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Home My WebLink AboutPermit Backflow Test 2008-8-19 -~~ji ., Status Issued 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe .CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-01240 ISSUED. 08/19/2008 APPLIED: 08/1912008 EXPIRES: 02/1912009 VALUE: Spnngfield TYPE OF WORK Backnow DevIce SITE ADDRESS 2600 WAYSIDE LN ASSESSOR'S PARCEL NO 1703224402600 PROJECT DESCRIPTION Backnow device Owner WALTER ADRIANCE Address 2600 WAYSIDE LN SPRINGFIELD OR 97477 Contractor Type Landscape Contractor OWNER # of UUltS Pnmary Occupancy Group Secondary Occupancy Group Pnmary ConstructIOn Type Seconda. y ConstructIOn Type # of Bedrooms Front yard Setback S.de I Setback S.de 2 Sctback Rearyard Setback Solar Setbacks Street Improvements Storm Sewer Available Speclallnsll ucllon Notes DeSCriptIOn Type 01 Construcllon ReSidential TYPE OF USE New Phone Number 541-736-3913 I CONTRACTORINFORMATION I LIcense ExpIratIon Date Phone BUILDING INFOR~ATION I # of Stones R-3 Height of Structure Type of Heat VB Water Type ATTENTlON./;l(t!l!J9 JJaw requires you to follow rule~lI(!AAlflli tfii the Oregon Utility ~o~~~~fj~'::=~ OOSm !II IlUIIlbef for the Oregon UtI11ly NotilIo"tlOlt CeRkfob~.aml 3.1314)- # Street Trees Rqd Paved Dnve Rqd % of Lot ~!,_verage .. _... h'" Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load REQUIRED PARKING Total Handicapped Compact .... I PUBLIC IMPROVEME~TS I Sidewalk Type DownspoutslDralDs NOTICE: THIS PERMlTSHAtl iM1R("M~ AUTHORIZED UNDER THIS PERMIT IS NOT \;;\;II\'II~IIOI'l"EiL' ..- ;: rBANB9N(;9 P;"!\ I VahWfll1,DilAVIBBBIO,. $ Per Sq Ft or mulllpher Square Footage or B,d Amount Value Date Calculated Paee 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2008-0I240 ISSUED. 08/19/2008 APPLIED: 08/19/2008 EXPIRES: 0211912009 VALUE: 225 F,fth Street, Sprongfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspectlOn Lone Total Value of Project Fees PaId I Fee Descrophon + 10% AdmlDlstratlve Fee + 12% State Surcharge + 5% Technology Fee Backfiow DevIce MIDlmum/AdJustment Plumbong Amount Paid Date PaId ReceIpt Number $520 $624 $260 $1700 $35 00 8119/08 8119/08 8119/08 8119/08 8119108 1200800000000000883 1200800000000000883 1200800000000000883 1200800000000000883 1200800000000000883 Total Amount PaId $66 04 Plan Reviews ,I To Request an mspechon call the 24 hour recordmg at 726-3769. Allmspections requested before 7:00 a.m. will be made the same workmg day, mspechons requested after 7:00 a.m. will be made the followmg work day. I Relllllred Tnsnecho~sl Bdckfiow DevIce Proor to coverong and provide a copy of the test report on sIte at the tIme of onspectlOn By SIgnature, 1 stdte dnd dgree, that I have cdrefully examoned the completed apphcahon and do hereby certIfy that all onformatlOn hereon IS true and correct, and 1 further cerhfy that any and all work performed shall be done on accordance WIth the Ordlllances of the CIty of Sprongfield and the Laws of the State of Oregon pertdlDlng to the work descrobed hereon, and that NO OCCUPANCY WIll be made of any structure WIthout permIssIOn of the CommuDlty Services DIVISIOn, Butldong Safety 1 further cerhfy thdt only contractors and employee, who are on comphance WIth ORS 701 005 wtll be used on thIS project 1 further agree to ensUle that dll requIred IIlspectlOns are requested at the proper hme, that each address IS reddable from the street, that the permIt card IS located at the front of the property, and the dpproved set of plans WIll remaon on the site dt all tlmd~n dh- .....-- ---- ~-!9-Za.py Ownel or Contractors Slgndture Date Pa2e 2 of2 ~1 ~, ~ ..~, I~ ~ ~ .".~l~ " Ij f)'I, ~ ~j l~ -" 'r-t~ ~j ~, ~, ej ~ f" Il ~ ~ ..1'!!!!!!4j ~ ~ Q, = ~ -"el l~ ~, e, ~ ~ ~ ~j f'\ Ii ~ ~ '''il' ci ~l ~, ""') ~ .Y ~l . " SP~ ~~~ , ,,,.."" '1"- -- - -" -" -- -- -. T . _:r<('"CJ~Y, OF SP~G~2ELQ,<:O~GON-. ~~.,::: 225 FIfTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . fAX (541)726-3689 CIty Job Number CoW\~ ..- 0 I Z l{ 0 Job LocatIOn zf::,o 0 (,./ ~ f I ~ e 17D 3 2Zl(l{ Tax Lc,t OC--bO C) Assessors Ma:, - Owner (;/(1/ / r M ,AI/'//\-A- (1- }1,,00 IP)Q~.~<'jr Lt--J & q(iJ f ,1O/, C >~, \ ~ ~ Statp r I . /) ('J AI -.. Address Phor p 7:.?C-)715 Zip "7'7 L( 1'/ City BACKFLOW PREVENTION DEVICE PERMIT FEE: ~ bbO~ u\!eS 'Iou \0 Contractor InformatIOn Olegon la~~:~le90n ~{~,\\ / f ~\\I:t-\:\~~ adoge~~~se !\I\e~~~ ::z-001.:--- "j,()v;()/" \~ !.1~~~,~'k'OU9" 1~A-,l1IeBOY "O~~~9SZ-00i obtaIn ~~~ the \e\e~"~~:1\ In 'I'oU !!\a'l ",~~o\e. "o\l\lc..... ;;~')n \n" .:.c~ "no" 1:.\11'" i.4A4) Phonp calling :/oke o!e';?:::;._"l32,.~ . . ~\O! '" ~.jjUU""'"'- ~u_ "ftntel16 State Zip 1.-/ Contractor Addrpss City Construction Contractors RegistratIOn # Expires By slgrung thiS penmtlapphcatlOn, I agree to call for an mspectlOn once the backflow preventIOn deVice has been mstaJled and IS vIsible for mspectlOn (726-3769) I also state that all mformatlOn on tins penmtlapphcatJOD IS correct Slgnaturp 1//4 I , M ~_ D ~~:l~-Z.OO.r ~\?,~ W~ \S ~O l\O~\~;~~~ CO~~~~ "n\\S !~~~~ fO'" Fo}~~ v~R \$ ~~I\N\I . -"Ir tCQ"^"^t\w\.~ p~~\\)v, <6;'17. crt? ~W{ '\ aO t) f ~'" Checked for Hlstoncal Status ~ Date of ApphcatlOn Checked for Delmquenclp< Shared Dnve (T )/BUlldmg Form&IBackflow PreventlOD )...{)& doc 225 FIfth Street Spnhgfield, Oregon 97477 541-726-3759 Phone ~ CIty of Sprmgfield OfficIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 1240 COM2008-0 I 240 COM2008-0 I 240 COM2008-0 I 240 COM2008-0 1240 Payments Type of Payment Cash Change Job/Journal Number COM2008-0 1240 COM2008-0 1240 COM2008-0 1240 COM2008-0 1240 COM2008-0 1240 Payments Type of Payment Cash Change l"RU..ClOtl RECEIPT #. 1200800000000000883 Date. 08/19/2008 Description Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee PaId By WALLY ADRIANCE WALLY ADRIANCE Item Total Check Number AuthOrization Received By Batch Number Number How Received djb djb In Person In Person Payment Total DescriptIOn Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee PaId By WALLY ADRIANCE WALLY ADRIANCE Item Total <":heck Number AuthOrizatIOn Received By Batch Number Number How Received djb djb In Person In Person Payment Total Page I of I 105802AM Amount Due 1700 3500 260 624 520 $66 04 Amount Paid $80 00 ($1396) $66 04 Amount Due 1700 3500 260 624 520 $66 04 Amount Paid $80 00 ($1396) $66 04 8/J 912008