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HomeMy WebLinkAboutPermit Backflow Test 2006-10-23 ." -Wi" . .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01363 ISSUED: 10/23/2006 APPLIED: 10/23/2006 EXPIRES: 04/23/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3220 RALEIGHWOOD AVE ASSESSOR'S PARCEL NO.: 1703221318400 Springfield TYPE OF WORK: Backflow Device TYPE OF USE: New PROJECT DESCRIPTION: Backflow Owner: CUSHMAN SUZANNE & MARK A Address: PO BOX 1514 SPRINGFIELD OR 97477 Contractor Type Plnmbing I CONTRACTOR INFORMATION I Contractor License DECKER LANDSCAPING & IRRIGATION BUILDING INFORMATION I Expiration Date Phone 541-688-7991 # 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 I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMATION I AI I 1:1\1 I IUN:Uregon law R.~Q!;I!I!JYQl!'l\.RKING Fr~~~If~~tback: RE IF THE WORK Overlay Dist: follow rules adopted by thif~iil1gon Utility Si~IS.tt1l~MIT SHALL EXPI IS NOT # Street Trees R9a,tification Center. Those rHundiC'iippeti:fOrtt Si~~1\qt\')l.~~ED UNDER THIS PERMIT Paved Drive Rqd: OAR 952-001-0010 thrOULGbmpuCl952-001 RetQ;u!!^~ett'l..C/l:OR IS ABANDONED FOR % of Lot Coveruge:JO. You may obtain copies of the rules b~ SOI~~WI~~~~AY PERIOD, caHing !hecen~er. (Note:.t~e teleehone ................. ...... ...... _....~""'.. .........1 ,......u................" I PUBLIC IMPROVEMENTS. Center is 1-800-332-2344). ' Street Improvements: Sidewalk Type: Storm Sewer Available: Special Instruction: DownspoutslDruins: Notes: I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e I of2 . aITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01363 ISSUED: 10/23/2006 APPLIED: 10/23/2006 EXPIRES: 04/23/2007 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 F..... p"uu $4.50 $2,25 $3.60 $14.00 $31.00 1 0/23/06 1 0123/06 10/23/06 10/23/06 10/23/06 Receipt Number 2200600000000001479 2200600000000001479 2200600000000001479 2200600000000001479 2200600000000001479 Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Miscellaneous Plumbing Amount Paid Date Paid Total Amount Paid $55.35 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. IR..n~l~ Backflow Device: Prior to covering and provide a copy of the test report 00 site at the time of inspection. Fiual Plumbing: When all plumbing work is complete. 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 descrihed 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. c;?& ~~?? Owner or Contractors Signature $- :;;-3- Cl b Date Paee 2 of 2