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Home My WebLink AboutPermit Backflow Test 2006-10-23 . -1I&t.r~f!~'.-Pl'.~; , ! " , , . '",:r -. ~ITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2006-01364 ISSUED: 10/23/2006 APPLIED: 10/23/2006 EXPIRES: 04/23/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 421 Mountaingate Dr ASSESSOR'S PARCEL NO.: 1702343403700 Springfield TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backflow Owner: BLACKWELL TIMOTHY J & BETHANY M Address: 586 S 68TH PL SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor MARKDARRENSCHELSKY BUILDING INFORMATION I License Expiration Date Phone 541-746-2501 # 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 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: AI I tON ilul~:UleYlili law requires you iO 4_11_... ~. .1_ _ _ -1_ _.L_ -I 1-... .L'" _ _ _. _ _ _ _ , ...... Tolal: Handicapped: Compact: - -- ---.-.-----~ ...- ---:3-" --.....J I PUBLtC tM..."","';_J;;lvIElN.T:S'ler. Those rules are set forti Street Improvements: In UAH l:Io~-uul-001 ('SllieWaf!tT';l~e'jl952-001 n1nx . 0090. You may obtain copies of the. rules b\ Storm Sewer l'IIuuAQf:. calli'ng the center Downspouts/Drams: ne . . \1..VtC. UIt:llt:llt:fJIIU Speclallnstrum~:PERMIT SHALL EXPIRE IF THE WORl(Jmber for the Oregon Utility Notification Notes: AUTHORIZED UNDER THIS PERMIT IS NOT Center is 1-800-332-2344). "- COMMENCED OR IS ABANDONED FOR ANY 1 BD DAY PERIOD, I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I on -~ ~. . .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01364 ISSUED: 10/23/2006 APPLIED: 10/23/2006 EXPIRES: 04/23/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project L."\f\W P~W Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Dale Paid $4.50 $2.25 $3.60 $14.00 $31.00 10123/06 10/23/06 10/23/06 10123/06 10123/06 Receipt Number 2200600000000001480 2200600000000001480 2200600000000001480 2200600000000001480 2200600000000001480 Total Amount Paid $55.35 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 Rp'lIJi~ Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. Final Plumbing: When all plumbing work is complete. 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 tbat 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 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 Omt::;;r'''"'" ~ '_ ,,/' '/06 Owner or Contractors Signature ~ Date Paee 2 of2 2i5 Fift'h Street Springfield, Oregon 97477 541-726-3759 Phone Job/Joornal Number COM2006-01364 COM2006-0 1364 COM2006-0 1364 COM2006-0 1364 COM2006-0 1364 Payments: Type of Payment Cred itCard cReceintl RECEIPT #: . ;J7~~ WiL...., . Ciii&f Springfield Official Receipt D.pment Services Department Public Works Department 2200600000000001480 Date: 10/23/2006 Description BackIlow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DARREN SCHELSKY Item Total: Lheck Number Authorization Received By Batch Number Number How Received Ikw 213225 In Person Payment Total: Page I of I 10:55:40AM Amount Due 14,00 31.00 2,25 3,60 4,50 $55.35 Amount Paid $55.35 $55.35 10/2312006