HomeMy WebLinkAboutPermit Backflow Test 2009-5-7
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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--
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Contractors Signatnre
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Date
Paee 2 01"2
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225 FlITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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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