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Home My WebLink AboutPermit Backflow Test 2010-10-8 SP~I.N.GF.IE.~.D... . ~~:.~. EJl!S';;~..~ f;;~~OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD . Building I Residential Permit PERMIT NO: 811-SPR2010-00477 IVR Number: 811149104753 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541.726.3769 Fax: 541-726-3676 permilcenter@ci.springfield.or.us PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00 SITE ADDRESS: 1620 LAWN RIDGE AVE, Springfield, OR 97477-2448 ASSESOR'S PARCEL NO: 1703252201800 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow for irrigation system OWNER: ADDRESS: PAUDOIS MICHAEL A & SALLY J 1620 LAWNRIDGE AVE SPRINGFIELD OR 97477 Phone Number: Contractor Type Contractor Name CONTRACTOR INFORMATION ~ Lie Type Lie No lie Exp Phone BUILDING INFORMATION ~ # of Units: o # of Stories: I Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Fl Basement: Sq Ft Garage: Sq Fl Carport: Sq Fl Other: Occupancy Load: # of Bedrooms: Sprinkled Building: Fire Alarms: Electrical Specially Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specially Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Energy Path: Site Information ~ I requireS you to ATIENTION: Ore90n b a~he Oregon Uti\\ly follow rules adopte~h:Se rules are S8t forth Notification cente~'iOthrOugh OAR 952-001- in OAR 952-001 -0 . co ips of the rules by 0090. You may obtam Nofe:' tile telephone calling the cen~;~ (on Utility Notification number for the 18900-332-2344). Center is - Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Springfield Building Permit 10f8/2010 1:40:04PM Page 1 of 3 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00477 IVR Number: 811149104753 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield,or.us PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00 SITE ADDRESS: 1620 lAWN RIDGE AVE, Springfield, OR 97477-2448 ASSESOR'S PARCEL NO: 1703252201800 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow for irrigation system DEVELOPMENT INFORMA TION ~ Fronlyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: 'REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Descriotion Tvee of Construction Unit Amount Unit Tvee Unit Cost Value h-;.i7-~~#~~~~:.~St~'7:,~'~:~;:~:B~~'~~':'~~5t(~~~Ii~Ji4l~,~~~4't,.rr;:7~:~~4+~::'": '~~1-:j'.~lk. ;~~-~~~]~"-;-:r . i\::"~':J Descriotion Backflow preventer Balance of Minimum Plumbing Permit Fees State of Orellon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Total Amount Paid Amount Paid $19.00 $39.00 $6.96 $2.90 $67.86 Date Paid 10/08/2010 10/08/2010 10/08/2010 10/08/2010 Receiot # .374546 374546 374546 374546 Springfield Building Permit 10/8f2010 1:40:04PM Page 2 of3 S::~~N~:~~ ~ORfGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00477 IVR Number: 811149104753 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00' SITE ADDRESS: 1620 LAWNRIDGE AVE, Springfield, OR 97477-2448 ASSESOR'S PARCEL NO: 1703252201800 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow for irrigation system Deoartment Received Due Date .Comoleted Result Reviewer Permi11ssuance 10/08/2010 10/08/2010 10/08/2010 Issued Nancy Machado Comments: Application Acceptance 10/08/2010 10/08/2010 10/08/2010 Over the Counter Nancy Machado Comments: Structural Review 10/08/2010 10/08/2010 10/08/2010 Not Required Nancy Machado Comments: Over the counter permit Planning Review 10/08/2010 10/08/2010 10/08/2010 Not Required Nancy Machado Comments: Over the counter permit Public Works Review 10/08/2010 10/08/2010 10/08/2010 Not Required Nancy Machado Comments: Over the counter permit Initial Review 10/08/2010 10/08/2010 10/08/2010 Over the Counter Nancy Machado Comments: Over the counter permit INSPECTIONS REQUIRED ~ Inspections 3620 Backflow Device 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 further certify that any and all work performed shall be done if) accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining. to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compJia!",ce with ORS 701.005 will be used on this projec~. 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 ::6: - .",," '''"o;:;;;'''~""' 0' ,~, .,,, .m"" 00 ".... .." 'm. ""0, ownerorc~ Date Springfield Building Permit 10/8/2010 1;40:04PM Page 3 of 3 rlu;:;=:~:.il~ 225 Fifth Street. Springfield, OR 97477. PH(541)726..J753 . FAX(541)72~3689 DEPARTMENT USE ONLY Permitno: r.e-2D10--- Date: /O~ ~/O 7 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contructor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CA TEGORY OF CONSTRUCTION City: Subdivision: Lot no.: DESCRIPTION OF WORK t{ rcL Name: City: Phone: E-mail: Business name: Address: City: Phone: E-mail: CCB license no.' Signature: 440-25()()..) (l1/OS/COM) FEE SCHEDULE Description Qty. Cost Total ... cost New residential I baIhroomIl kitchen (includes: firs! 100 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, underfloor low-point drains and rain-drain packages) 2 bathroomsll kitchen $374.00 $ 3 bathroomsll kitchen $439.00 $ Each additional bathroom (nver 3) $95.00 $ Each additinnal kitchen (over 1) $95.00 $ Residential fire sprinklers (includes plan review) o to 2,000 square feet $58.00 $ 2,001 to 3,600 square feet $116.00 $ 3,601 to 7,200 square feet $174.00 $ 7,201 square feet and greater $232.00 $ Manufactured dwelling or pre-fab (circle one) Connections to building sewer and $58.00 $ water supply Commercial, industrial, and dwellings otber than one- or two-family Minimum fee I I $58.00 I $ Each fixture I I $19.00 $ Misc:elIuneous fees 100' stonn, sewer. water line $76.00 $ Each fixture, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19.00 $ Irrigation systems / $19.00 $ 1'1 Piping or private storm drainage $19.00 $ systems exceeding the fIrst 100 feet Specialty fixtures $19.00 $ Reinspectinn (no. ofhrs. x fee per hr.) $58.00 $ Special requested inspections (no. of $58.00 $ hrs. x fee per hr.) Each additional inspection: (I) $58.00 $ Medical gas piping Minimum fee $ Enter value of installation and equipment S Enter fee based on installation 3.Qd equipment value. $ APPLICANT USE (A) Enter subtotal of above fees $~ iV (Minimum Perinit Fee ~.OO) tv (B) Investigative fee (eqnal to [A]) $ 7- (C) Enter 12% surcharge (.12 x [A+B]) $ {d ,7 <> (D) Technology Fee (5% of [A]) $ f TOTAL fees and surcharges (A through D): V~/\,. ~( u o . SP~~:=L~ L~ ~OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00477 1620 LAWNRIDGE AVE CITY OF SPRINGF[ELD 225 Fifth SI Springfield,OR 97477 541-726-3753 permjtcenler@ci.springfield.OLUS RECEIPT NO: 20[0000522 RECORD NO: 81 [-SPR20[0-00477 DATE: 10/08/2010 IQESCRI,PTldN:":":~';~.;.'~~~'i;:..~.i~;i;:' ';;;.', ."h}:},,,1(;');l??,;L~~'[:..: )~G.C:dQNJ'J-:_QQE . ,r.i'J!:":'~rviQJ.J.~J. DU E .' ;-.;: '~j;. 'J Backf[ow preventer 224-00000-425603 $19.00 Ba[ance of Minimum Plumbing ':ermil Fees 224-00000-425603 $39.00 State of Oregon Surcharge (12% of applicable fees) 821.00000-215004 $6.96 Techno[ogy, fee 15% of permit total) .___...__~0000-425605 ,..._... .. _ ,,_ .$2.90 IOIAL DUE: $67,86 L P"A Y.'M"E'N'I;' ,'I;y'P-E' r;:'...;P.....A..Y. '0"R:;';;C'iisH1ER'NMACHA.' 'DO.li. ", {;"O' M'M"'E.'N"I'S",t, "''"',' ,~_:'J ',;!$:;.'!".:;',. ;;;;','A'MO"U' N" I.P' A'.ID' "c." J c. . .,. '. ~.__~ :-=. . ""-~"'-'-~~___._............._=_,......_ -, -l.: _ ' :. ~".____""",(C,.",A:~.~~,.~......._~___... . - Cash PAUDOIS M[CHAEL A & SALLY J $67,86 $67,86