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HomeMy WebLinkAboutPermit Backflow Test 2006-8-30 . . 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 ou \0 :..c.c:,\J ... N ~~"-\~ '(\ U\I''"J 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" r '", " ~e,,\e\, ,.- \.l\II'\'! "'-'\ 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