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Home My WebLink AboutPermit Backflow Test 2003-9-12 . . '-<11 t OF SPRII"It.t<IELD' Building/Combination Permit PERMIT NO: COM2003-00883 ISSUED: 09/12/2003 APPLIED: 09/10/2003 EXPIRES: 03/12/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 969 NORTHRlDGE AVE ASSESSOR'S PARCEL NO.: 1703261204321 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Backflow device Owner: GUNN RICHARD C JR & SONJA E Address: 969 NORTH RIDGE AVE SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Buildings: PrimaryOccupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: ~ Range Type: Sq Ft Garage/Carport ~_1i:nergy Path: ~'~g\Ft Other: ~ .!i,)" '> ,- . ,i:-',::" ~ """,,,0 -$(~I!$~OUS Surface Area: ...... .- ~ /- , '" ~- . ~1:liE~OPMENT INFORM A TlON ".,' 0<f ....0 C; O;",rv ~0"".0 _ ~q,'-<.,'~' .,"'- 0" ",,'If~ ~ ~EQmREDPARKING ..s ~ S:) ,~ 0 ~0 O~ ~0 if ,ifi' 'CJ. ~ . ~ Overlay Dist: ~:::' cA;s' ....::>:<::- CJ- '0 q;0 ~,!:otal: .;::y;; 9:J~ # Street Trees Rqd: ~ ~o{) 0",,0 J~ 0"" 0'0 ~CHandicapped: cf' ~ ~~~. Paved Drive Rqd: .v...Ili ftlli ^'~ ~o o~ .':S'..~ r.,6~~pact: ~ ~~ S:) ~. ~o ..... C> (j ",,0~ ~ Rearyard Setback: f./.,' ~ ~ C:l ~ % of Lot Cover~ge: 'If ~0 <::>C>" ~~ ~o >:-'V # Solar Setbacks: A.~ ~ ~ ~ ~q; ~ ~0"" 00 " if r$-' rf ~'!l -:i.' 9 ,J. ;(.'...s k ..;; ~ ~C>. " .<20.N <t::"'~~~.$~ . I PUBLIC IMPR<;)~EMFiNis'i $''&~c,0~0~~''- ~~ '" ,- .". X' o);s' .'0 ~... Street Improvements: G' ~ CfO~ -I: ~ ,~id'i.w.alk Type: ~ ~ s::\.~<:.'rt-('Ili "~ s::\OJ c,q; P DownspoutslDrains: <:5 ~- <:.' R.3 VN SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Storm Sewer A v.i1able: Special Instruction: Notes: I Valuation Descrioti?n I Description Type of Construction $ Per, Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pa2elof2 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-00883 ISSUED: 09/1212003 APPLIED: 09/1012003 EXPIRES: 0311212004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line l..Fp.p.~ PaW Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $3.15 $14.00 $31.00 9/12/03 9/12/03 9/12/03 9/12/03 2200200000000001517 2200200000000001517 2200200000000001517 2200200000000001517 Total Amount Paid $52.65 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 Reouirp.d Tnsnection~ I I Backflow 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 T 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 be made of any structure without permission of the Community Services Division, Building Safety. T 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. ~ . ~ JU~ I) 1'-/cJ.-03 Owner of Contractors Signature Date Pa2e 2 of2 225 rIm"1 ,TRt:I;r . SrRINGIlELD, OR 97477 . rH:(54 1)72(;<-\75:~". fAX: (~4 I)72G-%89 ~ O. . 1"'""l ~ Job Location ro U Assessors Ma:, . 1"'""l, ~ ~ Owner 'i2,r,.j.A-If-O ~ St>r-1JA G~.J ~, ~:' Addres. SFfLr":::'M4I=reLi~ ~: .~ Q,)/ ~: C); U: . 1"'""l' ~: 1'\""- \U' Q: ~; oj . 1"'""l' ~: Q: (1): ;>:: (h): H: ,.." , ~: >: ~ 0) ~i ~; OJ ro: ~ " ., . . City Job Numbe" Co M.. 'Z-co ~ - DO e, <0 ~ eft, 0, A',cYZ.:n-IIl-l.DM::. ME . /702)'2(..,-1 L 004....7..1 Tax Lot cr "9 r0, 01Z. D-Ilf.r u G (E, A-JE Phonp 726 -6S-g0 City ,.-.,/L 47./.77 Statp Zip BACKFLOW PERMIT IS $52.65 (includes P"ermit Fee, State Surcharge & Administrative Fcc) COli tractor IlIformatioll Contractor M ~5ta r- S~C::: Phonp Address Cit:, Stato 7.ip Construction Contractors Registration # Expires By signing this permit/application, I agree to call for an inspection once the backtlow prevention devise has been installed and is visible for inspection (726-3769), I also state that all infonnation on this permit/application is correct. Signaturp ~~r/ Oat" For Office Use Date of Application Checked for Delinquencip. Checked for Historical Statu. Shared Drive (T:)/Building FonnslBackflow l.rcvcntionl-03.doc . 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00883 COM2003-00883 COM2003-00883 COM2003-00883 Payments: Type of Payment Check ~'~"--~~""'.". ~... I .,".' .i ....,. ....... ,. " Receipt #: 2200200000000001517 Description Backflow Device Minimum! Adjustment Plumbing + 7% State Surcharge + 10% Administrative Fee Received By jmp <":heck Number Batch Number Authorization Number Paid By RICHARD C GUNN JR 1696 City of Springfield Official Receipt. Development Services Department Public Works Department Date: 09/12/2003 9:47:00AM Amount Paid Item Total: 14,00 31.00 3.15 4.50 $52.65 How Received In Person Payment Total: Amount Paid $52,65 $52.65 . .