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HomeMy WebLinkAboutPermit Backflow Test 2009-5-7 . ._~RI!'IClI;!~I?,.' i\, Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00623 ISSUED: 05/07/2009 APPLIED: 05/07/2009 EXPIRES: 11/07/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 885 OAKDALE AVE ASSESSOR'S PARCEL NO.: 1703223402701 SPRINGFIETYPE OF WORK: Backtlow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backtlow device for apartment complex Owner: CLOVERDALE LLC Address: 840 BEL TLINE RD STE 202 SPRINGFIELD OR 97477 I, CONTRACTOR INFORMATION ~ Contractor Type Plumbing Contractor . RELIABLE PLUMBING & MECHANICAL License 182964 \ Expiration Date 11/01/2011 Phone 541-689-4235 . BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Constrnction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: o nll@~ 2 Setback: RE IF THE WORK 11 ; jR.:p,~)l~rd;$l;il'"IcIf,XPI RMIT IS NOT U 'HSolarl~t~~~!!{!R THIS PE "OR I Ut'\IL _ ..... 1\ r..lnnt>.u::n r C ,Ij\MENL;tU un \0 ~,_. .. \~ '( 180 DAY PERIOD, Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: . Total: # Street Trees Rqd: W re uirJ:I}~pisapped: Paved Drive R,qd:'ENTION:. Oregon la the 6re~9,mpaCt:J % of Lot CovHage: rules adopte1h~~e rules ale set forth Notification Center. rOAR 952-001- ._ ^^DOl;?_o01-0010 throug \ ..; ....'M h" I PUBLIC IMPROVElME>NTS'1 may Otbtarn(NG~i~~;h~' i~.I~phone . 1e cen er. .f. tlon l,.,o.ll"'~ .. ..,_._.......- I ltilityNotllca number for thS.dewalk'rt;y,p,e:2344) C nte' is 1-800-~~~- . e Downspouts/Drains: Notes: I Valuation Descrintion I ---=:.. . Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Page 1 of 2 Status Issued CITY OF SPRINGJ<H,LD Building/Combination Permit PERMIT NO: COM2009-00623 ISSUED: 05/07/2009 APPLIED: 05/07/2009 EXPIRES: 11/07/2009 VALUE: 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Valne of Project Fees Paid,' Fee Description + 12% State Snrcharge + 5% Technology Fee Backllow Device Amount Paid Date Paid Receipt Number $6.96 $2.90 $58.00 517109 517109 517109 2200900000000000495 2200900000000000495 2200900000000000495 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 Reouired Insnections . Backllow 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 herehy 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 or Springlield and the Laws of the State of Oregon pertaining to the work described herein, and tha.' NO OCCUPANCY will be made of any structnre without permission of the Community Services Division, Building Safety. 1 further certify that only contractors and employ~es 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. ' 1.1 A-- . II' Contractors Signatnre :5 t\Oq :::: Owne 0 Date Paee 2 01"2 ~~ 225 FlITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 gJ' Q. ."~;' ~, cxj., ~t -J,...:~l ....1. ~, ~,.. ~',; ~ L> .'~E""".""..']. '~_'.'..1 ~'-- :i i'l;'\, ff!'I~t ~'-i Cl1), ~ a:, ,,(.-l~ ~ ~.i'\, Ud~' ;- 'i, : '''^.-,-,~. ,; ~: .~ ~'i ., ".~I" I;::.'; ~, ~; ~ """",,' \:;CIi k'", ~; ~-' r _.>' ~j ~....':""I, <'. , ","'''''1 ,; ...I,', ~~ ........1-; , ~,'\, ~ ~~) f/V/'j ~'\ City Job Numbe~ - \J>d~ Job Locatir)M ~9/5 OCl~c1a Ie. Assessors Mar n O~dd.34 0 , Owner 0.AOD.Q...f'olctL.. I lJ'.J Address S? ~S C.):~..vvio Ie City S,?("'1f'l3tfP\0.A Tax Lot a'1D I phon" Stat~ CR.. Zip BACKFLOW PREVENTION DEVICE PERMIT FEE: $67.86 Contractor Information y \ 0t\'\'15\~ areA mo. (V--e \:- .9-l rt'c. t. Contractor ~ e. \ \r\ "" \0 , Address .(03?J Sui +t'G Phol'~ 0r;{CJ -4J...3S- City f /J~!l n e- State () f2.. Zip crt Lfo d- Construction Contractors Registration # ) C;:).q 10 tf Expires 1L\ I ) Perli} --' ....r' - ... - ,C'._ I~", ..",nllirp~ voU to . ~~\1\~;~M\1 S,~,"LL E)ZX\~~~~~{ \~~~~ . ~~)ii~~~~~~~~~~irte~h~~~r~;~~;,~t~~~!~l~~ B~I~\~.gL~lpeBft1l1~~~wm!lW~~ee ~o call for an mspe9H~nA9p..9Y2tb~'ba,~]<fl.?~~f~;'~N~q,1}5~~~IS~ hac:O',~ffH~t~_ea~~'a ~vlSlble for mspectlOll (726-3769). I a!ltQ)s~t'e"that'alJliiifo~~P8,&tIclrw,~10r.e penmtJapIll~ati&\.fs\Q!Jrrect. callmg the cer.~r. ( n Uti"ty Notiiication 1-1\' t " ' number for the I ego "2344)' , Center is 1 .800.332- . Si~-,? ~)J } bat~S" \ ,\ oq Date of Application ~ \ I. to q j Checked for Delinquenci,,< \f\e cJ\ c1n i ( (j \ For Office Use Checked for Historical Status / Shared Drive (T:}lBuilding FormslBackflow Prevention 7-08.doc 225"Fifth Street Spripgfield, Oregon 97477 54VV26-3759 Phone Job/Journal Number COM2009-00623 COM2009-00623 COM2009-00623 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Backflow Device + 5% Technology Fee + 12% State Surcharge Paid By MELISSA HOYT City of Springfield Official Receipt Development Services' Department Public Works Department 2200900000000000495 Date: 05/07/2009 Item Total: Check Number Authorization Received By Batch Number Number How Received kr 05553A In Person Payme_nt Total: Page I of I II :57:53AM Amount Due 58.00 2.90 6.96 $67.86 Amount Paid $67.86 $67.86 5/7/2009