HomeMy WebLinkAboutPermit Backflow Test 2009-2-27
CITY OF SPRINGFIELD
Building/Co~bination Permit
Status
Issued
PERMIT NO: COM2009-00286
ISSUED: 02/27/2009
APPLIED: 02/27/2009
EXPIRES: 08/27/2009
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone '
541-726-3676 Fax
541-726-3769Inspectiun Line
SITE ADDRESS: 538 CARDINAL WAY
ASSESSOR'S PARCEL NO.: 1703221203800
Springfield TYPE OF WORK: Backtlow Device
TYPE OF USE: Ncw
Residential
PROJECT DESCRIPTION: Backtlow Device
Owner: HORl ON BRYAN K & LEANNE M
Address: 538 CARDINAL WA Y
SPRINGFIELD OR 97477
I CONTRACTORINFORM,A!I,ON I
Contractor Type
Plumbing
Contractor
DELTA LANDSCAPE IRRIGATION INC
License
119285
Expiration Date
01106/20 I 0
Phone
541-688-9144
I, BUILDING INFORMATION I
# of' Units:
Primary Occupancy Group:
. Secondary Occupimcy Group:
Primary Coustructiou Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of' Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
, Sq Ft Basement:
Sq Ft GaragelCarport
S~ Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trces Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I ,PUBLIC IMPROVEMENTS I
Street ImprovemenN: AT- Sidewalk Type:
S S '1 b~1)1 "'Z'C'~ foil I ENTION: nro~~ . ,
torm ewer Ava, a e: <;.' ow ruDownspoutslDralDs:'qUi
Speciallnstructio~;fi/S PER;" Notlfj~"tio;;C:UuPted by the- Or:es you to
I1JrHO WlfT S In OAR 9~o_ 1 ,nter. Those rUI gon Utility
Note:: COM/ r::R/2ED U HALL E. " 0090, Yo~';~Ol-0010 Ihlough ~ are set forth
AlVy 1 ~~ltjCE() I'1~DER r,~:.!RE!f: J-" calling the ~~n~~~al~. Copies of ~~ ~~~:9~1-
- v u/j'y p-.r 10' AS '....: '::111/1';;'" ;~l/R '-"'U~fTor the Ore(~,v'oc',lfJe telephon~-'
tR/OD. :.qIVJ(~aluati'1I1lD~rcriotion 1 Gemer is l-ioo~:tlllty Notificalio
,- rUR -. , 32-2344) n
',. $ PCI' Sq Ft Square Footage .
Description Type of ConstructIOn I' I' B'd A Value Date Calculated
or mll tip IeI' or I mount
Paee I 01'2
Status,
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00286
ISSUED: 02/27/2009
APPLIED: 02/27/2009
EXPIRES: 08/2712009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fee.~ Pair! J
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backtlow Device
Minimnm/Adjustment Plumbing
Amount Paid
Date Paid
Receipt'Number
$6.96 '
$2.90
$19.00
$39.00
2/27/09
2/27/09
2/2 7/09
2/27/09
3200900000000000132
3200900000000000132
3200900000000000132
3200900000000000132
Total Amount Paid
$67.86
I Plan Reyiews 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... Ree) I~.i ,.~r!, .' II~!1~.~tio~~ I
Backtlow Device: Prior to covt'ring and provide a copy of the test report on site at the time of inspection,
By signatnre, I Slate and agree, that' have carefnlly examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certifythat any and all work performed shall be done in accordance \-vith
tbe Ordinances of the City of Sprillgfield and tbe 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 Scrvicc,s Division, Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will he nsed on this project.
I further agree to ensure that all required inspections Hre requested at the proper time, that each ad4ress 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
timeSdurin~~ 2~?7~61
Owner or Contractors Signatnre
Date
Paee 2 01'2
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
~: ' ' , (!? -- OeJ ;;;, JY' ~ .
~ City Job Numb..."" '
..;t 'Job Locati,," 53 g:' ~o I AlAi. vJ.A\ - Sff.-;itVt.. n <zuo
~ Assessors M~r /705'.;:;Jd- / d.., 0 3eu-u Tax Lot
..~~
~i
~ Owner
~
~ Addr~oo
~ City ~f--~N~F-Ia()
'~
~
~
~ '\)f-lr4-lR;rJ(y~~rD>-nr:;, ......,,, I {1.IC I CA"'ll \'iN, INC,
'~ Contractor --., . ,. "'vv
..s: Addrers p. D.'(;.o,,( '-f \) ')-\ l
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o
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rEI n+ 1-tD (2. To r0
53 r G4-fCo\ tJAL v1~
Ph"""
74(/- 6J2D
Z. 97 il,
Ip
Stot...
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BACKFLOW PREVENTION DEVICE PERMIT FEE: $66.04
Ph"",,
h U-CfNl(
Zip '17 r.j 0 V
Cit:. t:v... c. & N (.;
l-ttNO ~ cA-{>1r ,
G{m~....,,,t;~Contractors Registration # _
"tate
D'{L
c, )-ff 7 :
Expire<
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
pennit/apPliCatiO~ is correct.] .& "
z -l7~o /
Sign~tl1rp. ~~~ Dptp
For Office Use
Date of Applicat;n" did.. --1 /0 ~
Checked for Delinquenci,,< ~ Checked for Historical Stan,. '
Shared Drive (T:}'Building FormslBackt1ow Prevention 7.;.Q8.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00286
COM2009-00286
COM2009-00286
COM2009-00286
Payments:
Type of Payment
CreditCard
cReceiOll
RECEIPT #:
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DELTA LANDSCAPE/TERRY
THORN
City of Springfield Official Rcccipt
Development,Serviccs Department,
Public Works Dcpartment
3200900000000000132
Datc: 02/27/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm 030048 In Person
Payment Total:
\
Page 1 of 1
10:35:44AM
Amount Due
19,00
39,00
2,90
6,96
$67,86
Amount Paid
$67,86
$67.86
2127/2009