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Home My WebLink AboutPermit Backflow Test 2011-7-15 S~R..I.N G",FIE~, D .'~ '''; ~ " ."...... ,/./,.,,-"~ OREGON CITY OF SPRINGFIELD . Building l.Residential Permit PERMIT NO: 811-SPR2011-01753 , IVR Number: 811127086560 WWN.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/15/2011 ISSUED: APPLIED: 07/15/2011 07/15/2011 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 ' permilcenter@ci,springfield.or.us EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADDRESS: 277 WOODlANE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262206100 SCOPE: Baekflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device Phone Number: OWNER: ADDRESS: A l SCHIPPER SURVIVORS TR 2460 20TH ST SPRINGFIELD OR 97477 Contractor Type Landscape Contractor Plumbing Contractor Contractor Name BUilT BY DESIGN LLC BUilT BY DESIGN LLC CONTRACTOR INFORMATION' Lie Type CCB CCB BUilDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Units: o # of Bedrooms: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Sprinkled Bui'ding: Fire Alarms: Energy Path: Lic No 184126 184126 Lie Exp 10101/2012 10101/2012 Phone 541-942-6834 541-942-6834 Lot Size: Sq Ft 1 st Floor: Sq Ft2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Site Information I Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard MiiTENTION: Oregon law requires you to Retaining WalJollow rules adopted by the Oregon Utility Soils Report~eqiijr:e!liDn Center, Those rules are set forth , ' in OAR 952-001-0010 through OAR 952-001< 0090. YDU may obtain copies of the rules by calling the center. (Note: the telephone' number for the Oregon Utility Notification Center is 1-800-332-2344l., '.i,;o.J"., NOTICE: IFTHE WORK THIS PERMrT SHP\DLELR;.x~~~ERMIT IS NOT " AUTHORIZED UN FOR' COMMEI~CED OR IS ABANDONED . ' ANY 180 DAY PERIOD. Springfield Building Permit 7/15/2011 12:04:26PM Page 1 of 3 SP~~NG~EL~ ~~ ~OREGON WWIN .ci. sprin gfield. Of_ U s CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01753 IVR Number: 811127086560 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmitce nter@Ci,springfield.Of.US PROJECT STATUS: STATUS DATE: Issued 07/15/2011 ISSUED: APPLIED: 07/15/2011 07/15/2011 EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADDRESS: 277 WOODLANE DR, Sprin9field, OR 97477 ASSESOR'S PARCEL NO: 1703262206100 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: DEVELOPMENT INFORMATION I 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 I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Descriotion Tvee of Construction Unit Amount Unit Tvee Unit Cost Value FEES PAID ~ Descriotion State of Oregon Surcharge (12% of applicable fees) Technology fe! (5% of permit total) Backftow preventer Balance of Minimum Plumbing ~ermit Fees Tota' Amount Paid Amount Paid $6.96 $2.90 $19.00 $39.00 $67.86 Date Pa id 07/15/2011 07/15/2011 07/15/2011 07/15/2011 Reciot # 2011002034 2011002034 2011002034 2011002034 Springfield Building Permit 7/15f2011 12:04:26PM Page 2 of 3 SPi~~:EL~ L~~ ~OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01753 IVR Number: 811127086560 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/15/2011 ISSUED: APPLIED: 07/15/2011 07/15/2011 EXPIRES: VALUE: 01/10/2012 $0.00 SITE ADDRESS: 277 WOODlANE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262206100 SCOPE: Backflow Device WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device Plan Review ~ Deoartment Permit Issuance Received Due Date Comoleted Result 07/15/2011 07/15/2011 07/15/2011 Issued Reviewer David Bowlsby Initial Review 07/15/2011 07/15/2011 07/15/2011 Over the Counter David Bowlsby Comments: Over the counter permit Application'Acceptance""" ~:'. '/07/.1.5/201.1....' 07/15/2011'_', 07/15/2011 f - ~ve( the'C . ,: f:^":\'~~;:~fr;~~:;'~"'; ~~. - :~:':f:~ ~3~'_~~~~~Y~'t;;~_:~~.; {.~:~ ~t~$~lJ~ :~. ~ "'~:(~:gR:;::~ INSPECTIONS REQUIRED ~ ;.,<:;::'~:~O;'I~bY :' c ~-'-;~\ .~.;:;; .; ~:. ":J 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 construction. ~~ 0 n ~ ,f~aOI I Date Owner or Contractor Signature Springfield Building Permit 7/15/2011 12:04:26PM Page 3 of 3 225 Fifth Street. Springfield, OR 97477 ." PH(541)726-3753 . FAX(54l)726-3689 i<'4;.-:'ZJf/ft'>>;-''.'"<'-''';O''' "'-'. ',~''',k'Q';J::'-'),l'i "lI-iryc>'f;\+;'~i!;;'~'C~[ . "~"fDEPARTMENT.USE'ONLY~"~{t .' "-'"".."., __._ .,. ~"',_..c~~_', ''',''-~'!;;;~~ Permit no.: S/ I- ,D , 7 S- .3 Date: 7- I 5" - { I Plumbing Permit Application 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. :~?;j[~,'i'~;;;if;i@o:cAIifHG(jVERNMENT,;API:?,ROVAI!!.:llil;~~~%~;l Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY 'OF: CONSTRUCTlON-.' . Residential D Government D Commercial ii:~~~;;;:j(1JClB:$i[ljEI N F,()RMAl:l()N~AN D~~If()eATI()N~y1t,i,;~g~h . Name: .~.PRt)~;I;'RfY4]OWNI;R}j~~~lii'Ei;~1ilf:;~~~~~)~~~\~~~~~ of, !k:~;~~~:(.~;_r;;~~~:~~s~~r:~~~I~Fr;-EE~~~OH ED, (jlifE_it~~t~\::;:~~r~r~fl~~l~~~~rr2 ~iR!~~i!e~~~1~1t~~~~l~~i~~~J1~~~i gtI~I~&}"~t4~~1i',x~~~~t.~~~' New residential I bathroomll kitchen (includes: first JOOfeel 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 bathrooms/] kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over I) $95.00 $ Residential fire sorinklers (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 $58.00 $ Each fixture $19.00 $ Miscellaneous fees 100' storm, sewer, water line $76.00 $ Each fixture, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19.00 $ Irrigation systems / $19.00 $ /"" Piping or private storm drainage I $19.00 $ s stems exceeding the first 100 feet Specialty fixtures $19.00 $ Reinspection (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 $ ~,.,'" ;;'~:""c''Ic'''?;I](:<h'~~' "<,,~;O ':oic'~:M"<i:tt~';>;1 "'" "fl." ;,~"ijj~'~' Mjnimum fee $ ~1~te~icijrg~(pipiJj"g;!;$~i~,_ .f;U~~~)f~~ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ ~'~'~~"'BJlF ,.....".,.~!l!{'.~~~~~'" ,i!fii; c,', ~;". "'A:RRUeP,;NjlilJSE".:.",,,...,., : .~~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ 5g (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.[2 x (MB]) $ 6 Tl (D) Technology Fee (5% of [A]) $ C' TOTAL fees and surcharges (A through D): $ 17g~ V City: ZIP: ~ 7'17 Reference: 7 Taxlot.: D b/OD \t{1i~i;~:h~t'i_~~~~!f~~~;;tt~_s_CRI-e;tloN~'QF.~W,OR'K:tS:'B5tT~g~~ti~w~~li'~ City: Phone: 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 ITom licensing requirements under OAR 918-695-0020. Signature: ZIP: . CONTRAcrOR,.,INST;ALLA T,ION:".,.:".,," ,,,,,f. LG Signature: , 440-2500-J (] lI08/COM) SP~I.NGFIEL~ ^jJ.~ ~". ',~, ~ ' OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 WWoN .ci, springfield, or, U S , 811-SPR2011-01753 277 WOODLANE DR permitcenter@ci.springfield,or,us RECORD NO: 811-SPR2011-01753 DATE: 07/15/2011 'S; ",~0f't~Fl' ~~<tth i;Zit~:/;~;x?J;' <+ ;4P:C,COJ;jN:r~CQDE ,;~ ,',': t"?,; ~:;2~~::.('<AMQU NTJ),OE>?~:l;),.~ :!;'E'1, ~ j 224-00000-425603 19.00 224-00000-425603 39.00 821-00000-215004 6.96 100-00000-425605 2.90 TOTAL DUE: 67.86 ~EfMENTJ,Y;PE,'; }[:i~YdB~"'{1~CAiJi!ER'~~2!'i(S~Y; :;;t:Q9.MME1'Ifs-:~- _c;.<' 'Ie' ~'-'i~~MJ~JjNI.PAlb"f:}E;,'" - -/ Credit Card BUILT BY DESIGN LLC $67.86 RECEIPT NO: 2011002034 'D' E' SC'R II"T'I'ON' """"""~"""";;;-''',;- t .. _:. "'.,~'~-' ,_., ,dFx.4 0,' Backflow preventer Balance of Minimum Plumbing Permit Fees State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) 020528 TOTAL PAID: $67.86