HomeMy WebLinkAboutPermit Plumbing 2005-02-15Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/C ombination Permit
PERMIT NO: COM2005-00179ISSUED: 0211512005
APPLIEDz 0211512005
EXPIRES: 08/1512005
VALUE:
SITE ADDRESS: 3505 E 17TH AVE
ASSESSOR'S PARCEL NO.: 1703343400400
PROJECT DESCRIPTION: Install RP and double check valve
Eugene TYPE OF WORK: Backflow Device
TYPE OF USE: New
orth
Commercial
Owner:
Address:
FEDEX FREIGHT WEST INC
YO FEDEX FREIGHT WEST-STE #3062 PO BOX 649002
SANJOSE CA 95164 to
Contractor Type
Landscape
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Contractor 10 through
GLENN LANDSCAPE SERVICES INC pies
1-
bpxpiration Date Phone
541-461-43750u3u2006
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
\T 1HE Handicapped
l liltl '
$61S?d'if.J
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
nla
EXP\R E
9Fo-,5-q nr
or multiplier
Sidewalk Type:
Downspouts/Drains:
Compact:I1H\S PERIJ
DONE'
[\1 \
D TOR
ABAN
Square
or Bid
F'ootage
Amount
Description Twno orit---__--o_61o1
Pase I of2
Value Date Calcu\ateat
0c1-00
Total:
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-726-37 69 Inspection Line
Building/C ombination Permit
PERMIT NO: COM2005-00179ISSUED: 0211512005APPLIEDz 0211512005EXPIRES: 08/1512005
VALUE:
Fee Description
+ l0Yo Administrative Fee
+ 77o State Surcharge
Backflow Device
Minimum/Adj ustment Plumbing
Total Amount Paid
Amount Paid
Total Value of Project
Date Paid
2n5t05
2n5t05
2n5t05
2flst05
Receipt Number
2200500000000000175
2200500000000000175
220050000000000017s
2200s00000000000175
$4.50
$3.15
$28.00
$17.00
$s2.6s
Plan Reviews
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work '
day.
Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to that all required inspections are requested at the proper time, that each address is readable from the
street, that the card is the front of the property, and the approved set of plans will remain on the site at all
times
Z-tr-c;<-
or Contractors Signature
Paee2 of2
Date
Keourreo lnsDecuons I
225 Fifth Street
Springfietd, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
.relopment Services Department
Public Works Department
RECEIPT #: 2200500000000000175 Date: 0211512005 9:46:12AM
Job/Journal Number
coM2005-00179
coM2005-00179
coM2005-00179
coM2005-00179
Description
+ 7o/o State Surcharge
+ l0% Administrative Fee
Backflow Device
Minimum/Adjustment Plumbing
Amount Due
3.15
4.50
28.00
17.00
Item Total:$s2.6s
Payments:
Type of Payment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard KENETH GLENN djb 003727 In Person
Payment Total:
$s2.6s
-$s2.o--
2/ts/200s Page I of I
lntl*tttan.D
225 FIFIH STRf,ET . SPRINGFIELD,OR 97477 o PH:(541)726-i'753 o IAX: (541)726-3689
City Job Number Lowr?oo f - Oo l-7 1
Job
Assessors
3So
ia o33 L( ) L/
Tax Lot c)oLloo
trLOwner
Address P.tt x /^Lt q DO 9T{43tze
City Sr ., +u* (l* stat"-&--zip Hz ?r'tq
BACKFLOW PER},flT M $,52.6C,5 (includes Permit Fee,State Surcharge & Administrative Fee)
Contuactor Informatian
Contractor
fot law
U L{70L{ a rules adop t-t-
0090
B ,952-00,are set ?74 r,4Citycopiesot
Construction Contractors the
the rures /-3(-, 6
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devisi has been installed and is visible for inspecti on (726-3769). I also state that all information on
this permitiapplication is correct.
n
S
THIS PERMIT SHALL
NOTICE:
NY 1BO DAY PERIOD
P
Use MII IS NOI
A
Z-/f-oiDate of Application
Checked for Delinquencies k Checked for Historical Status
Sharcd Drive (T:)iBuilding Forms/Backflow Prevention l-03.dm
CITY OF SPRTNGFIELD OREGON
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