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HomeMy WebLinkAboutPermit Backflow Test 2007-3-22 . Status Issued I I 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1460 DELROSE AVE ASSESSOR'S PARCEL NO.: 1703243305200 Springfield PROJECT DESCRIPTION: Backflow Owner: DYBEVIK GARY A & DEBRA K Address: 1460 DELROSE AVE SPRINGFIELD OR 97477 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00422 ISSUED: 03/22/2007 APPLIED: 03/22/2007 EXPIRES: 09/22/2007 VALUE: TYPE OF WORK: Backflow Device TYPE OF USE: Repair Residential I CONTRACTOR INFORMATION I Contractor Type Plnmbing Contractor License DECKER LANDSCAPING & IRRIGATION BUILDING INFORMATION I # of Units: Primary Occnpancy Gronp: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Heigbt of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Expiration Date Phone 541-688-7991 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION. Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: . ' . ,..' .IPUJJLI(;:>IMPROVElI<,"-I',,, I Street Improvements: \ IV\~' - '\.~;) 0'1 \t-a i~s ai3 SGI 'Ol !l.11t:.I" _ &,;:\010 ;>e (1.1 i>-? 952- Storm Sewer A:vailable:\~'" n'''-. ..(\,0 _1.1"\'1 Q. _\.lIeS , ~\O".. ce"I'" " {V ... .~e ' SpecialInstructi'!nbe.liO{1 ~_oo~o \(1 "OS o~ I :; ~,o(\e NoIII\ p. 952-r:/J oi:lla.in COi~)'. l\'Ie \e"\'~'.(;;lt\O: . Notes: in 011' '(01.1 {(\a.'J nlecl,\;'\O \\liI.'] \;'\0\\ . C\090. ..._~ \hQ c0 ^,,,,(~cn \J ..r. '>"I:/X C(~,\\"-""(,C\1..\\'l.o'~ - ~ ..oC~' nU{(\\)t'. ce(\\ens ' I Valuation Descriotion I Description $ Per Sq Ft or multiplier Sqnare Footage or Bid Amount Tvpe of Construction Pa~e 1 of2 REQUIRED PARKING Total: Handicapped: Compact: . .,\ftr, " -11r: 1~ln~\I I'tU' (,1.. EX\-,\\'\i:" I.. 1 11-\IS PERM\I SHi\ll lHIS PERM\\ IS NO ~~~'fll~'RT:)ijle: ll\'m~: i\\3MlDONED fOil ~y,W,@ifro?aQ~: OD i\1'i~ 1BO Di\'( PERI . Value Date Calculated . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00422 ISSUED: 03/22/2007 APPLIED: 03/22/2007 EXPIRES: 09/22/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees P",id I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid $4.50 $2.25 $3.60 $14.00 $31.00 3/22/07 3/22/07 3/22/07 3/22/07 3/22/07 Receipt Number 2200700000000000390 2200700000000000390 2200700000000000390 2200700000000000390 2200700000000000390 Total 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. I Reouired Tnsnedions I Final Plumbing: When all plumbing work is complete. 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 I fnrther 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 witbout permission of the Community Services Division, Building Safety, I 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 tbat all reqnired 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 ~; construction. /:~ K~/~ 5-;);)-07 ~ '--- Owner or Contractors Signature Date Pa~e 2 of2 ..... . . . . CITY OF SPRINGFIELD, OREGON SPRINGFIELD' " '1~~i L~.,...~ _.._ _" .~.~. ,,< .'."" .. ... 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54I)7Z6-3753 . FAX: (541)726-3689 ~~ ~4 ~ "~ t~ ~ ~ .,~j '. 14 ~ ~ <,----,-4 'f 4 l~ -"'r-t4 ~l ~4 :""'4 ~ ~\(q ~ ~ .,e4 ~ ~ CI. ~l e; e.:J '.,.-:J4 l,~ ~4 ~4 ~ ~ ~ ~4 ~~ ~ ~ r'l;.....ij ~J ~4 "-') ~ ~l City Job Number ~ I..Jn '7 - D tJ (....{ 7.. "2-- Job Location /LJho bl3-f2-(Js 6 Assessors Mar 1103 ~4 3305;.';1 [Jl)' Owner (~~(,'" ~ I Addres~ I L-J l? () Q \ 0[ O';.Q City ~P{\~Q :d& Dy 6 e. v~t A-u~ Stat" De Tax Lot Phon" Zip l' 7417 BACKFLOW PREVENTION DEVICE PERMIT FEE: $55,35 Conuacwrlnformauon Contractor \\'). -t.c.... \(~ .. L""..J s c... cr1 Addres& <Y. Q SQ\[_ "if City Jj ( \ I '" ,~ Df'lL J-- .L ('.r \~.... ~ l~ State OR... Construction Contractors Registration # <6]0<6 Phon" r. I '^ L- Zip OJ It( 0'\ Expires 9-30- 07 By signing this permit/application, I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). I also state that all information on this permit/application is correct. Signature ~ ;;:? ~ L '---'" - For Office Use Date of Application 3/;;;f:;J..Jp--7 .t/ Checked for Delinquenci". Oat" j-d'd.- 07 Checked for Historical Statu. ~ Shared Drive (f:}lBuilding FormslBackflow PrevcntionS-06.doc