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HomeMy WebLinkAboutPermit Backflow Test 2007-6-18 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54 ])726.3753 . FAX: (54 ])726.3689 ~: r 00 K'6:J ~ City Job Number. l O,..v\ -z007- ..~ Job Location q 4 8'" D4.;e '- €. J{j C didl ~ AssessorsMor n o~ Z7Z- \ '.,,-.Jl " I~ ~ ~ ~..--c-~ ~ rl ( ,- I~ ..~~: ".....( ~( :-( ~ ~\. ~~ ~ ~ "> ~ Q, .~( ~( ~ ',e< t~ ~( e.i( ~. ~ ~ ~ ~l. .~ ~ ~ ~ ~ ~ SPRINGFIELD. lJ\~ ~-~ Tax Lo' 00760 Owner A) 0 (2./h /lrJ ~O X Address 9L/ X oA;eL.f:N f City SPf2Z;VGt:-:ZfLL~ Stet.. dr< Phop" (j'fl) 6 s: 3 - :? '-1(2- Zi;- 9747"/ . BACKFLOW PREVENTION DEVICE PERMIT FEE: $55.35 r-------- -~.. ----'---, --..-..,..- _.---- - -~ Con"acwrlnformauon . ' ~ . ......-........ ...__..~ _._..c.........._._... _...-.:f:.~~-~............... .......--..-. .._- /lJ~ ~o6N YA<eY Ct9-/2-..f",~<"".,c.,~~ Contractor Addrers 'PC), 130)( -f"'!9c! ,<.",~~~~~~~~~~fs<{l) <{"J/ rC616 . ~,\,-'v' ,\" ~~'V' "- City;[.OG<0vf ~-(\CV~~~~S,,~'t~t~~(2. Zip 97YOs;.- i...ArJ\:>(C."1"oo( 0uT/<-1crrJ!2.5"0fP:.Uf:tj:F~1'~ -:> -I I Construction Contractors Registrati6rt#~:'0\).<..~\'~4'~~' 5 ;;> Expires.) 5 1(08" ~, ....:~'".... \ \'C" \,'V' \'0,,' 0'-> '. ....~ e'" '\ \J~{I.'1 ^" " J.~ ~ '0" By signing this permit/application, I agree to call for an inspection once the ba~\t16~~-e<f~tf6~'(ie~!fe has been installed and is visible for inspection (726-3769). I also state that ~q~foffi1~tj.6l~~~'" 'Q permit/application is correct. . ~.O\e '!,.eo ~",e'~" 0 ~ ~e' ~O<;o.0 ~ ~\O oo~ ,\\< ,0\).100 'I"e~. ~\.,o <'_~ 10 '0' '!,.e~' Cj ~ R,e e \.e ~"" :\'\'v ,J.t{, (je<;o. rJCj\. cP ;~ ~o -7 \o~o~'l>~O:~PD~"'~ ~ot~\~t,~ ( 0\.'" 50 "'~ ~<>' <0"\~' ~v' !;)~v ~ O~ ..J,o'-> e "e O~0 !{,CjCj' \<;0. 10. ~ ~e. '\' "Cj'!i,\,<;o.9J \o~ .,,\ ,,,, v'" ';0'(.1" e"'. ~v~ (j Signatur~~ J /~ For Office Use . Date of Application b ~ij,-07 --- Checked for Historical Statu< l.. Checked for Delinquencip< Shared Drive (f:)fBuilding FonnsfBackflow PreventionS-06.doc . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00863 ISSUED: 06/13/2007 APPLIED: 06/13/2007 EXPIRES: 12/13/2007 VALUE: . Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Pbone 541.726.3676 Fax 541.726.3769 Inspection Liue SITE ADDRESS: 948 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272100700 Springfield TYPE OF WORK: Backtlow Device PROJECT DESCRIPTION: Backtlow device TYPE OF USE: New Residential Overlay Dist: # Street Trees Rqd: Paved Drive R~dfes yOU to ON' OY!'JgtibOl\~d'fa~~e'on Utility ATiENT\ . ted by the Or 9 et lorth . ,,_... ,"les adoP _' ._ ,,,Ips are 5 ~. .~- ~.--". "'''-- - .r."-.'.V../' Notilicati(fPtial,;ICJM,i>~OMlJMEI'iTS'.les by in OAI\~; ~~y obtain COP'~~h~ telephoneSidewalk Type: 0090. ter (Note. T ation calling the cen 0 . gon Utility Notl IC Downspouts/Drains: number lor the. 1r~800.332.2344). Centel IS Owner: NORMAN FOX Address: 948 DARLENE ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION. Contractor Type Landscape Contractor NEW MOON YARD CARE License 7433 I BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R.3 Heigbt of Struct,,'\(.. Secondary Occupancy Group: TYl!e {v.--\\,\~!-NO Primary Construction Ty!\e'nC~:, VB r-.\..\.. t.Y-lwa~r T~.lW \S ~OI Secondary Construction'itVp~:I't.?WI\"'i SI-\ ?1\~~ng~.IFYI>~e\:O\\ # of Bedrooms: ""\\"\\'5 oIleD Ij\'.mt. ":Ij;Q~"a'ib: r-.1j""\I-\On r:n O? IS r-.tS~rinkled Building: nla _...c.~\r.cu '""" Vr-.~~"~~Q Dr-.'/ TOEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion , Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Paee I of 2 Pbone Number: 541.653.8412 Expiration Date 05/31/2008 Phone 541.431-6616 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Otber: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Value Date Calculated -Wi . . LI1 t OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2007-00863 ISSUED: 06/13/2007 APPLIED: 06/13/2007 EXPIRES: 12/13/2007 VALUE: 225 Fifth Slreel, Spriugfield, OR 541.726.3753 Phone 541.726.3676 Fax 541-726-3769 Inspectiou Line Total Value of Project Ff'f'S PfolillJ Fee Description + 10% AdmiDislralive Fee + 5% Technology Fee + 8% State Surcharge Backnow Device Minimum/Adjustment Plumbiug Amount Paid Date Paid $4.50 $2.25 $3.60 $14.00 $31.00 6/13/07 6/13/07 6/13/07 6/13/07 6/13/07 Receipt Number 1200700000000000759 1200700000000000759 1200700000000000759 1200700000000000759 1200700000000000759 Tolal Amount Paid $55.35 I Plan Reviews I 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. IRf'~ Backnow Device: Prior to covering and provide a copy of the lest 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 thai all information hereon is Irue and correct, and I further certify that aDY and all work performed shall be done in accordaDce with the Ordinances of the City of Springfield aDd Ihe Laws of the State of Oregon pertaini~g to the work described herein, aDd Ihat NO OCCUPANCY will be made OfoDY slructure without permission of the Community Services DivisioD, BuildiDg Safety. I further certify Ihat only conlractors 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 al the proper time, that each address is readable from the streel, that Ihe permit card is located al the froDI of Ihe property, aDd the approved sel of plans will remaiD OD Ihe site al all ~d~ing constructionn ~~ ~ ~ 6~(3 .-0/ 6w~er or Contractor~ Signature Date Paee 2 of2 225 F.iftb Street Springfield, Oregon 97477 541-726-3759 Pbone . \~ Wir.. .' 1iiiY of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journal Number COM2007-00863 COM2007-00863 COM2007-00863 COM2007-00863 COM2007-00863 Payments: Type of Payment Check cReceintl RECEIPT #: 1200700000000000759 Date: 06/13/2007 Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Backflow Device Minimum/Adjustment Plumbing Paid By NORMAN FOX Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2657 In Person Payment Total: Page I of I 11:02:ISAM Amount Due 2.25 3.60 4.50 14.00 31.00 $55.35 Amount Paid $55.35 $55.35 6/13/2007