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Home My WebLink AboutPermit Backflow Test 2009-6-30 _~P.81N!QIp,Il!!I:!I,. ~I . ~'i' CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00960 ISSUED: 06/30/2009 APPLIED: 06/3012009 EXPIRES: 12130/2009 VALUE: Status . Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 7345 THURSTON RD ASSESSOR'S PARCEL NO.: 1702350002600 Springfield TYPE OF WORK: Backllow Device TYPE OF USE: New Public PROJECT DESCRIPTION: Irrigation/Backllow Device Owner: Address: SPRINGFIELD SCHOOL DISTRICT 19 525 MILL ST SPRINGFIELD OR 97477, I CONTRAC~OR IN~O~MATI?N 1 Contractor Type Plumbing Contractor License GREEN THUMB LANDSCAPE & MAINTENA131659 BUfLDING INFORMATION 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 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: . Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION 1 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: . Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: ._" +1"\ ATTENTION ~re~eo; ~~~h;<I,~uiiLIC IMPROVEMENTS 1 follow rules a op I '1leo a . ..' ^l Street Improv~II1ents:ion Center. T10sert OA;c", . I' ,IOTlCSidewalk Type: . 1 u~':';';"2,001'OOlO through "'.,, v.~ _\ TH L:. Storm Sewer l\:vailable: obtain copies 0\ ;;1-8, II ,- ,.<} IS PEDownspouts/Drains: Special Instru"'li;;~:. Yo~;a~nter. (Note: the t~lbl:l ~. " AUTHOR'flED "FlALL EXPIRE IF TH call1~~r fO~ fhe Oregon Utility ~otl"c,.llun COMMENCED UNDER THIS PERM'/ WORK Notes: num Center is 1_800-332-23.,4). ANY 180 OR IS ABANDO IS NOT . DAY PER Inn NED FOR I V alu,ation Desc~iDtio~ I Description Tvpe 'of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Dale Calculated Paee I of2 _~l'!tN<:#.IjI~~, 1. Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00960 ISSUED: 06/3012009 APPLIED: 06/30/2009 EXPIRES: . 12/3012009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fe~' Paid 1 Fee Description + 12% State Surcharge + 5% Technology Fee Backnow Device Minimum/Adjustment Plumhing Amount Paid Date Paid Receipt Numher $6.96 $2.90 $19.00 $39.00 6/30/09 6/30/09 6/30/09 6/30/09 3200900000000000501 3200900000000000501 3200900000000000501 3200900000000000501 Total Amount Paid $67.86 I Plan Reviews " To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested 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. Re~,,~Ire~ I nsneeti,on,' 1 Backnow 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 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. Owner or Contractors Signature Date Paee 2 of2 Plumbing Permit Application It*.~'DEPARTMENT;iusEfoNLf~JiI ~~E:1:A0iili(YA:<ill;%G*'''8'H;oV:-;'',':>s~#.;;;,,'rj}/LtY;;)f!'iJ+~ I Permitn~.: (~tl-CY60 I I Date: (;/20/0'7 [' 225 Fifth Street + Springfield, OR 97477 . PH(541 )726-3753 . FAX(541)726~3689 This permit is issued under OAR 918.780-0060. Permits are issued 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_'0-~'0!l!lO'C.A' .l!:,xG.OV' ...'if' "R.OV.A"!tI!:r::J::"'rk::~~1 ~_,,_m4 . ;'Ii .ERNMEN"zAI'!r; . ",.'~01!i000~.0.0 I Zoning approval verified? DYes D No I I Sanitation approval verified? DYes D No . I 'Sc ': ....; M,'''';'[41. C W', , .. '.' ....,. ,j,"' _ , .', "', ....., ., -, ," "r,~gr: "", w. "j 11II?__III?CAtEGORY:lfOF),f.CONStRUCTnON,:;;~_ I 0 Residential J 'Q( Government I. 0 Commercial ., 1l!.I!lliIl;)OBlfSltEIINf:O~I\IlATIONrANblil!O.CATlONiillll?lII?l I Job site address:~ 11l-UI2$\tJ,.! ~'b I I City: ('SDfl.trJl1F1~\) I State:' Ot'L I ZIP: 'FJ.4=rt I I Subdivision:\(l9~ I.Lotnofl~~ I 1"''"!l\lI''''''_d'Alli''''''OES'CR.I'''rIO.NlPO.. "dlW ORK~il:i""lFll'l!li'li~iiil ~~;ti%hiilJ:Wf(';ff~m& . r:"J w. rY% . . .~.~_1Ift;1iIfL_'WN~.,"=dUI I LA1J~1'1::; I ~\fi!A1IoJ IIJs:r-kl.LKIlON I ~Jl-n-\ ~-FLo-vJ ;31'0'1mim 'H', -+4))>';' *">>""""'; .... .... .' . . '~"'fiJtl@2l12!if"~ "'^"'",Y'<;;;;-=:~'-: %4. '4:""7'_~~FI'"?-4TpROPERt:i'd!'OWNERG""''''ll'G~,''I..,''>>d'~?G0T0 __=;w~j:Y M_~0."'YUJ~* " . -., _ _.'.. ',' .." . -="='~"';"'''''.'r-:'''m:"""._L(,4.0''''''' I Name: ~N Ce:l:?\-aD ~t.ll;;,.LIc.. ('c..HrnJL.5 . . "-.-J- I Address: 6 2- .:; fJlll-L- S, I I City;St>'f.\,Jl1fia::t\ I State: 0 12.... I ZIP: 1=74~:}- I Phone: I Fax: I E-mail: This installation is being made on residential or fann property owned by me or a member afmy immediate family, and is exempt from licensing requirements under OAR 918-695-0020, Signature: 1-.".BKd'Ji;:r"'?"C(jNTRAcTORll'INStA"IEATIONii!',.,a"-li~'...') ii1Wlt4ki&-ut~,_ _ _ _ " ___, ____:II _ __ __ _ _ ,',', - __ _",,_bE1]i1R, "'''',K'1<,Glli'M] I Businessn~me:O~l\-n\U,M!\' 1::kIJ\..?- rJlPrIlJ,. I Address:Pf)~)( 61=1-1_ . I City: ~~ I State: olL I ZIP:'J-7.so+- I Phone:5c3. 3(,;2..=732.:='" I Fax:5)J:=?64 "3cr' I E-mail:ho".!i'l.p(.;la.-~\"b.-v-l9"''''1'....:.\y...... + I CCB license no.: I~ J..,.5'l ] BCD license no.: '-+<.<;'1 I Plumbing license no.: ~ I Printname:::-p,. +40LL./ ,,-\~A k..E- I Signatur~ --- 440-2500-1 (1 t/08/COM) I New residential 1 bathroomll kitchen (includes:firsl 100 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, lmderfloor low-point drains and rain-drain packages) 2 bathrooms/ I kitchen $374.00 $ I 3 bathroomsll kitchen $439.00 $ Each additional bathroom (over 3) $95.00 I $ I Each additional kitchen (over I) $95.00 I $ I Residential fire sprinklers (includes plan review) I o to 2,000 square feet I I $58.00 I $ I 2,001 to 3,600 square feet $116.00 I $ I 3,601 to 7,200 square feet I $174.00 I $ I 7,20\ square,feet and greater I $232.00 I $ I Manufactured dwellin2 or Dre-fab (circle one) I Connections to building sewer and I I $58.00 I $ I water supply . Commercial, industrial, and dwellings other than one- or I two-familv Minimum fee I I $58.00 I $ I Each fixture $19.00 $ I Miscellaneous fees 1 100' stann, sewer, water line $76.00 I $ I Each fixture, appurtenance, and piping $19.00 $ I Stann water retention/detention facility $19.00 I $ I Irrigation systems $19.00 I $ I' [ Piping or private stann drainage $19.00 $ I svstems exceedinlI the first 100 feet I Specialty fixtures '1 $19.00 I $ I Reinspection (no. ofhrs. x fee per hr.) I $58.00 $ Special requested inspections (no. of $58.00 $ I hrs. x fee per hr.) I Each a(jditiooal inspection: (1) $58.00 $ I Minimum fee $ I 1 Enter value of installation and equipment $_. I' I Enter fee based on installation and value. $ -------- I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Investigative fee (equat tn [A]) I (C) Enter t2% surcharge (.t2 x [A+B]) I (D) Technntogy Fee (5% of [A]) I TOTAL fees and sureharges (A through D): $6'/). C11) I $ I $ IQ'~ (Q I $ '2, "I'*' $-l.A. "1 t91 ~ l .Z$..o 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone iiiAt City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-00960 COM2009-00960 COM2009-00960 COM2009-00960 Payments: Type of Payment Check Check' Job/Journal Number COM2009-00960 COM2009-00960 COM2009-00960 COM2009-00960 Payments: Type of Payment Check Check cReceintl RECEIPT #: 3200900000000000501 Date: 06/30/2009 Description Backflow Device. Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge Paid By GREEN THUMB LANDSCAPE GREEN THUMB LANDSCAPE Item Total: Check Number Authorization Received By Batch Number Number How Rel'eived 6756 6760 By Mail By Mail Payment Total: njm njm Description Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 12% State Surcharge Paid By GREEN THUMB LANDSCAPE GREEN THUMB LANDSCAPE Item Total: Check Number Authorization Received By Batch Number Number How Received 6756 6760 By Mail By Ma;l Payment Total: nJm njm Page I of I 1:51:17PM 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 Amo~nt Paid $64.96 $2.90 $67.86 6/30/2009