HomeMy WebLinkAboutPermit Backflow Test 2007-6-18
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00893
ISSUED: 06/18/2007
APPLIED: 06/18/2007
EXPIRES: 12/18/2007
VALUE:
~
SITE ADDRESS: 4011 MAIN ST
ASSESSOR'S PARCEL NO.: 1702314105500
Springfield
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Backflow device
Owner: PAPA'S PIZZA-SPRINGFIELD
Address: 2706 WILLAKENZIE RD
EUGENE OR 97401
Contractor Type
Plumbing
I CONTRACTOR INFORMATION I
Contractor
DOUGLAS LEE JONES
Phone
541-747-1254
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Snnnkled Building:
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I DJi\,\ELoRMENT INFORMATION I
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Froulyard Setback: ~{3. S 'XX; ~<bverlay Dist:
Side I Setback: ,>..-r"'''' '\~ ~~~~ # Street Trees Rqd:
Side 2 Setback: ~,~ S" ~~~ ~~ Paved Drive Rqd: '
Rearyard Setback:,'" ~~'}\ ~ \::,~ {:l ~ % of Lot Coverage:
Solar Setbacks:~\) s'X <>..VvX; <\ '0~ <>..\'0~'
.,,,, ."'''' _y,-, _y'<C'
'~'\\' ~"\\.:: ~'
~ <;J~~ "b'0~
Street Improvements:" ~ '\
Storm Sewer Available:~
Special Instruction:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Notes:
Description
Tvpe of Construction
License
104606
Expiration Date
02/17/2009
BUILDING INFORMATION I
n/a
Lot Size:
Sq Ftlst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
'Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC 1l\1YI<.vV lC"IENTS I ' "o\l 10
,,\lIles, '1'\"
SidewaIkr\l1ypHe", 0(\ U\I I.J
N', Ole\,lv' ,,\'Ie Ole9 e\ 10l\\'I
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", \lIeS "vvr 1\'10se fv" R 9" -
101l0\f'l ~iO(\ ce(\\e~. 0 \\'IlO\l9\'1 O~\'Ie l\lleS '0'1
t-IO\I\ICa 952-00.-0 '(\ collies 0 lell\'lO(\e
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I "--,lli(\9\\\"v, Ole901l~' ,2.344).
Valuation Descriotion ( \('I\'oel 101 \ne S . _800-332
,.' ce(\lel I
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
Value
Date Calculated
Pa~e I on
A
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Total Amount Paid
.
Amount Paid
$4.50
$2.25
$3.60
$14.00
$31.00
$55.35
Total Value of Project
Fees ~
Date Paid
I Plan Reviews I
6/18/07
6/18/07
6/18/07
6/18/07
6/18/07
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00893
ISSUED: 06/18/2007
APPLIED: 06/18/2007
EXPIRES: 12/18/2007
VALUE:
Receipt Number
2200700000000000983
2200700000000000983
2200700000000000983
2200700000000000983
2200700000000000983
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.
L...Peouired Lu'~\f'ition~ 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 carefnlly 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 OrdiDances 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 withont permission of the Community Services Division, Building Safety.
I further certify that only COD tractors 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.
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Owner or Contractors Signature
Pa~e 2 on
(, (l~!b1
I
Date
225 Fifth St~et
Springfieta; Oiegon 97477
541-726-3759 Phone
· ria..~
~ of Springfield Official Receipt
.elopment Services Department
Public Works Department
Job/Journal Number
COM2007-00893
COM2007-00893
COM2007-00893
COM2007-00893
COM2007-00893
Payments:
Type of Payment
Check
cReceint 1
RECEIPT #:
Date: 06/18/2007
2200700000000000983
Description
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum/Adjustment Plumbing
Paid By
SPRINGFIELD PAPAS
Item Total:
t:heck Number Authorization
Received By Batch Number Number How Received
djb
3400
In Person
Payment Total:
Page I of I
2:59:52PM
Amount Due
2,25
3,60
4,50
14,00
31.00
$55.35
Amount Paid
$55.35
$55.35
6/18/2007
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54 ])726-3689
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. ~ City Job Numbe' COM 2007-C=>.
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Owner II-tt. ? .fl.Rf\'.s G12ov. C(
Address 1.\ elll 11\1\ kn,.l S, r
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Tax Lot
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BACKFLOW PREVENTION DEVICE PERMIT FEE: $55.35
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Contractor Information
Contractor
A~' s,. ~<>>,"'V>>\ N.G
Addrers 'S<?'L-( N , l (.,111
Cit: ~~I\"'l.{,f1B---.:i>
Construction Contractors Registration #
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Phonp l'110fl~~~ ~Q\
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State~\) L:J~\' s .ZIP:-- '~'''-<:lld,~~
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By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been installed and is visible for inspection (726-3769). I also state that all information on this
permit/application is correct.
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. ~ _________- Checked for Historical Status e-------
SignatureJJi1JJJ.l~ ~ __
Date of Applicatio!'
Checked for Delinquencipo
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