HomeMy WebLinkAboutPermit Backflow Test 2009-3-30
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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BACK FLOW PREVENTION DEVICE PERMIT FEE: $67.86
. Contractor Information
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By signing this permit/application, I agree.to call for an inspection once the backflow prevention device
has been installed and is yisible for inspection (726-3769). I also state that all information on this
permit/application is correct.
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Sha;red Drive (T:)lBuilding FormsIBackflow Prevention 7-08.doc
Status
Issued
CITY OF SPRINl.l'lELD
Building/Combination Permit
PERMIT NO: COM2009-00407
ISSUED: 03/26/2009
APPLIED: 03/26/2009
EXPIRES: 09/30/2009
VALUE:
225.Fifth Street, Sp,'ingtield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1401 Market St
ASSF;SSOR'S PARCEL NO.: 1703253310004
Springfield TYPE OF WORK: Plumbing Only
TYPE OF USE: Alteration
PROJECT DESCRIPTION: Install new water lines and backtlow devices for SUB relocating meters
Commercial
Owner: JAMES M BROWN REVOCABLE TRUST
Address: PO BOX 165
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Plumbing
Contractor
RIGHT WAY PLUMBING
License
4956]
Expiration Date
]2/16/2010
Phone
541-484-3787
BUILDING ]NFORMATlON I
.,'
# or Units: # of Stories:
Primary Occupancy Group: J!~i!ht uf Structure
Se~ondary Occupancy .Group: \1'0'" '11J'pe~Heat:
Primary Construction Type ~ leo'oJ. le<i>ol'~talri:J:ype:
Secondary Construction Type: 01'< \'a' \'(\'00 '" 'O-le~ajlg~'t'Xpe:
# or Bedrooms: ~ Ole~eO '0'1,,'0 IU.W O\>-?Eu~iW~th:
...~,\\O ''3-00~ \. '\'(\~IOU.<i>'(\", 0\ \sp-v.nRle~uilding:
AY:- .\D:~ ^\0 11'\.\\' ......\e ",,\e ...ir\c?':
~o\\O~e~~\O~;()~\'~~\i\1'< ~irEY,EL'o.civIENT INFORMATION I
~O\\~ ~,t:i~'3-'1 '1..'01. 0\' ~I:~
. Of>' -{OU. '0 eel'< Ole<:j, ()()_'O
Frontyard Setback:\~()(?,()' '~<i> \'0 \ \'(\'0." ,,'0 Overlay Dist:
Side 1 Setback: ei>\\ 'f;>el \0 I'<WI \ # Street Trees Rqd:
Side 2 Setback: <;o,,<S' Ge Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks:
Lot Size:
Sq Ft ] st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:.
Sq Ft GaragelCarport
Sq Ft Other:
.occupant Load:
nla
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
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I Valuation Descrint:~ I
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valuc of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Water Line - 1st 100'
Water Line - Each Addtl100'
+ ]2% State Surcharge
+ 5% Technology Fee
Backllow Device
Amount Paid
Date Paid
$13.68
$5.70
$76.00
$38.00
$4.56
$1.90
$38.00
3/26/09
3/26/09
3/26/09
3/26/09
3/30/09
3/30/09
3130109
Total Amount Paid
$177.84
I Plan Reviews I
CITY OF ~rKl1~GFIELD
Building/Combination Permit
PERMIT NO: COM2009-00407
ISSUED: 03/26/2009
APPLIED: 03/26/2009
EXPIRES: 09/30/2009
VALUE:
Receipt Number
2200900000000000302
2200900000000000302
2200900000000000302
2200900000000000302
1200900000000000227
1200900000000000227
]200900000000000227
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 Reollired Insnections .
Water Line: Prior to filling trench and includiug required testing.
Backtlow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, ] state and agree, that I have carefully examined the completed application and do hereby certify that all
iuformation 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 frout of the property, arid the approved set of plans will remain on the site at all
timez:ction~ ~ ~
Owner or Contractors Signature
Paee 2 of 2
3/2,0 In 9
Date
225 Fifth Street
SpriIigfield; Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00407
COM2009-00407
COM2009-00407
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
Description
Backf10w Device
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
RIGHT WAY PLUMBING
iCLD~
City of Springfield Official Receipt
Development Services Department
Publie Works Department
1200900000000000227
Date: 03/30/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
017965 In Person
Payment Tutal:
Page I of I
3: !0:45PM
Amount Due
38.00
1.90
4.56
$44.46
Amount Paid
$44.46
$44.46
3/30/2009