HomeMy WebLinkAboutPermit Backflow Test 2008-9-15
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01411
ISSUED: 09/15/2008
APPLIED: 09/15/2008
EXPIRES: 03/15/2009
VALUE: ,
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726,3676 Fax
,541-726-3769 Inspection Line
SITE ADDRESS: 2484 7TH ST
ASSESSOR'S PARCEL NO.: 1703262100100
Springfield TYPKOF WORK: Backllow Device
PROJECT DESCRIPTION: Backllow device
TYPEOF USE: New
Residential
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
NOTICE: % of Lot Coverage:
THIS PERMIT SHA' I J:Vn,,, _ '
,.,u I nU~!K.r-_:c- ~.~ IF ,. vVUt11\
I"tIIl'LlIl'IlftItITff . '
COMMEJi.:tJ Iii I I. I, NOT
ANY 180 DAY PE' I.;, AtlANDDNEO fOR Sidewalk Type:
RIOD. .
! Downspouts/Drains:
Owner: EFFIE TAYLOR
Address: 2484 7TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION 1
Contractor License
BRA,U_N "~l~J!~,f:.Ar.E,:.,I,~<;:~", rpnllirp.s vou to 12499;
;o::,);V rules aChIPBIlmD~INF(1RNfJi4nON I .
,.., I U6 I ''-Jvi,rZ I
Notltl(,atlon Centt;;;:l. 1111,.,........ I cn...... ~ - -. ~
# of Units' in OAR 952-001-001 0 i/1[''f~.~R 952-00~- ,
Primary Occupancy Group: 0090" "YRl.t3may Obtail\\] 4EflS t~~,~i~~~e Y ,
Secondary Occupancy Group: calling the center. ; 'M'blification
Primary Construction Type numbeytpr the, Ore r:i: :f4'
Secondary Construction Type: Center 16 1-8 ange - ype~)'
# of Bedrooms: Energy Path:
Sprinkled Building:
Contractor Type
Landscape
. -
I DEVELOPMENT INFORMATION 1
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
. Street Improvements:
Storm Sewer Available:
Special Instruction:
,',j':~':"f':-' ....",
Notes:
Description
I ':' aluation Descriution I
$ Per Sq Ft
or multiplier
Tvpe of Construction
Square Footage
"
or Bid Amount
Page I 01'2
Phone Number: 541-543-9382
Expiration Date
03/31/2009
Phone
514-2750
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:
Value
Date Calculated
I
I
I
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2008-01411
ISSUED: 09/15/2008
APPLIED: 09/15/2008
EXPIRES: 03/15/2009
'C
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 1
Fee Description
+ '10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid. Date Paid Receipt Number
$5.20 9/15/08 2200800000000001398
$6.24 9/15/08 2200800000000001398
$2.60 9/15/08 2200800000000001398
$17.00 9/15/08 2200800000000001398
$35.00 9/15/08 2200800000000001398
Total,Amount Paid
$66.04
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.
I ~~I'\,i.,r~d ~~s.'e~tion.~ .
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection,
. I'
By signature, I state and agree, that 1 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 witb
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 or'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 propel'time, that each address is readable from the
street, that the permit card is located atthe,front of the property, and the approved set of plans will remain on the site at all
times during construe 'on.
(
tJ(,,;{uol
Owner or ~ lntractors Signature
r I
Date
Pagel 01'2
.,
225 Fifth Street
Springfjeld; Oregon 97477
541-126-3759 Pho~e
Job/Journal Number
COM2008-01411
COM2008-01411
COM2008-014 I I
COM2008-01411
COM2008-01411
Payments:
Type of Payment
CreditCard
cReceintl
Item Total:
Check Number Authorization
Received By Batch Number N'umber How Received
djb 057860 In Person
Payment Total:
RECEIPT #:
2200800000000001398
Description
Backflow Device
Minimum/Adjustment Plumbing
'+ 5% Technology Fee
+ 12% State Surcharge \
+ 10% Administrative Fee
Paid By
JORDAN GRAHAM
Page I of I
City, of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 09/15/2008
2:46: I2PM
Amount Due
17,00
35,00
2.60
6,24
5,20
$66,04
Amount Paid
$66,04
$66.04
, ~,
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9/15/2008