HomeMy WebLinkAboutPermit Backflow Test 2009-5-11
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SPRINGFIELD 1=--'
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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BACKF.!-O~tPREV'E~T1.0NJiDEV' <''F[.'OERMIT FEE:'--$67.86 --,
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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 visible for inspection (726-3769). I also state that all i~ormation on this
permit/application is correct. W if\c \NO?' :\
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00643
ISSUED: 05/11/2009
APPLIED: 05/11/2009
EXPIRES: 11/11/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phonc
541.726-3676 Fax
541-726-3769Iuspectiou Line
SITE ADDRESS: 864 S 68TH ST
ASSESSOR'S PARCEL NO,: 1802031105200
Springfield TYPE OF WORK: Backllow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: backllow device
Owner: MICHAEL MCFARLAND
Address: 317 30TH ST UNIT 214B
SPRINGFIELD OR 97478
Phone Number: 541-
Contractor Type
Landscape
I CONTRACTOR INFORMATION I
U \0
Contractor ",I,Lc.~nseS '!oly!!JX'l>iration Date
MEDALLION LANDSCAPE ~~!nTlgE}'!N~~~, \~'!:Ill)(e9.~l\~e\ 10\\102/28/2010
Bu..ri:DiNGHNFORMArf.l0N:I"O~'" 952,-UsU b"
, '" "e 'u e ,
IU"-. \'ol\Vv' OW\\I'v-.- 01\1' '
.1 l'IICa \ ,,(y\ -0 o"les \ "nOl\e
,.0# of,St,,!'ies: b\ail\ C ~ . \ne \e et: '/r9IISize:
'l\' "" .. .-,,~ 0 1~0\8. "o\il\Ca,
\ \!Si.gljt)~r.~tr\\~I!!re \ l\ \J\i\i\'i I' Sq Ft 1st Floor:
OC'Type,of HeaY:,e 0\e900 ,,~",2344), Sq Ft 2nd Floor:
{C". - +n{ \\ eO ~.;,;;:;'- .
'YJI.\MtType:1e\ is ~ - Sq Ft Basement:
R'ange T~r . Sq Ft GaragelCarport
Energy Path: Sq Ft Other:
Sprinkled'Buildingi nla Occupant Load:
Phone
541-933-2745
# of Uilits:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
VB
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC {l\W~H'-1;;ME.Nif~ILL EXPIRE If lHt\VSvuNr;OIT~
I \.Ll I 111.' .. , TJJI".'p"~RMIT
. AUTHORIZED UNDER !:IiUl'it'tj'NEIJ'fDR
COMMENCED OR \SOD~~~nspoutS!Drains:
ANY 180 DAY PERI ' .
,
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of 2
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-00643
ISSUED: 05/11/2009
APPLIED: 05/1112009
EXPIRES: 11/1112009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone.
541"726-3676 Fax
541,726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Backllow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$6,96
$2.90
$19.00
$39.00
5/11109
5/11109
5/11/09
5/11109
1200900000000000373
1200900000000000373
1200900000000000373
1200900000000000373
Total Amount Paid
$67.86
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,
1R.,~r,!l.ired Insnecti?t~J
Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signatnre, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 fnrther 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 pertainiug to the work described herein, aud
that NO OCCUPANCY will be made of any structnre without permission of the Community Services Division, Buildiug Safety.
1 further certify tha't only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
1 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 ou the site at all
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Owner or Contractors Signature
Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
5111-726-3759 Phone
Job/Journal Number
COM2009-00643
COM2009-00643
COM2009,00643
COM2009-00643
Payments:
Type of Payment
CreditCard
cReceioll
City of Springfield Official Receipt
Development Services Department
Public Works Dcpartment
RECEIPT #:
Date: 05/11/2009
1200900000000000373
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
KENNETH CORNELIUS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
040938 In Person
Payment Total:
Page I of J
10:04:40AM
Amount Due
19.00
39.00
2.90
6.96
$67.86
Amount Paid
$67.86
$67.86
5/1112009