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Home My WebLink AboutPermit Plumbing 2007-7-24 ~~ .O~~ r~ r ~.. ~ :-~ ~ ~~ ~ .~ eo~~ ~ ~ 0) ~ ."l!!!!!!!l" W . ~: ~ ~ .~ ~q ~~ l1 ~ e; , .. ~ r~-1;'-J~ y~ y---.i t)) ~ .~ . '. ~~ ,~ ,~~ CITY OF SPRINGFIELD, OREGON City Job Number C~ 70 07-<.:) (0 ~ I . Job Location] -7 ~}~~..~ jl/(l~ir - - --S )---- 'r-- - _ ,.' -_.._-- - Assessors Mar ) 7 0 "33 -5"Z- 2- - "'.J .--:--- ---, -- -- ..--~ - /!17CJO [11 Tax Lot s-r:: r' 5ZS- / /? ~ k- 0' e. / -C u.. {L- Gr~ I/L-J (/ H-/t~l.J Phon!" Statf> 02- Zip '77Cf77 BACKFLOW PREVENTION DEVICE PERMIT FEE: $61.50 Con"acrorlnformailon Contractor m ~..J2 a .~ ~ /l/ # _ , w r~A/JJ" Car ~p t?' ~.'-. <;: j- 1/ / u -e /.' .L ,;(Ie Addres~ ? 0, /3 0.)( City ~5 0. P J r ~J~ Phon!" State_I-=> 1<. ') II :r Zip CZ / V7./ Expires ..:2.. - -< .r - 0 r Construction Contractors Registration # By signing this permit/application, I agree to call for an inspection once the backflow prevention device has been installed and is visible for in'spection (726-3769). I also state that all info~~n on this permit/application is correct. t~~\tesot\ \)\\\~'(\ ~ \e.'tI Ote~ a\ \0 / ~ ~.Ote~06'O,!\'(\e~es~1es fl.$~. ~ ~ ~~~609\e~ose~o ~~ 1/ - 0 '"/ Signaturf" Il\.. .,f:,P"t. - *'t~Mie\ ~ ~p- T r r \o\\~~ot\ $\$~~ 009'~ \'(\e \e\~Qe.\\Ot\ ~0'S ..0. t#J'l- e.'f 0'0 INO\e. ~\\'i ~o \1' Ot'" ''1'''' ~ "jp'et. 'I at' \)\~ 1J,raA4\. ForOf~:'~\'(\e ~eOte~ - m.o;;~ _~t \6 '\ ~'(ftPO' OfPVI\ "" Date of Application 7;Z~;: 7 /. ~.- Checked' for Delinquencie~ v----- Checked for Historical Status NOTICE: . THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. - Shared Drive (T:)/Building Fonns/Backflow Prevention 7-07.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01091 ISSUED: 07/24/2007 APPLIED: 07/24/2007 EXPIRES: 0112412008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 711 MILL ST APT 1 ASSESSOR'S PARCEL NO.: 1703352214700 Springfield TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backflow device Owner: BURGE LIMITED PARTNERSHIP Address: 525 HARLOW RD SPRINGFIELD OR 97477 Phone Number: 541- I CONTRACTOR INFORMATION I Contractor Type Landscape Contractor MEDALLION LANDSCAPE SERVICE INC License 7118 Expiration Date 02128/2008 Phone 541-933-2745 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a 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: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Alll"lmnN- ~jIIft ~ ~~~"A ~a follow rules a=QyIwt19~f)= Notification Ce . VilIV 1"..0 an. HI In OAR 952-G01-G010through OAR 852-001. 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility NotlfiGalloft Center Is 1-eoo.aaa-2344). Sidewalk Type: Downspouts/Drains: Description Type of Construction NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AU I HUKILtcrt:t1~ufn 7; r.e- rEm.ilT IS NOT I Valuation Description I COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD.. $ Per Sq Ft Square Footage V I or multiplier or Bid Amount a ue Date Calculated Notes: Pa2e 1 of 2 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 Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid $5.00 $2.50 $4.00 $16.00 $34.00 7/24/07 7/24/07 7/24/07 7/24/07 7/24/07 Total Amount Paid $61.50 I Plan Reviews I CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01091 ISSUED: 07/24/2007 APPLIED: 07/24/2007 EXPIRES: 01/24/2008 VALUE: Receipt Number 1200700000000000954 1200700000000000954 1200700000000000954 1200700000000000954 1200700000000000954 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reouired Insoections I Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all ti;j2:,truct;on/ ~ ~ '---- '---- Owner or Contractors Signature Pa2e 2 of 2 j-J-$/-O? Date 225 Fifth Street Springfi~ld, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01091 COM2007-01091 COM2007-0109 1 COM2007-01091 COM2007-01091 Payments: Type of Payment CreditCard cReceint I RECEIPT #: 1200700000000000954 Date: 07/24/2007 Description Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By KENNETH CORNELIUS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 05256C In Person Payment Total: Page 1 of 1 11 :45:36AM Amount Due 16.00 34.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 7/24/2007