HomeMy WebLinkAboutPermit Backflow Test 2008-10-31
Status
Iss u ed
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-01606
ISSUED: 10/31/2008
APPLIED: 10/31/2008
EXPIRES: 04/30/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone .
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3771 Olympic St
ASSESSOR'S PARCEL NO.: 1702300002105
Springfield TYPE OF WORK: Backtlow Device
TYPE OF USE:
Commercial
PROJECT DESCRIPTION:
Owner:
Address:
BFD INVESTMENTS LLC.
5729 MAIN ST PMB 242
SPRINGFIELD OR 97478
, I, CONTRACTOR INFORMATION'
Contractor Type
Contractor
License
Expiration Date Phone
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constrnction Type
Secondary' Construction Type:
# of Bedrooms:
. ,.... you to
A11~BUILDING-IN:(i)~:~~~'n Utility
follow rules adopLQ C Y . rules are set forth
Notificati(l,.q~SJor;les:~t;~:;" hOAR 952-001-
, OAR 9~lgbt of,Strncture9 f the rules by
In . 'OJ' n copies 0
0090., YO:YP"',!f<~~a. : Note: the telephone
callingWatet6fype. ( Ut'l.ty NotificatIOn
. an '\l1JJ.u'cgon II
numbeR g lP~' 800-332-2344).
KileOlgyt'Plitn:
Sprinkled Building: , n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft B'asement:
Sq Ft Garage/Carport
Sq Ft Otber:
Occupant Loa'd:
I DEVELOPMENT I~FORMATlON I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
NOTICE: % of Lot Coverage: "
THIS PERMIT SHALL EXPIRE IF THE WORK
--~;';-;-; llf'"'r"" -I'I~~':.""IT 'r. ..nT
MUlrr. iL!lll..........;u.. .-..~-
COMr ,Il.f.K:~f~FOR
ANY 180 DAY PERIOD. Sidewalk Type;
Street Improvements:
Storm Sewer Available:
Special1nstrnction:
DownspoutslDrains:
f'
Notes:
I Valuation DescriDtion ,I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calcnlated
Pa~e I of 2
Status
Issued
CITY OF ~t'Kll~GFIELD '
Building/Combination Permit
PERMIT NO: COM2008-01606
ISSUED: 10/31/2008
APPLIED: 10/31/2008
EXPIRES: 04/30/2009
VALUE:
225Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fee~ Pai? I
Fee Description
+ 10% Administrative Fee
+ 12% State'Surcharge
+ 5% Technology Fee
Backflow Device
Minimnm/Adjustment Plnmbing
Amount Paid
Date Paid
Receipt Number
$5.20
$6.24
$2.60
$17.00
$35.00
10/31/08 '
10/31/08
10/31/08
10/31/08
10/31/08
3200800000000000716
3200800000000000716
3200800000000000716
3200800000000000716
3200800000000000716
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 ReolJire~, r~snect~,~ns I
By signatnre, I state and agree, that I bave carefully examined the completed application and do hereby certify that all
information hereon is trne 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 tbe work described herein, and
that NO OCCUPANCY will be made of any structnre without permission of the Com'munily Services Division, Building Safely.
I further certify tbat only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure thatall 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 tbe site at all
times during cons~niction.. "A 1 I
<- ~,.AYp,&- <'0 ~J/.OP
Owner or Contractors Signatnre
Date
Pa2e 2 on
,
225 Fifth Stl;eet
, . '
Springfil'4I, Oregon 97477
541f,726~3759 Phone .
City of Springfield Official Receipt'
Development Services Department.
Public Works Department'
Job/Journal Number
COM2008-0 1606
COM2008-0 1606
COM2008-0 1606
COM2008-0 1606
COM2008-0 1606
Payments:
Type of Payment
CreditCard
cReccintl
RECEIPT #:
3200800000000000716
Date: 10/31/2008
Description .
Backtlow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% Slate'Surc'harge
+ 10% Administrative Fee
Paid By
JAMES R CLA YTON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cJc 501220 In Person
Payment Total: .
Page I of I
1O:28:30AM
Amount Due
17.00
35,00
2.60
6.24
5.20
$66.04
Amount Paid.
$66.04
$66.04
. 10/31/2008