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Home My WebLink AboutPermit Backflow Test 2011-7-19 -. CITY OF SPRINGFIELD 5 ;~RI.N..G FIE.~.D -- lib- -~ _,_)~ I;Ji!' <i, '<'0", OREGON Building I Residential Permit PERMIT NO: 811-SPR2011-01775 IVR Number: 811125876856 www.ci.springfield.or.u$ 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perrnitce nter@ci,springfield.or,us PROJECT STATUS: STATUS DATE: Issued 07/19/2011 ISSUED: APPLIED: 07/19/2011 07/19/2011 EXPIRES: VALUE: 01/14/2012 $0.00 SITE ADDRESS: 2443 8TH ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703261201202 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install Backflow device for irrigation system Phone Number: OWNER: ADDRESS: MOE WAYNE M & DORIS I 2443 N 8TH ST SPRINGFIELD OR 97477 Contractor Type Plumbing Contractor Contractor Name OWNER CONTRACTOR INFORMATION I Lic Type OWNER BUilDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o Lie No 0000000 Lie Exp 08/12/2025 Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Fl Carport: Sq Ft Other: 0 Occupancy,Load: Electrical Specially Code Edition: Springfield Fire Code Edition: Mechanical Specially Code Edi'iOA< 'TION' Oreg I ' . . " I "" . on aw reqUires you to MUnicipal I Development C~'Ow rules adopted by the Oregon Utility Plumbin9 Specially Code ENitl6'i0ation Ce;2ttln Those rules are set forth Residential Specially CodJ'EliIlilJ?,,952-001-001 0 through OAR 952-001- Structural Specially Code B~i~g;,,You may obtain copies of the rules by call1nq the center. (Note: the tefenhnnp Site InformationnumOer to~the Oregon Utility Notification . &_,~er is 1-800-332-2344). NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD_ # of Bedrooms: Sprinkled Building: Fire Alanns: Energy Path: Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit 7/19/2011 10:49:45AM Page 1 of3 SPR. I.N G FIE~ .~' frj+tl ~ . ::;$/h,,"~ OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01775 IVR Number: 811125876856 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: STATUS DATE: Issued ISSUED: APPLIED: 07/19/2011 07/19/2011 EXPIRES: VALUE: 01/14/2012 $0.00 07/19/2011 SITE ADDRESS: 2443 8TH ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703261201202 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Install Backflow device for irrigation system DEVELOPMENT INFORMATION ~ Overlay Dist: # StreetTrees 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 ~ Descrietion TVDe of Construction Unit Amount Unit Tvee Unit Cost Value FEES PAID ~ DescriDtion .~~ckf1o~,~~~!~___,_,,___._"., _ St~h~ o! 2~e-2on ?urch_~~.9_e ,~~?O(~ 5:f a~~~i~~~.~~ f~e.~) . Technology fee (5% of permit total) ~~!..a_n_ce of M~imum ~J~-;g~~Fees _._.~_4_ ----- - - Total Amount Paid Amount Paid $19.00 .~---,--- $6.96 --,--- - -- -"-..- $2.90 -"'---"-~--'''-- $39.00 $67.86 Date Paid 07/19/2011 07/19/2011 -- .'~---"."-- 07/19/2011 07/19/2011 ReciDt # 2011002057 2011002057 .' -- --- .' -- --- 2011002057 -.-- ~---,--- 2011002057 Springfield Building Permit 7/19/2011 10:49:45AM Page 2 of 3 S.PR. ING.FIE...L~.D .'~ .'.iir~ !.:fs%., OREGON CITY OF SPRINGFIELD 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us Building I Residential Permit PERMIT NO: 811-SPR2011-01775 IVR Number: 811125876856 pe nnitce nter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/19/2011 ISSUED: APPLIED: 07/19/2011 07/19/2011 EXPIRES: VALUE: 01/14/2012 $0.00 SITE ADDRESS: 2443 8TH ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703261201202 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Install Backflow device for irrigation system Plan Review ~ DeDartment Received Due Date Application Acceptance 07/19/2011 07/19/2011 Comments: No PW orPlanning impacts ComDleted 0711912011 Result Over the Counter Reviewer Chris Carpenter Plumbing Review 07/19/2011 07/19/2011 07/19/2011 Not Required Chris Carpenter Comments: Over the counter permit ~~ ~~:ot\l"""'~" i;IDi!i~L~ey~~~ >~,:~ ~,:~~"l' ':'_:,._-.' ~';~ "~97!2~/~_~2t~_~~:b7t,~-9!'?-Q.l' J - '"C-:,~71r91301_11f~~~:' Over,the~C;ourifer~5?7;"~'_i'(:Chris'CafPenter/:i,\'t&'L -~: ~,' r;:~q'mT:ef1~::~::G~~0fh~tcQ_~nler~p~f~~r'}?t~' Jlt',~~ '~:$<~~j,:_~,-::~t:_~I-~i2~~~ < _}<~~:- J~S-:~;; '; ~:_:1,~g;;~~'?~. ~__;"_-~;__c, M;_~y::: ,,'_;:;~~'- ~~ ~ ~ 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 in 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 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 times during constr~~ ~ /j - I '- - 1/ Owner or Contractor Signature Date Springfield Building Permit 7/19/2011 10:49:45AM Page 3 of 3 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. +~~~~~r<[QGAt~GO~ERNMENT:iAg~ROVA~$~~~I~~~~ Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CATEGORY 'OF. CONSTRUCTION: ' Residential D Government D Commercial ~~i?'22@OB?SI'l'E.INF.~RMA:\!IQNli.A.N[)!ilurOGATION:!l~;\i'~:@1 Job site address: '2 'l? (l~ S' r City: c,: ,rr.{ Reference: '70"3 Taxlot.6 /"?-() );'S1~~:ff~,~:_,:~;~~j1~~~f;~[jI;SCRIJ?]I(j'N~'OEJ~WO RK'~~;ll}tf~1&Vl~!~L!i~ f tJ<;'~LL 3~YC:LOt.AJ F6'L ( yf'rZ.-t 4 V'f77 '-'IV ,PR~RER~YtJ0WN EBV)g11~'~r:l:l1f;%{\q~~~~~i~~1~\ Plumbing Permit Application 225 Fifth SI"el . Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 . Name: City: Phone:9\; ;;- E-mail: ~ This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licen~?irements under OAR 9 I 8.695-0020. SIgnature: ./ /~ .' CQNTRACTOR".}NSljALLJ\TIQN,,:; ""_;'i~;':.\tl:;:"t;\:; ,,'?' ' Business name: tJ-z-.;;Jf;:;:?--. Address: City: Phone: E-mail: CCB license no.: Plumbing license no.: Print name; Signature: ZIP: Fax: BCD license no.: 440.2500.J (11/08/COM) W'-")f.;'i' '~"'-:';;;",.;:~""-';'h;<!e;'; : ')-'~".+- ,"--"'--:</";\''*''",}:F'tS':':0.~' . ;'''!''DEP.ARfMEN't.USEONLy~;~~~1 , . ). , . . ,- . . ~'.~. .., .. ." - '. '''. ; <,",. ",.!,;;:;.: Date: liJ~Lt::';"~118~~~~*,1~1i~~tE-EE~S~Ct4 EO-U i.n:i:Mt1}~"/,~j~t{i;~~~~:~~rr~~N; ~D~i6riptrgti~i~~~\1\11~;;;;%J?i;:';~ 'Qfi~ ~;"l'Ola!~ l'&\ ~~I,>l!"".iB',K~'<:;;;\i J:.~\-!ti~rr,.x'f"?kW:t:1(i';~~",,~*~ ~""",~l<.J!,; ~,,-[>::.~.Q~t!,t:,: New residential ] bathroomll kitchen (includes: first J 00 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, under floor low-point drains and rain-drain packages) 2 bathrooms/l kitchen $374.00 $ 3 bathroomsl] kitchen $439.00 $ Each. additional bathroom (over 3) $95.00 $ Each additional kitchen (over 1) $95.00 $ Residential fire sorinklers (includes plan review) o to 2,000 square feet $58.00 $ 2.00] to 3,600 square feet $116.00 $ 3,60] to 7,200 square feet $174.00 $ 7.20] square f~et and greater $232.00 $ Manufactured dwelling or pre.fab (circle one) Connections to building sewer and $58.00 $ water supply Commercial, industrial, and dwellings other than one- or two-family Minimum fee $58.00 $ Each fixture $19.00 $ Miscellaneous fees 100' storm, sewer, water line $76.00 $ Each fixt,ure, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19.00 $ Irrigation systems Ii $19.00 $ r"1 Piping or private stOrm drainage $19.00 $ svstems exceeding: the first 100 feet Specialty fixtures $19.00 $ Reinspection (no. of hrs. x fee per hr.) $58.00 $ Special requested inspections (no. of $58.00 $ hrs. x fee per hr.) Each additional inspection: (1) $58.00 $ 'f";' i.'__';~~:'"F,~,;qD<";'.~;';"'"-;~~'~'~~'''li'~y;#nii'DY\~ Mi,nimum fee $ ;,1JY1;edlcaJ 'gas:plplngm~~;~:ti}~1k",~. J:~'i€':!1d4~1?1 Enter value of installation and equipment $ Enter fee based on installation and equipment value. I $ 'l\\S'"~..~r>o",~- "--<,,:-,"",~,,, ^ k"'.~.,,, :. c: .J!;P..I?l!I~J!;N;r1liU.SE~". c : "" . .l' (A) Enter subtotal of above fees $ ~~ (Minimum Permit Fee $58.00) (B) Investigative fee (equal to [All $ (C) Enter ]2% surcharge (.12 x [A+Bll $ &96 (D) Techno]ogy Fee (5% of [All $ ;2-'tE..- TOTAL fees and surcharges (A through D): $ 4>704> SP.R.:.~. N...G.........FIE~ ~'I ':f ,~ '''~ OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 8t Springfield,OR 97477 541-726-3753 www.cLspringfield.or.us 811-SPR2011-01775 2443 8TH ST permitcenter@ci.springfield,or,us RECORD NO: 811-SPR2011-01775 DATE: 07/19/2011 'c;j!..';." ~'~";''6i',f.''fy;.';'~'_ '-ACCOUN'T{CODE"."".'>-; .;: ,. AMOUNiLD,UE'"'''' .'.1 224.00000-425603 19.00 224-00000-425603 39,00 821-00000-215004 6.96 100-00000-425605 2.90 TOTAL DUE: 67.86 L ,PAYMENT TYPE.: G,., pAY6'R":'':~CASHIER:'CC_I\RPEN.TER.. ;;IT,CbMMENIS, .,;;, ' .." ,AMojJN'N>'AII)';-~';' 'I _........_---'-..~___...;.._ _~_~___.""'-',_.,,_.,___."__'"__~ _.......<.~""=.m;;;.~~c.~.x.""'=...,."'_"-<-__,~. "H' ._, ..~__."""~;\;-XL..J:~_.".,_._~_,,,,,~__~,_.~_~,_._~_~~ . ~",. ,. .,.., _ Cash OWNER $67.86 RECEIPT NO: 2011002057 ~DESCRip.tlbN ',Y':' ,', " ..'-,~"'k{{ Backflow preventer _,~alance of Minimum Plumbing Permit Fees State of Oregon Surcharge (12% 01 applicable fees) _Technology fee (5% of permit tat~9., TOTAL PAID: $67.86