HomeMy WebLinkAboutPermit Plumbing 2009-1-26
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-001l9
ISSUED: 01/26/2009
APPLIED: 01/26/2009
EXPIRES: 07/26/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6546 B ST
ASSESSOR'S PARCEL NO.: 1702344202000
Springfield TYPE OF WORK: Plumhing Only
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backflow Device
Owner: STALEY ROBERT E & JUDITH S
Address: 6546 N B ST
SPRINGFIELD OR 97477
Contractor Type
Landscape
I CONTRACTOR INFORMA T~ON I
Contractor License
SCHELSKYS LANDSCAPE AND IRRIGATI 12170,6330
BUlLDIN~ IN,FORMA TION I
Expiration Date
02/28/2009
Phone
541-744-7135
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure.
Type of Heat:
Water Type:
Range Type:
Energy Pa.th:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
"
I DEVELOPMENT INFORMATION I
REQUlREDPARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: . C8ffilli'ct:
. Ires Y u'
% of Lot Coverage: . o'eOon laW requ Utility
. !'~!.~~~;~~~d~p\e9, by_:h'~oI~:e~~~et jO~t.h
,_. "8\1l"" ".- hOl'''''''<'''v-.
I PUBLIC IMPRQYEMENTS ~01_0010thrOUg . j the rules by
ill v~., -. ~a" O'S'ld-in cnlkPTles O.telephone
090 'Iou ,,,' I ewa c ype.. .
o li'ng the center. . \,~~"v:;iia" N.otiticatlon
ca I jar the D..ownspontsIDrallls:
number . 1_800-33~'~')~~J'
center IS .
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes: NOTICE:
TUJ(' n[""ft'''T'''''\LL _. - .
-.-. ~'"'''' Vlln L.l\rlnc ,- .....': \..I....l.l~
~UTHORIZED UNDER THIS PEI~~~lititi6;r'DescriDtion I
,~OMMENCED OR IS ABANDONCIJ FOR .
D . t' ANY 18TCI nAVfCDi=Rltnn t' $ Per Sq Ft Square Footage
escnp IOn ype 0 ons ruc IOn It' I' B'd A
or mu Ip lef or I mount
Value
Date Calculated
Page 1 of2
_a?&QU!!~,IiJ!~~J"J ~
;:~,. \~r,(>' ~,. ?;'" ':~>'\''''
Status
Iss u ed
225 Fifth Street, Springfield; OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backnow Device
Minimum/Adjustment Plumbing
Total Amount Paid
Amount Paid
$6.96
$2.90
$19.00
$39.00
$67:86
Total Value of Project
Fees Paid J
Date Paid
1/26/09
1/26/09
1/26/09
1/26/09
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00119
ISSUED: 01/26/2009
APPLIED: 01/26/2009
EXPIRES: 07/26/2009
VALUE:
Receipt Number
2200900000000000100
2200900000000000100
2200900000000000100
2200900000000000100
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, ,Re'1,~,jre~ T~,~..'e,ctions I
Backnow Device: Prior to covering and provide a copy o/'the test report on site at the time of inspection.
,
By signature, T state and agree, that T have carefully examined the completed application aud 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 described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that ouly 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 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
times during construction.
Owner or Contractors Signature
Page 2 01'2
Date
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ZZ5 I1ITH STREET .0 SPRINGI1EW, OR 97477 . PH:(54l)726-3753 . FAX: (541)726-3689
City Job Numb.. (? c; -- (JO/ / <7
/ ;2 -Sf
Job Locatio" (_/J 5 {,t &
Assessors M~r Tax Lot
Owner
80.~ 'S" 4(c,-<
,
b 5'rfk ,f J+rc~1-
SOPtJ,
Zip
Addrp<<
Pho"p 7'1 (-is 05
'?N7?
Statp ol? .
City
BACKFLOW PREVENTION DEVICE PERMIT FEE: $66.04
Contractor 5"" LI -
Addrp<< ;: o. fj~ X
City Ejr
S'c.J~ fS-k" I,
,
c:.c;.~J,c,,~ 7- :::Z:-vv--;~ ah'lo..... r~,
"
7?L( S-
Phonp 7'iC/- 7(55
State (') e
Zip ;7 7'f'O I
Construction Contractors Registration # {, S:s 0
Expires 2.- 2'<5"-/0
By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been installed and is' visible for inspection (726-3769). I also state that all information on this
permit/application is correct. ' .
SignatuTP g............
0~
~
Date--."l2- b /z.. 0 0 '1
For Office Use
Date of Application / ~ ;;;J.t -- 0 '7
Checked for Delinquencipc
J __..;--------..
Checked for HistoricalStatu<
-----.
Shared Drive (T:)IBuilding Fortn&lBackflow Prevention 7-OB.doc
225 Fifth Street
Springfield, Oregon 97477.
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works'Department
Job/Journal Number
COM2009-00 119
COM2009-00l19
COM2009-00 119
COM2009-00119
Paymelits:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
2200900000000000100
Date: 01/26/2009
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DARREN SCHELSKY
Item Total:
Check Number Authorization
Received By . Ba~ch Number Number How Received
njm
055130
055130 In Person
Payment Total:
Page 1 of I
1:51:50PM
Amount Due
19.00
39.00
2.90
6.96
$67.86
Amount Paid
$67.86
$67.86
1/26/2009