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HomeMy WebLinkAboutPermit Backflow Test 2009-2-6 CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2009-00182 ISSUED: 02/06/2009 APPLIED: 02/06/2009 EXPIRES: 08/0612009 VALUE: G Status Issued , 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1026 J ST ASSESSOR'S PARCEL NO.: 1703264413700' Springfield TYPE OF WORK: Backnow Device TYPE OF USE: New Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: .' . NO,.ICE.:"" cuM \ f)(?IRE If I~J'~~I~~ 1~~~lJ~r~N~~'rOR COMMENCED U~ \~D.J' .. Sidewalk Type: ANY 180 DAY PERI. DownspoutslDrains: PROJECT DESCRIPTION: Backnow device Owner: Address: HELEN B BRUZER REVOCABLE LIVING TRU 1026 J ST ,SPRINGFIELD OR 97477 Contractor Type Landscape I.<:ONTRACTOR INFOR~ATION . , Contractor. laW requireS yauti.O~ense OASIS IRRIGAT10'Nq,X;G:~hV tM orego~~ ~~lt\li . '; .. ,~ -, - ", ,,~"".....' - -/ - ,~;,;~n-,I':BUILDI~G'INF0RlVI>\']II~Ii"'1i I . '-?_('O",\~uv lV .... .~ 01 tne \.Ulv..., -J j- _~',\{~\~ay o#tof%(o~~~:~M telephone VL:'~-3no the cenHeig~l,~t;St"uctu?~ilicatlOn C~\I\l'... ~r~gu I V'''"1 ) n1\mber lor the!YP:'83!i't'CJ!J:2344 . VB center Water Type: Range type: Energy Paih: Sprinkled Building: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I Fronlyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: , ' ~ , Notes: I Val~ation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square'Footage or Bid Amount Paee 1 01'2 Residential Expiration Date 01/31/2010 Phone 541-343-7482 n/a Lot Size: SqFt 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 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00I82 ISSUED: 02/0612009 APPLIED: 02/0612009 EXPIRES: 08/06/2009 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 I Fee Description + 12% State Surcharge + 5% Technology Fee Backllow Device Minimum/Adjustment Plumbing AmountPaid Date Paid Receipt Number $6.96 $2.90 $19.00 $39.00 2/6/09 2/6/09 2/6/09 2/6/09 2200900000000000148 2200900000000000148 2200900000000000148 2200900000000000148 Total Amount Paid $67.86 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. .R,eo,!i.~~~ Tns'Jection.~ I Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify tbat 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 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 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 timesdurinr;~\).,~ L-~ -04 Owner or dlDtractors Signature Date Page 2 of2 225 FlFI1I STREET. SPRINGFIELD, OR 97477 . PH:(541)7Z6-3753 . FAX: (541)726-3689 ~ ~ ..1'!""l< I~ ~ ~ Assessors Mar ..~< ~< ~ ~ Owner ~ Addres. I; '> City .~ ~ ~\ \; ~ ~ ..~ :> ~ Q 'C1' e) ..~ l~ C : ~ ~ ~\ ~ o ~ ~ ~ ~ " CityJObNumberCP~ZO~ ,- au I t"Z- +-' Job Location /OZ- G '-S- os, (7632f,CfL{ Tax Lot ( 57c.)~ V6U~tllf Gi.. (il'Uo L\;. 5f("~ ~'-f:- \L SeC( AJc. r+- S-h'e~-t 1?hnnp Y'S/'- 751") Z. Yl G-\1.'7 lp Stat~ OD.' Contractor Address PhoIl'" '3 l..() -1'-[ ~L. State 0 (L Zip ~ '( Lf 0 IS C:;S-l'lG Expireo \~ ~ (_C(J \ ~ City Construction Contractors Registration # By signing this permit/application, I agree to call for an inspection once.~; ~ow prevention device has been installed and is visible for inspection (726-3769). I also st{~~ ~rmalion on this , permit/applicatio is correct. C~:. t>,\.\. 'Cf-.?\<r; ?'t.?-\J\\" ?- Sig""'~ awt52 ~~~~o~~"""'"~~,. 'V<) -O{ CGWI\~\\. . Ull.'l \,\:."r_ , p.~'l "\ 'O\) For Office Use Date of Application ~/~o~ Checked for Delinquenci~. ~ v-- ' Checked for Historical Stah,. , / Shared Drive {T:)lBuilding Forms/Backtlow Prevention 7...{l8.doc 225 Fifth Street ~'lringfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00 182 COM2009-00 182 COM2009-00 182 COM2009-00] 82 Payments: Type of Payment Check .cReceintl RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000148 Date: 02/06/2009 [)escription Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge Paid By OASIS IRRIGATION LLC Item Total: l.:heck Number Authorization Received By Batch Number Number How Received djb 6304 In Person Payment Total: ! Page I of I 9:23:06AM Amount Due 19,00 39,00 2.90 6,96 $67.86 Amount Paid $67,86 $67.86 2/6/2009