HomeMy WebLinkAboutPermit Plumbing 2005-6-8
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. \...111' OF SPRINGl'l~L1J
Building/Combination Permit
PERMIT NO: COM2005-00692
ISSUED: 06/08/2005
APPLIED: 06/08/2005
EXPIRES: 1210812005
VALUE:
SITE ADDRESS: 4531 ,FRANKLIN BLVD SPACE 1 Eugene
ASSESSOR'S PARCEL NO.: 1703344400301
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install 2 backflow devices
Owner: SHAMROCK PARTNERS LLC
Address: 770 TAMALPAIS SPACE 401 B
CORTE MADERA CA 94925
Contractor Type
Plumbing
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: '
I CONTRACTOR INFORMATION 1
Contractor
TWIN RIVERS PLUMBING INC
License
17695
Expiration Date
03/1112007
Phone
541-688-1444
BUILDING INFORMATION I
R-3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Patb:
Sprinkled Building:
n/a
VN
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Otber:
Occupant Load:
\Cr: I DEVELOPMEN\fINFORMATION I
"Q1 I'IJ;'MII S\1f1,U- '-'HIS I'tRM\1}~ I'U'
"\\1\S OR\1.tO llNOtR"\ flQv,e.!i\~i\j)istlR
fl,1l1~ NCtO OR IS fI,\.\ # Street Trees Rqd:
CONlM\ Ofl,'i I'tR\OO. Paved Drive Rqd:
MI'i ,,\\ % of Lot Coverage:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Anilable:
Special Instruction:
Notes:
Description
REQUIRED PARKING
Total:
Handicapped:
Compact:
ATTENTI~J.JJ1LI~ IM:PROVEM~N~Slto
follow rules adopted by the Oregon Utility Sidewalk Type:
Notification Center. Those rules are set forth Downspoutsmrains:
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the OreQon Utili!)' Notification
Cl'~~i~~t~:; ~;;c;f~;i~n I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Value
Date Calculated
Pal!elof2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2005-00692
ISSUED: 06/08/2005
APPLIED: 06/08/2005
EXPIRES: 1210812005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
FI'I" PiWU
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$4.50
$3.15
$28.00
$17.00
6/8/05
6/8/05
6/8/05
6/8/05
Receipt Number
1200500000000000805
1200500000000000805
1200500000000000805
1200500000000000805
Total Amount Paid
$52.65
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.
I Rl'ouirl'rllll'ol'diOlW
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, 1 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 sball 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 ofany 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 dur.'ng construction.
r=6il~~ ~~f.6~
Owner or Contractors Signature
Date
Pal!e 2 of2
225 Fifth Street
Springfield.. Oregon 97477
541-72(j-3759 Phone
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.JiJ.!Y of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200500000000000805
Date: 06/08/2005
11:40:57AM
Job/Journal Number
1 COM2005-00692
CbM2005-00692
COM2005-00692
COM2005-00692
'I
Payments:
Type of Payment
Check
Descrlptlon
Backflow Device
Minimum! Adjustment Plumbing
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
SHAMROCKPARTNERSLLC
Item Total:
l:beck N umber Authorization
Received By Batch Number Number How Received
Amount Due
28.00
17.00
3.15
4.50
$52.65
Amount Paid
djb
1080
In Person
Payment Total:
$52.65
$52.65
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6/8/2005
Page I of!
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SPRINGFIELD
if" ,CITY OF SPRINGFIELD, OREGON
.,
225 nrrH STREET. SPRINGnELD, OR 97477 . PH,(541)726.3753 . FAX: (541)726-3689
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Assessors Mop '7051 Lfl..( L(
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, BACKFLOW PERMIT I($2~Udes Permit Fee, State Surch~rge & Administrative Fee)
Contractor It..; ,'Y ;2" v~IL':rt,~ '^lnp,?C......'^^ I".--~
~IJ:'t..C;:,. ~l r..'i.I'I\\t \~ :"\1 IS \-\01
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Construction Contractors Registration #
Contractor Information
Cit:,
State 0 tL
17b')J~
b (if{ - / 'T~lf'
Zip 97f{()<.f'
Expires 0 p ~ 7
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible for inspection (726-3769). I also state that all information on
this permit/application is correct.
Signatur~~O ~AJ) ~ J ;,,p
Date of Application
b-%-O~
Checked for Delinquencip'o
to'
~()regon'aw~~~
,., aoovlOd~ setfuTtl\
tlllCWtl fU\eS ntet 'Those rules are 952-001.
tlOti~~1.o010\hfO~g~ ~~" roles by
For Offic~. ~u \'lIa'I.~~'n~:~7U,e tel~P~~~
calling Ul'l ""r.__ 'on Utility I~u\if,-
bar tor \he ore~^", '>.<12-2344),
I\UflI (;enter Ia 1-ouv-
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Checked for Historical Status
Shared Drive CT;)fBuiJding FonnslBackflow Pre~entionl-03.doc