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Home My WebLink AboutPermit Backflow Test 2009-6-30 _~~!~G!!llrJ.:~J I . Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00958 ISSUED: 06/30/2009 APPLIED: 06/30/2009 EXPIRES: 12/30/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676'Fax 541-726-3769 Inspection Line SITE ADDRESS: 2109 J ST ASSESSOR'S PARCEL NO.: 1703361200100 Springfield TYPE OF WORK: School TYPE OF USE: New Public PROJECT DESCRIPTION: Irrigation System/backllow device Owner: SPRINGFIELD SCHOOL DISTRICT 19 Address: 525 MILL ST SPRINGFIELD OR 97477 Contractor Type Plumbing I CONTRACTOR INFORMA~IO~ 1 Contractor License GREEN THUMB LANDSCAPE & MAINTENA131659 BUILDING INFORMA nON I Expiration Date 09/05/20 I 0 Phone 503-362-7327 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction 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 I ~t Floor: Sq Ft 2~d Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMA nON 1 REQUIRED PARKING . Total: 'j Handicapped: I' Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: . au to ...,.........r-"ITlf"'\l\l. (\rpf10n law requires y..... f~'li~\~ rules adopte.;J b~I~P.U.BiJc:iMIiR0MEMENTS. HotificatlOn Center. ,ho. . _ u ,_ Street Improvements bAR 952-001-0010 through OAR Yo", U b In btain copies of the rules y Storm Sewer Availiible:J" You may Ot . Note: the telephone Special Instruction: callmg the chen oer. g(on Utility Notification number for t e re ) Center is 1_BOO-332-2344 . Notes: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: . Solar Setbacks: Sidewalk Type: Downspouts/Drai~ls: NOTICE: THIS PERMIT SHALLJXPIRE IF THE WORK / UTHOR/ZED UNDER THIS PERMIT IS NOT '.'ir::lti%I:U UH IS ABANDONED FOR I Valuation Descriotion I "(: SO DAY PERIOD, Description Tvp'e of Construction $ Per Sq Ft or multiplier Square Footage' or Bid Amount Value Date Calculated J/ / Paee I of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: C.OM2009-00958 ISSUED: 06/30/2009 APPLIED: 06/30/2009 EXPIRES: 12/30/2009 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 1 Fee Description + 12% State Surcharge + 5% Technology Fee Backtlow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $6.96 $2.90 $19.00 $39.00 6/30/09 6/30/09 6/30/09 6/30/09 3200900000000000500 3200900000000000500 32009000Q0000000500 320~900000000000500 Total Amount Paid $67.86 I Plan Reviews J 1 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 Reului-erl Insnections. "II... n.. II ",,,. ,.. Backtlow 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 hereby 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 of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will he 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 wm'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. Owner or Contractors Signature iJate Page 2 of 2 Plumbing Permit Application 225 Finh Street + Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-J689 Permit no.: (!.cl-- QS-'6' I Date: .!J c go-- 0/ This permit is issued under OAR 918-780-0060. Permits are. issned only to the person or contractor doing the work. Permits expire if work is not started within 180 days' of issuance or if work is suspended for 180 days. 1;i'4L~i.J!!I!OCAIL:;;.GOVERNMENT~AI'lRRO.vA'::~~lii1!1 I Zoning approval verified? DYes D No I I Sanitation approval verified? DYes D No I l~f;=I~~TEGIR~~~:~~:~TRUIT~O~0=~'1il I'-""**'ffiil P, li' '" -RMA'TION"'A.'N. O"""OC A' "TIO. N"'dr2isiiWJ 1i?jl,;c.c,.UOBlf,SITE,INl'v . . , . :?L." """*,,,,,,; I Job site address: 2\09 U ~~ I City: 'SI-R1\Je,gf\t::'L-f, . I State: DR. I ZIP: 9.:t41=l I Subdivision: \')O~\rL-- 1 Lotno,,:~ 11II.1l4nr,,'41R',*[)ESCRI~TI(lN~OI'l!tWORKI11fJl1.1ilB~ 1L--,h\'!.<-C..+l>F: IE'.EI6iIrTION 11\l'l:r7ti.-U?t1oJJ ",}In-! I );A~~w ", ?jj!i~.IIll~~_RRO~ER1;Yili!OWNER~lr~_ I Name: S1>'e.I!J(,FIELb PU~L.lC C::c+/onLS I Address: .t)ZS MIt...L- ST I City: ~~'l<IJJClFttSu I State: OR I ZIP: q74 '1'1- I Phone: I Fax: I E-mail: This installation is being made on resi~ential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature: liljiliill."lJ"'''''*1j;'CO.. "NtRACTORYIINSTAI!I!ATION_.~4l",;U;.{t"J14 ~~R*H'jm;ft!t. .'. , .<, ,'i!I1, " " (;.k Ki<:_.,,,","" iJffi?,*"WR> I Businessname: C,RF.,.",'/f.1U>>11', IJrtJt" ';? MoM1-.}" I I Address:po'1:,Q)( bl::J.'2. I I City: 1';-A-L-~ I State: DR I ZIP: Cf'1?,14 I Phone:,>A ~7;J.32-:::} I Fax: ,~,'5:?.?>~ 63"1/ I E-mail: hnVli1'J..fcJ~~L\1M1,,\~<'C.~ I CCB license no.: 17,1 M::.9' I; , t.~~ I I~. ,. .. 1 ,<.uUv.nS"H;''''U.'l'''' nv.' I Printnarne:'),.~ILE. I Signat~.- (~tJ1l!A/\ '... ~i(J! ' 440-2500-J (llI08/COM) I New residential I bathroomll kitchen (includes: jirsi' /00 feet of water/sewer lines, hose $238,,00 $ bibs, ice maker, underfloor /ow~pojnl drains"and rain-drain packages) I 2 bathrooms/I kitchen $374.00 $ I I 3 bathroomsll kitchen $439.00 $ I I Each additional bathroom (over 3) $95.00 I $ I I Each additional kitchen (over'l) $95.00 I $ I I Residential fire'sprinklers (includes plan review) I I 0 10 2,000 square feet $58~00 $ I' I 2,001103,600 square feet $116.00 $ I I 3,60] to 7.200 square feet $174.00 $ I I 7,201 square feet and greater $232.00 $ I Manufactured dwellin2 or pre-fab:(circle one) I Connections to biJilding sewer and I: I I $58.00 I $ I water supply I I Commercial, industrial, and dwclli~gs other than onc- or I two-family . I Minimum fee I I $58.00 I $ I I Each fixture $19.00 I $ I I Miscellaneous fees I 1100'-stonn, sewer, waterline $76.00 $ I I Each fixture, appurtenance, and piping $19.00 $ I I Storm water retention/detention facility $19.00 $ I I Irrigation systems $19.00 I $ / I I Piping or private storm drainage $19.00 I $ systems exceedinll the first 100 feet I Specialty fixtures $19.00 I $ I Reinspection (no. ofhrs. x fee per hr;) $58.00 I $ I Special requested inspections (no. of $58.00 $ hrs. x fee per hr.) i I Each additional inspection: (I) $58.00 $ Minimumfee $ I Enter value of installation and equip~ent $_. Enter fee based on installation and eq'uipment value. $ I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Investigative fee (equal to [A]) I (e) Enter 12% surcharge (.12 x [A+B]) I (D) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through 0): $S3.OC' I $ I $ r".'H> I ., 'A (j/ $ L;:"-' I -.$-Wl ~_ I (oi - 'bto 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone. Job/Journal Number COM2009-00958 COM2009-00958 COM2009-00958 COM2009-00958 Payments: Type of Payment Check Check Job/Journal Number COM2009-00958 COM2009-00958 COM2009-00958 COM2009-00958 Payments: Type of Payment Check Check cReceiotl RECEIPT #: 3200900000000000500 Description Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge Check Number Batch Number Paid By GREEN THUMB LANDSCAPE GREEN THUMB LANDSCAPE Received By nJm nJm Description B?Skflow, Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge City of Springfield Official Receipt Developmert Services Department Public Works Department Item Total: Authorization Number 6755 6760 Date: 06/30/2009 , . How Received By Mail By Mail Payment Total: Item Total: Check Number Authorization Received By Batch Number Number How'Received Paid By GREEN THUMB LANDSCAPE GREEN THUMB LANDSCAPE njm njm Page 1 of I 6755 6760 By Mail. By Mail Payment Total: . 1:36:28PM Amount Due 19,00 39.00 2.90 6.96 $67.86 Amount Paid $64,96 $2.90 $67.86 Amount Due 19,00 39.00 2.90 6.96 $67.86 Amount Paid, $64.96 $2.90 $67.86, 6/30/2009