HomeMy WebLinkAboutPermit Backflow Test 2007-3-22
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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
..... . .
.
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CITY OF SPRINGFIELD, OREGON
SPRINGFIELD' "
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225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54I)7Z6-3753 . FAX: (541)726-3689
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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 (~~(,'"
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Addres~ I L-J l? () Q \ 0[ O';.Q
City ~P{\~Q :d&
Dy 6 e. v~t
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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.
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Shared Drive (f:}lBuilding FormslBackflow PrevcntionS-06.doc