Project Fees Palll ,. Fee DescriptIOn + 10% AdmmlstratIve Fee + 12% State Surcharge + 5% Technology Fee Backllow DevIce Mlmmum/AdJustment Plumbmg Amount PaId Date PaId ReceIpt Number $500 $600 $250 $16 00 $34 00 7/16/08 7/16/08 7/16/08 7/16/08 7/16/08 1200800000000000784 1200800000000000784 1200800000000000784 1200800000000000784 1200800000000000784 Total Amount PaId $63 50 Plan Reviews I To Request an mspectJon call the 24 hour recordmg at 726-3769, All mspectlOns requested before 7:00 a m will be made the same working day, mspectlOns requested after 7:00 a.m will be made the followmg work day I, ~e~illlre~ TnsnectlO,!s . Backllow DeVIce Prior to covermg and provIde a copy of the test report on sIte at the tIme of mspectlOn By sIgnature, I state and agree, thdt I have carefully exammed the completed dpphcdtlOn and do hereby certlly that all mformatlOn hereon IS true dnd correct, and I further certIfy that dny dud dll work performed shall be done m accordance WIth the Ordmances of the CIty of Springfield dnd the Laws of the State of Oregou pertammg to the work described herem, and that NO OCCUPANCY wIll be made of any structure WIthout permIssIOn of the Commumty Serv.ces DIVISIOn, Bulldmg Safety I further certIly that only contractors and employees who are m comphance WIth ORS 701 005 will be used on thIS project I further agree to ensure that all reqUIred mspectlOns are requested at the proper tIme, that each address IS readable from the street, that the permIt card IS located dt the front of the property, and the approved set of plans will remam on the sIte at all times dunng construction " /-/c::- z;oP 6w;;;y<lfC~nature Date Paee 2 of2 ~i ~4 e; .,'e!'!l. 1~ ~ ~ a".r-I( '. lq f'1: .Ii ~ <(:~ 1v-3 '.~E~ : v-. - ~l ~ ~\. ~j ~ ~ eo) lJ-.J~ > ~ 01 ~ e; _" 0"_)' !,...b 5: ~ > ~ ~:'-(j ~\ j~ ~ ~ e; (vIr":: ,~ t)) ~ ~l SPRINGFIELD ' 225 nm-J STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 Job LocatIOn f/. Tax Lot 08'100 97l(7.,f BACKFLOW PREVENTION DEVICE PERMIT FEE: $63.50 Contractor InformatIOn Contractor /R# ~.f;,--Y<J .~AL~ Addr"<< f/; ~~ dkJ ~~~~hOnf' (~~/~;:(s7~vP~~ Clty;~~~ u";:-- - ~-:W~~~~ ZIp 9?.:?J!~ r,#t~e.~\\ ~~t\~C;/ lP ? -/r:; ~<J ? Construction Contractors RegIstratIOn #,.b~-<<,\;J'%\:;:P" ,~<;,.o' \"vaQ _a....~ Explfes of - ? I-/) <;' t- \'\.'~' r€w ,,(\'\V (".ov' _ \,,~ _\"...\\\'.- \ "~s. 1j1j~~o'O\\l.\\'-~o'-~\~~'t:r..l\" / Ie // r/L /~C' /iJ""'-- / (' /" //" 1 \,',,0',1>1 <;.\e\ ,,0<;' ^"'?;v L --> Tr - / {/ {,./ Co- r '~--(OV r:fa Q\e;,(\\),,)" By slgmng tlus permlt/apphcatlOn,-Uagr:ee\t&"".j~rol\aumspectlOn once the backflow preventIOn deVIce \.J."I \\\1\-=' \of't"At'tW has been mstaIled and IS vIsIble for mSJ?~IQD~LO-3769) I also state that all InformatIOn on thIs 0.,\\ (j" permlt!apphcatIOn IS correct " 1 Slgnatt>r;: /- ~t::J~\ D~~~ -c:/? _ ~....~v...~~\., ~\)\' ~\..\.. \~\~ '( ~~~fi> ~t~:! ~~, ~~~J'(. f.;~~~ For Offic~jC. '(~~\1~fi> ~ C\'(. \~ f)~' $'(\~\l"~c,~v '(~-/..' ~$ ~~~ fi>~ c,\).t<l \ 'O~ fo.'-- / ;::/ Date of ApphcatIOn ~6/of I ....------_ .........--- Checked for Delmquencle< Checked for Hlstoncal Statuo Shared Dnve (T )/Butldmg FormsIBackflow Prevenhon 1-08 doc 225 FIfth Street Sprmgfield, {}regon 97477 541-726-3759 Phone "P~'lN~~J~~'H.I"llll";I' " -, CIty of Sprmgfield OffiCIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008,0 I 067 COM2008,0 1 067 COM2008-0 1 067 COM2008-0 1 067 COM2008-0 1 067 Payments Type of Payment Check cRecemtl RECEIPT #, 1200800000000000784 Date, 07/16/2008 DescnptlOn Backnow Device Mmlmum/AdJustment Plumbmg + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee PaId By ALL SEASONS LANDSCAPE Item Total L:heck Number Authorization Received By Batch Number Number How ReceIVed dJb 19235 In Person Payment Total -0 Page 1 of 1 11 37 33AM Amount Due 1600 3400 250 600 500 $63 50 Amount Paid $63 50 $63 50 7/16/2008