HomeMy WebLinkAboutPermit Backflow Test 2007-6-18
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54 ])726.3753 . FAX: (54 ])726.3689
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SPRINGFIELD.
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Tax Lo'
00760
Owner A) 0 (2./h /lrJ ~O X
Address 9L/ X oA;eL.f:N f
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. BACKFLOW PREVENTION DEVICE PERMIT FEE: $55.35
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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 ~
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For Office Use
. Date of Application
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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 ~.
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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
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6w~er or Contractor~ Signature Date
Paee 2 of2
225 F.iftb Street
Springfield, Oregon 97477
541-726-3759 Pbone
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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