HomeMy WebLinkAboutPermit Backflow Test 2009-2-11
Status
Issued
CITY OF ~rK1NGFIELD
-Building/Combination Permit
PERMIT NO: COM2009-00197
ISSUED: 02/1112009
APPLIED: 02/1112009
EXPIRES: 08/1112009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541- 726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 640 T ST
'ASSESSOR'S PARCEL NO.: 1703262404308
Springfield TYPE OF WORK: Backl10w Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: bACKFLOW FOR IRRIGA T10N
Owner: WAFFORD KAY L
Address: PO BOX 183
SPRINGFIELD OR 97477
Contractor Type
Contractor
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I BUILDING INFORMATION'
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
NOTICE: Range Type:
THIS PERMIT ~nm Path:
AUTHOR/7m II~nr:n ~~~~HHE WOI'I~
L;UMM,:nE~!ELW~~'I~~~~HWW i
ANY 18u UA Y PERIOD. -, .
Overlay Dist:
,# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
, Occnpant Load:
# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
'Secondary Construction Type:
# of Bedrooms:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I ~UBLlC IMPROVEMENTS'
Street Improvemimts:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:.
I Valuation Descrintio~ 1
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calcnlated
Page I of 2
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Snrcharge
+ 5% Technology Fee
Backflow Device
Minimum/Adjnstment Plumbing
Total Amount Paid
Amount Paid,
$6.96
$2.90
, $19.00
$39.00
$67.86
Total Valne of Project
Fe,es Paid'
Date Paid
Plan Reviews I
2/11/09
2/11/09
2111/09
2/11/09
CITY OF SPRINGFIELD
Building/Com binatilmPermit
PERMIT NO: COM2009-00I97
ISSUED: 02/11/2009
APPLIED: 02/1112009
EXPIRES: 08/t1l2009
VALUE:
Receipt Number
2200900000000000163
2200900000000000163
2200900000000000163
2200900000000000163
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will b,e made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I ReolJir~d Insn~ctio~s ,
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
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 thaI 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 be rein, and
that NOOCCUP ANCY 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
times during construction.
&l~ L,
Owner or Contrac~ .Signature
Page'2 of 2
2.. - / r ..-j) '7
Date
225 FIFTH STREET,. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Zip q 74- 7 7
StatoO R..
BACKFLOW PREVENTION DEVICE PERMIT FEE: $66~04
, Phono
State
Zip
Construction Contractors Registration #
Expireo
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.
Dotp
For Office Use
Date of Applicatio~ 2.-1 /1 ) 0 9
,
0(J2..--"-,
j/
Checked for Historical Status~.C-S
Shared Drive (T:YBuilding FormslBackflow Prevention 7-08.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_00197
COM2009-00197
COM2009-00 197
COM2009-00 197
Payments:
Type of Payment
CreditCard
cRcceint 1
RECEIPT #:
Date: 02/11/2009
2200900000000000163
Description
Backtlow Device
Minimum/Adjustment Plumbing
+ 12% St.ate Surcharge
+ 5% Technology Fee
Paid By
ROBERT JENSEN
Item Total:
Check Number Authorization
Received By. Batch Number Number How Received
CJC 090884 In Person
Payment Total:
Page I of 1
9:33:34AM
Amount Due
19.00
39,00
6.96
2,90
$67.86
Amount Paid
$67,86
$67.86
2/11/2009