HomeMy WebLinkAboutPermit Backflow Test 2006-8-30
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CITY OF SPRINGFIELD'
Building/Comlbination Permit
Status
Issued
PERMIT NO: COM2006-0I115
ISSUED: 08/30/2006
APPLIED: 08/3012006
EXPIRES: 02/21l12007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa.
541-726-3769 Inspection Line
SITE ADDRESS: 2197 OLYMPIC ST
ASSESSOR'S PARCEL NO.: 1703254201202
Springfield TYPE OF WORK: Backtlow Device
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Backtlow device
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CASH CONNECTION INC ,,,p<'O'\ 13',,,,, Ole<;~P \ lo(\i\
% ORE OWN DOLLAR STORE INC 2197,~l\Y.MPI<:;~T",le '0;'2, 001-
SPRINGFIELD OR 97477,~,,\. \1\8"~,~~i\ Ot>-~ ::',IC'5 'O'j
tlu1\J ~,. _.,..;.p:SO\ "", ....'"'O'(\~
,I CONTRACTOR'INFORMATlONC"
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Contractor' : '" ',(', "'.''', ;\\0 O(c90(\_'J~'2.-'2.3t;icense
TWIN RIVERS PWi\1BING"U,<g\'OOO 17695
Expiratio~1 Date
03/11/2007
Phone
541-688-1444
Owner:
Address:
Contractor Type
Plnmbing
I BUILDING INFORMATION I
# 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 Patb:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Ba;ement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: Total:.
ur: \~'\ 11-'"
# Street Tree~IR!ld: VU\ut II' "\ n'- Hlmdicapped:
'.~"'i,.Y. Lt."." 11'...,,"1'
Paved DrIve R!ldi->.MI \ ~t1r\\. S PERi'll' Compact:
% of Lot, ~<&e'fjjge: EO UNOER \\-\1 aONEO '~Ol'\
AU\~.~~~~rI'O OR \s ~Bi\\'l
I PUBLIC IMPR'OXEMENTS'I \,tn'V"
Sidewalk Type:
Street Improvements:
Storm Sewer Available:
Special Instruction:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Valu"
,
Date Calculated
Pa~e I of2
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2006-01115
ISSUED: 08/30/2006
APPLIED: 08/30/2006
EXPIRES: 02/28/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa.
541-726-3769 Inspection Line
Total Value of Project
Fees ~
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backtlow Device
MinimumlAdjustment Plumbing
Amount Paid
Date Paid
$4.50
$2.25
$3.60
$14.00
$31.00
8/30/06
8/30/06
8/30/06
8/30/06
8/30/06
Receipt Number
120060000000000\352
1200600000000001352
1200600000000001352
1200600000000001352
120060uOOOOOOOOl352
Total Amount Paid
$55.35
I Plan Reviews ,
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
r Reonired Insnections .
Backtlow Device: Prior to covering and provide a copy of the test report on site at the time ok' inspection.
By signature, I state and agree, that I have carefully e.amined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall he done in accordnnce with
the Ordinances of the City of Springfield nnd the Laws of the State of Oregon pertaining to thc work described herein, and
that NO OCCUPANCY will be made of any structure without permission of tbe Community Servic'$ Division, Building Safety.
I further certify that only contractors and employees wbo 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 tbe property, and the approved set of plans will remain on the site at all
times during construction.
~f~
Owner or Contractts Signature
~/5o /0 t.
Dale I
Pa~e 2 of 2
225 Fifth Street
SpringflCld, Oregon 97477
541-7i6-3759 Phone
· ii:~
.. of Springfioeld Official Receipt
~elopment Services Department
Public Works Department
Job/Journal Number
COM2006-0 1115
COM2006-0 1115
COM2006-0 1115
COM2006-01115
COM2006-0 1115
Paymcnts:
Type of Payment
Check
cRcccintl
RECEIPT #:
1200600000000001352
Date: 08/30/2006
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
TWIN RIVERS PLUMBING
INC
Item Total:
l.:heck Number Authorization
Received By 8atch Number Number How Received
djb
24513
In Person
Payment Total:
Paj(e I of I
8:58:05AM
Amount Due
14,00
31.00
2,25
3,60
4,50
$55.35
Amount Paid
$55.35
$55.35
8/30/2006