HomeMy WebLinkAboutPermit Plumbing 2007-10-2
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225 FrITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
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City Job Number (p KIt Z-o 0 7
Job Location L~,~??" ~ (D1- 1 <; 61-e--V\
Assessors Ma~ 1 7 t:> J "Z 7/ -S , Tax Lot (:) '-I jC ()
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BACKFLO"$O~~~~'P~(~,,~ii:~UT FEE: $61.50
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Contractor Information
Contractor ?r. IAk \ a (e- 0..At; Q.-VL.( (~')&~ <J HV;'j -
Address Z q 3b 0 [f {UtA! LC{: ,k:.QW Phone Iogq S L/.~
City NO; 0r7 il Stat" dP 7.ip Cf7 Y u L
Construction Contractors Registration # {~(:? c( L c- 8 ExpiresEf: ~~~) 0 8(
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By signing this permit/application, I agree to call for an ~~ctio~k~~'&~~;;~\~ention device
has been installed and is visible for inspection (72~~r. \:.~ ~~~~'W~tion on this
permit/application is correct. ,\\\<0 ~ O~\1."'\) ~~ 'CO ~
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SignaturF I lJ ------ C~~'\ \ ro~ Datp ! 0 - Z - 0 7
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For Office Use
Date of Application
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Checked for Historical Status
Checked for Delinquencif><;:
Shared Drive (T: )/BuiJding Fonns/Backflow Prevention 7 -07 .doc
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01494
ISSUED: 10/02/2007
APPLIED: 10/02/2007
EXPIRES: 04/02/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 438 SCOTTS GLEN DR
ASSESSOR'S PARCEL NO.: 1703271304500
Springfield
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backflow device
Owner: SUNBURST CONTEMPORARY HOMES
Address: 1399 HWY 99 N
EUGENE OR 97402
Contractor Type
Landscape
CO es you to
follow rules adopted by. the Oregon Utility
Contractor Notification Center. ThlY.ti'tOMt9 are ~~ion Date Phone
EUGENE LANDSCAPEltkJJW~J:()010tJilOOph OAR 952-om~1/2008 689-5455
B S aT me rUles OJ
the telephone
IWmbar for the Oregon Utility Notification.
'lfof"5"tol&~tAl 111-800-332-2344). Lot Size:
Height on;fr'Ucture: Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
R-3
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paveg"p,{L,ve Rqd: Compact:
oMalJh,~~verag.e: "U. EXP\RE \f THE WORK
TH~ PERM\T ~H TH\5 PERM\T ,~ NOT
I PUBLI~ ABANOONtU ruR
~D. Sidewalk Type:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pae:e 1 of2
Status
Issued
CITY OF SPRINGFIELD
, Building/Combination Permit
PERMIT NO: COM2007-01494
ISSUED: 10/02/2007
APPLIED: 10/02/2007
EXPIRES: 04/02/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid Date Paid Receipt Number
$5.00 10/2/07 1200700000000001264
$2.50 10/2/07 1200700000000001264
$4.00 10/2/07 1200700000000001264
$16.00 10/2/07 1200700000000001264
$34.00 10/2/07 1200700000000001264
Total Amount Paid
$61.50
I Plan Reviews I
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
times during construction.
s~~
1A1- '2 ..0 J
Owner n' ctn,mel"" S;gna.."
Date
Pae:e 2 of 2
225 Fifth Street
.
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01494
COM2007-01494
COM2007-01494
COM2007-01494
COM2007-01494
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200700000000001264
Date: 10/02/2007
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
EUGENE LANDSCAPE AND
IRRIGA nON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
3855
In Person
Payment Total:
Page 1 of 1
1:54:23PM
Amount Due
16,00
34,00
2,50
4.00
5,00
$61.50
Amount Paid
$61.50
$61.50
10/2/2007