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Home My WebLink AboutPermit Backflow Test 2009-10-1 225 FIFTH STREET. SPRINGFIElD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~~ e) "~~ l~ ~ ~ Assessors M~r "~ '. Ij ~~ Owner -< l~ Addrp<< I~ City .~ ~ ~\ ~ ~ ..~~ > Addrers ~ Q City .~ ~ "~~ 1~ ~ ~ ~ ~ Sigmtnrp ':-j~ / ~ ~ ~ ~~'4 Date of ApplicatioI' ~ Checked for Delinquencie< ~ M I' . . , City Job Numb., COM lOo 7' - Dill 5' i lob Location . Z. 5b 0 ~o.v /70"3 Z 7 Z- ( s+-- Tax Let ()(kCO J,^- '::> -l....... 2 3.(; 0 SPIi...."'" -ht>=/J s: c:..~u~V\. \'e:-;t.( ~ O^ ~ i- :honp 7l("S-!7<':::<( 97l(77 {)(L" St?tp Zip BACKFLOW PREVENTION DEVICE PERMIT FEE: C'~) 67 ~ ~m; "~''FIt,~~.%,t\'''t>~.,':~-.''', -, ..- ~:t. "'.1\,""'''',' r '^"'."5. >'''~ ll~cijnfrIiEiiJA7iifo'1!fil:;io )~~i:~~~'!d.tt'~~~2~tr{::~!1:~ G\k'-'\.."""'" Contractor LAv....sL.A "........ ~ ~J-j 23oS- SP~ Phonp <;)l{1-7z6-6 ~~O State 97" 7 7 Zip C)(L. , s36~ Expires IC::/?YO u...CZ' Construction Contractors Registration # By signing this permit/applic has been installed and i IS' permit/application' co ct. , n, I agree to call for an inspection once the bacldlow prevention device e for inspection (726-3769), I also state that all informalion on this D?t". /O'--/~ ? For Office Use 1~~1 .~ ...---' Checked for Historical Status Shared Drive (T:)lBuilding Forms/Backf1ow Prevention 7-OB.doc _.lli~~~.!~!1:\~' illIlif "',.", "'/ Wi):} 1; . .~".' Status " Issued--'--.-.,.---- ----- CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01459 ISSUED: 10/0112009 APPLIED: 10/0112009 EXPIRES: 04/0112010 VALUE: . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726~3769 Inspection Line SITE ADDRESS: 2360 DON ST I ;" ASSESSOR'S PARCEL NO.: 1703272101800 " Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Alteration PROJECT DESCRIPTION: backtlow dev ATTENTION: Oregon law requires you tD f"lI"w rules adopted by the Oreg~~_~~~:Yh Owner: SCHOENBERG JUSTIN A & K~S3~~~~_~~~-b~'1~'{h;;U'~h-OAF{952-001- Address: 2360 DON ST .. " \\l "," ma obtain copies at the rules by SPRINGFIELP OR 97477 OO~~lii:~~he /enter. (Not,~::~e ~~~~P~~t~;" number Tor lilt;' VI ":::'.':'.:: ':"':;';"~O'A II , CONTRA€:r~R'fNFORMATION), Residential Contractor Type Landscape crintractor GEORGE GUNN License LCB5363 BUILDING INFORMATION I Expiration Date Phone # of Units: Primary Occupancy Group:: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . # of Stories: Lot Size: !II on !!f!~ht of Structure Sq Ft 1st Floor: THIS ,T,yp'e ofrHeal:LL EXPIRE IF THE WOFS'q Ft 2nd Floor: J,.I. 'IQVII 011M ~ I >>;'~f~~!1WI~'uER THIS PERMIT IS Nalq Ft Basement: AUTH~~~,?~~T?'f{~ S ABANDONED FOR Sq Ft Garage/Carport COMrEnergylPath: I Sq Ft Other: ANY 'Spriiikle'dHf.;Jidll;\r n/a Occupant Load: I DEVELOPMENT INFORMATION' Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: - Overlay Dist: # ~treet Trees Rqd: Paved Drive Rqd: o/u'of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: I Valuation Des,criotion I Description Tvpe of Construction $ Per Sq Ft or multiplier ,Square Footage or Bid Amount Value Date Calculated Pa2e I 01'2 Status Issued 225 Fifth Street, 'Springfield, OR 541-726-3753 Phone 541-726-3676 Fax . 541-726-3769 Inspection Line Fee Description + 12% State Surcharge + 5% Technology Fee Backtlow Device Minimum/Adjustment Plumbing Total Amount Paid v Amount Paid $6.96 $2.90 $19.00 $39.00 $67,86 Total Value of Project Fees Paid I Date Paid Plan Reviews I 10/1/09 10/1/09 10/1/09 10/1109 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01459 ISSUED: 10/0112009 APPLIED: 10(0112009 EXPIRES: 04/0112010 VALUE: Receipt Number 2200900000000001126 2200900000000001126 2200900000000001126 2200900000000001126 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 I nsneetions I Backtlow Device: Prior to covering and provide a copy of tbe test report on site at the time of inspection. By signature, I state and agree, tbat I bave carefully examined tbe completed application and do hereby certify that all information hereon is true a~d correct, and I further certify that ~ny and all work performed shall be done in accordance with the Ordinances oftbe City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be 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 furth~r agree to ensure that al~uired inspections are requested at the proper time, that each address i~ readable from the street, that the permit card is.located the front of the property, and the approved set of plans will remain on the site at all times during construct' ~ y--: -'1--. ./ ./-' c:.--- ~ Owner or Contractors Signature ) Page 2 of 2 /j---/ ---cr Date 225 Fifth Street Spil'ingfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-01459 COM2009-01459 C0M2009-0 1459 COM2009-0 1459 Payments: Type of Payment Check cReceintl RECEIPT #: -,r.:~;'~,' 1IIi:'. " - ."... ""'...........~ '. City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000001126 Date: 10(0112009 Description , Backf1~w Device Minimum/Adjustment Plumbing .+ 5% Technology Fee ri . '+ 1'2% State Surcharge Paid By GUNN LANDSCAPING Item Total: Check Number Authorization Received By Batch Number Number How Received cjc 4642 In Person Payment Total: / Page 1 of 1 10:12:19AM Amount Due 19.00 39,00 2.90 6.96 $67.86 Amount Paid $67.86 $67.86 1011/2009