HomeMy WebLinkAboutPermit Backflow Test 2008-11-6
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01631
ISSUED: 1lI06/2008
APPLIED: 11/06/2008
EXPIRES: 05/06/2009
, VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone'
541-726-3676 Fax
541-726-3769Inspection Line
SITE ADDRESS: 673 68TH PL
ASSESSOR'S PARCEL NO.: 1702352308800
Springfield TYPE OF WORK: Backnow Device
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Backnow device
Owner: SHUTT DONALD L & BARBARA.J
Address: 673 N 68TH PL
SPRINGFIELD OR 97478
Contractor Type
Landscape
. I ,CONTRACTOR I,NFORMATION I
NOTICE:' ,
Contractor "tHIS PERMIT SHALL EXPIREl1\l:if~WORKxpiration Date
SCHELSKYS LAJiP:~5{j\J1I):~'I"iIMI~".W~.it-JT~ PW.RQ~1i~5ONOT 0212812009
C r\Pi/'BmJl..1)~~GJINRORM'A"T.I'c;,~.FOR
AI~Y 180 DAY PI:KiUIJ. .
# of Stories: . Lot Size:
Height of Structure Sq Ft 1st Floor: .
. Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft GaragelCarport
Energy Path: .Sq Ft Other:
Sprinkled Building: 'nla Occupant Load:
f"'rTr-~ITI""t\I. nr~nf"'\n law fA'lllires VOU to
I DEl\iEJIIOP.M, E,N;r''f'N, F0RM!\Tl0~'I''' Ullllty
,tJ set forth
I'JUtlIIGi;;l.lIUII'V\:JIH<.:Jt. .,.....~- '----'-, , .
in OAR 952-00)-001 Othrough OAR 952-001-'
009(pV\'O~a~1!?~slibtain copies of it he rules by
caffi~lf~~b1j:$.~~~qC/i:lote: the telephone
nur!iilt~<\&rl~e !'WilBon Utility Not]flcatlon
% otJeqll~0~rtaiiao-332-23:H). .
Phone
541-744-7135
# of Units:
Primary Occupancy Group:.
Secondary Occupancy Group:
Primary Construction Type
Secondal)" Construction Type:
# of Bedrooms:
.R3
VB
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
'Sidewalk Type:
:Downspouts/Drains:
Notes:
. I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft .
or multiplier
Square Footag~
or Bid Amount
Value
Date Calculated
Pa2e I of 2
Sta tus
Issued
. " CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01631
ISSUED: 11/06/2008
APPLIED: 11/06/2008
EXPIRES: 05/06/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726"3753 Phone
541-~26,3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Backl10w Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$5.20
$6.24
$2.60
$17.00
$35.00
11/6/08
11/6/08
11/6/08 ,.
11/6/08
11/6/08
Receipt Number
2200800000000001618
2200800000000001618
2200800000000001618
2200800000000001618
2200800000000001618
Total Amount Paid
$66.04
I Plan Reviews I
il.
To Request an inspection call the 24 hour recording at 726-3769. Ail 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 R~9.u.i~ed I nso~c.tinn~.1
Underground Plumbing: Prior to filling the trench and including required testing.
Final Plumbing: When all plumbing work is complete. '
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 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 the work descrihed 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 are in compliance withiORS 701.005 will be used on this project.
I further agree to ensure that all 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 the site at all
~uFin~ constructio, n.~ ~, .'
. \.. f----- D ~' ------- __/~!L;-o 6~
Owner-;;;:- Contractors Signatu~e ~ -:::> Date
Page 2 01'2
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Spt;ingfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
cOM2008-0163 1
COM2008-0163 I
COM2008-0 1631
COM2008-0163 I
cOM2008-0 163 I
Payments:
Type of Payment
Cred itCard
cReceintl
. RECEIPT-#:
2200800000000001618
II :22:06AM
Date: 11/06/2008
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12%' State Surcharge
+ 10% Administrative Fee
Amount Due
17.00
35.00
2.60
6.24
5.20
$66.04
Paid By
DARREN SCHELSKY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
025120 In Person
Payment Total:
$66.04
$66.04
cJC
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11/6/2008