HomeMy WebLinkAboutPermit Backflow Test 1992-4-22
}<.EN:
COMMERCIAL/lNDUSTRIAL.
PERMIT APPLICATION
.JOB NUMBER 9/077/ .
~ -
~
INSPECTION LINE: 726-3769
OFFICE: 726-3759
225 Fifth Street, Springfield, Oregon 97477
LOCATION OF PROPOSED WORK.
ASSESSORS MAP' /703
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TAX LOT.
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ADDRESS: RJ 12.)(, ~~/ :<kP~ ~p Mew
CITY: t;hr7TUANC> " / ~...e~r/~ ;TATF.~i"L
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ZIP: C;'L.::;-:-. :"Wi>CcJ
PHONF. ~2'!5 ?"'ilc
BP.f> ~Loo-J
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DESCRIPTION OF WORK:
NEW'~ REMODEL
ADDITION
DEMOLISH OTHER
VALUE:
NAME
'~~ON ~\~e-lZ-
ARCHITECT' ~~, vaJ. i _, ~"..._TI
ADDRESS
PHONE
CONST.
CO NT RACTO R .
CONTRACTOR'S NAME
ADDRESS
EXPIRES
GENERA' '
~t:)~"'(;L c.o....,~"-
PLUMBING: IC;;~ '1"~>'I'\"""'N ?o ~'( \ \li'la1- "'d.:(JNI Q1WO
...t l'-'l.
~ ... ,
5Co75
ro.\'k'I \qZ-
MECHANICA' .
ELECTRICAl'
PLUMBING
NO. FEE CHARGE
Single Fixture
Relocated Bldg.
(new fix. addtl)
Water Service
It.
Sanitary Sewer
It.
Storm Sewer
It.
Backflow Device /5.00
MECHANICAL
NO 1=1=1=
Furnacel burner & vent
< 100,000 BTUs
Furnacel burner & vent
> 100,000 BTUs
Floor furnace and vent
Suspended wall or floor
mounted unit healer
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Single
duct
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duel
Permit Issuance
TOTAL PERMIT
IS.DO
TOTAL PERMIT
- OFFICE USE -
HANDICAP ACCESS:
QUAD AREA"
LAND US.'
FLOOD PLAIN:
. OF BLDGS'
. OF UNIT~'
ZONING'
OCCY GROUp.
CONSTR. TYp..
LIGHTING POWER BUDGET:
. OF STORIES.
HEAT SOURCF.
WATER HEATER'
SQ. FT.
$/SQ. FT.
VALUE
SQ. FTG MAIN
x
SQ. FTG ACCES~
x
X
SQ. FTG OTHER
TOTAL VALUE OF PROJECT
PLAN CHECK FEE
RCPP
DATF
BY
I BUILDING PERMIT
15% State
SurchalJl.e
I MECHANICAL
15% State
SurcharGe
I PAVI NG
PLUMBING
15",0
.75"
DEMOLITION
5% State
Surcharge
FENCE
VALUE $
I SIDEWALK
I CURBCUT
FT.
SUBTOTAL
PERMITS
SYSTEMS
DEVELOPMENT
FT.
TOTAL PERMIT FEES I
EXCLUDING ELECTRICAl
7~ -8", 'of
-'1Q"~"~
PHONE
(lI.~ ~\2"'n
I
~HARGI
I
I
I
I
I
I
I
I
I
$10.00 I
I
/S.7S
. REQUIRED INSPECTIONS .
It Is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an Inspection, call
726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready
for InspectIon. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made
the following work day.
SITE INSPECTION: To be
made after excavation, but
prior to setup of forms.
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work Is covered.
FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel in place, but
prior to placing concrete.
CONCRETE SLAB: To be
made after all lnslab building
service equipment, conduit,
piping, accessories and other
ancillary equipment items are
in place but before any
concrete is placed.
UNDERGROUND: Plumbing,
electrical, gas, sanitary sewer,
storm sewer, water and
drainage lines. To be made
prior to covering or filling
trenches.
UNDERFLOOR: Plumbing,
electrical, mechanical. To be
made prior to installation of
floor insulation, decking or
floor sheathing.
POST & BEAM: To be made
prior to installation of floor
Insulation, decking or floor
sheathing,
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to installation of
decking or floor sheathing.
MASONRY: Steel location,
bond beams grouting or
verticals in accordance with
UBC 2415,
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
FINAL PLUMBING
FINAL ELECTRICAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
ADDITIONAL COMMENTS.
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No work is to
be covered until these
inspections have been made
and approved.
ATTIC DRAFT STOPS &
CURTAIN WALLS
FIREPLACE: Prior to placing
facing materials and before
framing inspection.
FRAMING: To be made after
the roof, all framing, fire
blocking and bracing are in
place and all pipes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
INSULATION & VAPOR
BARRIER: To be made after all
insulation and required vapor
barriers are in place but
before any lath or gypsum
board interior wall covering Is
applied.
FIRE & SEPARATION WALL:
Located and constructed
according to plans.
LATH AND'OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
Interior and exterior, Is in
place but before any
plastering Is applied or before
gypsum board joints and
fasteners are taped and
finished.
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material in
place.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
PAVING: After gravel is in
place but prior to placing
as phal t or concrete.
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special inspector shall be employed
by the Owner! Contractor during
construction of the following work. A
copy of the special testing reports shall
be furnished to the Building Division.
STRUCTURAL CONCRETE: In
excess of 2500 P.S.1. (306 a,1)
STRUCTURAL WELDS:
Performed on the job. (2722 f)
HIGH STRENGTH BOLTING:
During all bolt installation and
tightening operations. (306
a.6)
SPRAYED ON
FIREPROOFING: U.Be.
Standards 43-8.
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division before
beams are placed. (2501 U.B.C.
STDS, 25-10,11).
)(
STRUCTURAL MASONRY: (306
a.1)
~~/~ j)EM/'Ip.
,
*In addition to the inspec-
tions specified, the Building
Official may make or require
other inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
SITE PLAN REVIEW BOARD: Must be requested 2 days In advance
of the date you wish inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
requesting this Inspection.
FINAL BUILDING: Requested after the final plumbing, electrical,
mechanical and Fire Department inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been issued by the Building Division
and posted on the premises.
PLANS REVIEWED BY
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
herein 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 Bul/ding Safety Division. I further certify that only contractors and employees
who are In compliance with ORS 01.0. will be used on this project.
I further agree to ensure t t all ~u ep Inspections are requested at the proper time, that project address is readable from the
street, that the pe~plltl rd Is I ca d at the front of the property, and the approved set of plans will remain on the site at all
times during constru on.
/"
,/
/ 'signature
/
VALlDATIONI
71.11
I f//
I l:1o~NT RECEIVED:
V RECEIPT ..
/5.7S
-f'~/ -;;'
DATF
Date 3/ 'Z- 'i /~7
DATE PAID:_o/2.2-/5'2
RECEIVED BY: ~#~
. ,
.
SPRI.IELD
DEVELOPMENT SERV'CES
PllULlC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
:'25 nnN Sfr.'1I r
:;fl/UNUnl:l.p. Oil' fh:lI/
(.r;03) i:"j; :Ii:d
p.pril 23, 1992
Thompson Landscape Co.
P.O. Box 11562
Eugene, OR 97440
Attention: Ken
Subject: Backflow Permit
Gentlemen:
Enclosed is your receipt for the backflow permit for B85
Oakdale Street. Your copy of the approved application is also
included for your records.
I have also enclosed the original permit application your
signature. Please sign the application on the back page by the
red "x" mark, and return it to this office at your earliest
convenience.
please call our inspection request line (747-3769) for the
required inspection once the device is installed, but before
the trenches are covered.
Thank you in advance for your attention to this request.
P;;7f~
Donald 1100re
construction Representative
.... " .,.
2:1:1 Fillll SlrOI)I, Springfield, Oregol1 97477
~
.m NUMBEIl -9 /Q_"Z7./
COMMERCIALIINDUSTRIAL .
PERMIT APPLICATION
INSPE.CnON LINE: 72G.:J769
OFfiCIO: 72G<I'I\i\1
IUt.:^,IUrl ut 1'llUI'u~.a:1J WOln,:
$>'ii? ~ cQ~/C Drf-Lc
/703> . __'A _2__.__.9_ .C>
mx LOT: ___2.:'2- /"1
^~::~jE::;~()ns r\'.1^r:
~~-,;;,~~';:., *Z~';;~~:';-t-~-_.._S?l-f'rl7U__8- ~-- PHONE _~_:7_':~__ <-';.-:/:1-2:. _. 77"~_:.8t; '..f
ADunES,; \'t:'l?:,r'-_S_~ 1.~t..L __31fC2S_&:{Jf'~tf<-U.-Lu., - - - . --0/7,,/,77. __u_
CII Y ll,i(..\C..\N o. r _ .. . ~...er~,E I~ STATE: QR",___ . ZIP: C::iJ<::~-CC~<;SC~
DE;~cnIPTION OF WOnK: _\~~,,_~~"'" .:;-.,J-::-!~~""'-"--'~C)C~.
NEW. /" _ IlEMODEL __ ADDITION DEMOLISH on-I Ell -- -
VALUE: ___
NAME
':r~\(;.i~'"n<":I'-' '~-b\u~ 1'-t2-
ARCHITECT: _ _~\""I.,.",:,_"2<<-LL_\"':'C-:\_0 :CL-
ADDRESS
PHONE
W('c' . ... ,-
__.I"".:l..:~>:i:,k)_
CONTRACTOR'S NAME
ADDRESS
CONST.
CONTRACTOR"
EXPIRES
PHONE
GENERAL:
i.-\-,....\J..X.~\'I'="~ Lc,.....-;~L~\L..
PLUMBING:\(", N ~t~(\'i?'>C:I,,_~9_\.l,I,_\_\!?k~_~~0.~I~LS!\N0__ -U.:...--:.:..,:.:..._.. -
5&>75
I~'\".~ \," (,..'l( _ -',W'-,
_ __\.11-_ ;.u. .I~__. w~. L_~",.JI.;
MECHANICAl.
ELEcrRICAL: __
1-.---
.-.- ---
_NQ.u
.___ __~~UM~lNG
__MEGt!ANJ.!::AL
_ _F_"~_ _CHARGE
_NO.__
_FEE _. _ .CltAI1GE_
GtlCkllow Device
/5.!C>O
Furnnce/blllllCr & vent
___ _ __,,-1QQ,QQ()~CY~
FUllwce/bulllcr & vent
___ _.?"JQQ~qQ_QXU~!_ _______ ___
Floor furnace anti vent
Suspended wall or floor
mounted unit heater
Appliance Vent
separate
Statiollnry evap.
cooter
Vellt Fan/Sinole
c1uet
Vent Systelll np<lIl
Irolll AC or llllJ.
Mechanical eXll.:lUsl
Ilood ami duel
Sin!]le Fixture
1II1Iocatt~(\ BldU.
\llt~W Iix._a~!d~JL_ _
Wale I Service
II.
. :,;;uliI ary. Sewer----.
II.
StUlIll Sewer ---
II.
Permit Issuance
$10.00
TOTAL PERMIT
/5.00,
TOTAL PERMIT
- OFFICE USE -
HANDICAP ACCESS:
FLOOD PLAIN: __
OUAD AREA:
LAND USE:
11 or IILUC~~:
11 OF UNITS:_________
ZONING: __. _
OCCY Gr<oup:
CONSTR. TYPE:_.
LIGHTING POWER nUDGET:
.. UI :;/UIIII":;
ilEAl ';OUHCE:
WAlEH IIEAn,H:
SO. FT.
$/50. FT.
VALUE
~iO. FTC Mt,IN
___._.__ X
so. FTG I\CCESS
x
SO. FIG OTHEH
X _ ~ _u_
TOTAL VALUE OF PROJECT___
PLAN CHECK FEE
RCPT"
DATE
BY
5% SlalC
~~rclwrg~.__ __
PAVING
51)/0 Slale
Surcl1arqc
FENCE
VALUE $ ___
SIDEWALK
--.-
J500 DEMOLITION
~_ __f_ __ __ _. __. .._ __.
.75
[lUILDING PEHMIT
I PLUMBING
5% State
~~lfEJ.!!~9~ _ .__
MECHANICAL
FT.
SU IlTDrA I.
l'Ef!~~TS
SYST EM S
DEVE LOPMr,-N-I..___
CURBCUT
FT.
TOTAL PERMIT FEES
EXCLUDING ELECfRlCAL
/5.7S
,.
,'--.-
. REQUIRED INSPECTIONS.
It is the Icspon:..,ihilily olll1e perlllit Iwlder 10 see t11R,t all inspections ilre made althe proper lime. To request nn inspection, call
726.3769 (recorder). sl<:llc YOlll Cily dc::;ionaIlJ<.! iob number, job addrcr.s, type of in:;peclion H)quc:,!r.HI and whfm YOll willi)!: n:ady
for in~;J1el:ljon. n(l(llll.::;I:; Il)ccivnd helUln .!;()O :UFl. willllf~ IlHldl) 1I1f~ :";lI11C wlllldll!l d;IY, 1()(pll~:"I:; rrl;lflf~ :1111]1 '/:f)f) :l.Itl. willllf: 111:U":
Illu fol1owilltj wurl\ <lilY.
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work is covered.
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No wl,)lk i~~ tu
be covered until 010$1)
inspections have been rllfldc
and approved.
PAVING: Afll)! W;lv,~1 i:.. in
pl:ICf] but pdf)!' III pl:t1:in!1
:L:..pllall or CI.1l1Clr]II.:.
SITE INSPECTION: Tu 1.l(.~
made afler excavation, bul
prior tu ~:;etup 01 lorlll~;.
FOOTINGS & FOUNDATIONS:
To b(~ rnade alter trenches arc
excavnted ;':lI1d forms arc
erected, all ~;Ieet in place, but
prior to placiny concrete.
FIREPLACE: Prior to placino
facing materials and befow
(raming inspection.
SPECIAL INSPECTIONS: In ::Jccofd;Hlce
Section aOG of the State Specially Code
a special inspeclor slli111 be crllployc(J
by Ille Ownerl Conlraclor dllrin~l
con:;lrllclion of tile followin~l work. ^
copy (If tile f,pecial lc~.tinfl nJp'_)rl~ :;l1al1
b'] furnished 10 the BlIildlno Divj~;ion.
ATTIC DRAFT STOPS &
CURTAIN WALLS
CONCRETE SLAB: To be
rl1:1d.! ~l(jcr nil insl;!\) huildin!J
scrviGe equipment, r;omJuit,
pipin{l, accessories and otllel
ancillary equipment iterns are
in place but hefore :Jny
concrete is placed.
FRAMING: To be 1l1;l(.J(~ aflCI
Ihe roof, all (mming, file
blocking and bracino are in
placu amJ all pIpes, ctlilllllCYS
and vents arc complete and
lhe rouuh electrical. plumbing
and mechanical are appt'Oved.
STRUCTUflAL CONCflETE: In
exces~. of 2500 p.z~.1. (306 a.l)
STRUCTURAL WELDS:
r"~tlr:'tnl,:d (.>/1 Ill.: i,.,I). I;:;'::: '1
UNDERGROUND: PlullllJinU,
eleclrical, O:lS, sanitary sewer,
stOlln sewer, w;1ter and
tlrainage line~,. To be I1Hldc
prior to covering or fillinU
lrenches.
INSULATION & VAPOfl
BARRIER: To be ronde alter HII
insulation and required vapor
barriers ;.ue in place but
before any lattl or gypsum
board interior wnll covctin~l is
apIJlied.
HIGH STRENGTH 1.l0LTING:
Ourin~l ;JII bolt insl;lll:lli(ln ;)n{l
lightening oper:lliolls. (306
'1.6)
SPRAYED ON
FIREPROOFING: U.U.G.
Standard~. 43-U.
UNDERFLOOn: Plurnbinn,
elechical, rnechnnical. To be
made prior to insinUation of
rloor insulation, decking or
floor sheathing.
FIRE & SEPAflATION WALL:
Located and constructed
according 10 plans.
SPECIAL GRADtNG,
EXCAVATION AND FILLING:
Durinn enrll1worlc t:30G n.11 (,
Chapler 2U)
POST & f] EAM: 10 be made
prior 10 installation of floor
insulalion. decking or floor
sheathin~J.
LATH AND/OR GYPSUM
BOARD: To be lIlade a(ler all
lathing ami UYP~HlIll bO;lId,
inlerior and cxtel'iOl, i~: in
place bul bcfole any
plastering is npplied or befol'C
gypsum board ioints :lnd
fasteners are t;!ped and
finished.
GLU-LAM lJEAMS: In~:peclioll
Cerlificntc by ;1Il apProv,~(1
;1\Jency, fl.lt'lll~;l1r.:d 10 II\~~ Cily':;
BuildinO Oivi:;iul1 b.:lrlH~
Ilt~am:; ;Ill) placed. (:!~lOI U.UC
STDS.25-10,ll).
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior 10 installation of
decking or floor !5heathing.
SIDEWALK & DRIVEWAY:
Required for all <";OIlClctc
paving within street right o(
way, to be made alter all
exc<1vating complete and form
work and sub-base material in
place.
STRUCTURAL MASONIIY: (:\OG
n.7)
X---~t'2_j)&d$
MASONRY: Sleol location,
bond beams nroutlng or
verticals in accordance with
UBe 2415.
ROOF SHEATHING AND
NAILING: Prior to installing
any roof covering,
CURB AND APPROACH
APRONS: Afler forms are
eleclec! but prior to placing
concrete.
Oln addition to tile inspec-
tions specified, tile Blllldin~l
Official may Ilwlw or requite
other inspcction~.; l)f any
construction wod\ 10 cn~u'c
compliance with Ihe Building,
City or Devclol:1I11'JnI Code.
-------------------------------------------------------
FINAL PLUMBING
SITE PLAN REVIEW 130ARD: Must lJu rcquestcel 2 d.1Y~ in aelvanct.:'
of the date you wish inspection. All project cotl(liliofls such as
landscaping, parking lot slripino, etc. must be compleled I)I]IOH~
requesting this inspection.
FINAL ELECTRICAL
FINAL FIIlE DEPARTMENT
FINAL BUILDING: Heque~~tctl ;lltcl' IlIe finClI pltlflllJin~1. ,]I'Jctllc~iI.
mechnnical and Fire Deparllll/:nl inspccllon~3 are "we!l:: ;11111
approvud. No OCCUP;lIlcy III II,,: 11It:llli~.f~S. can !itJ 1l1;l{h~ 1111111 :1
CCltilicalc of OCf,:lIpal1cy 11:1:; IJ1J!:1l i:~:~lIed IJY till..: UlIilrlittU I.lIVl::it'll
and posted on Il1e plellli~;u~;.
_ _ _n FINAL MECHANICAL
ADDITIONAL COMMENTS: __
PLANS REVIEWED BY
DATE ___
By signature, I ~~tate and agree, that Illave carefully examined Ille completed application ilnd do llCteby certify Ihal all infot'fll<:llion
herein is lrue and correct, and I further cellily tllat any and all work performed shall be dOlle in accordance willl llle Qrdin;1IlGCS
of thc City of Sprinufielcl, and the Laws o( ttlC Stote of Oregon pertaining to tho work cle~r;rilJed herein, and that NO OCCUPANCY
will be made of any structure without permission of tho BuUding Safety Division. I further cenily tllal only contractors (lnd Ur1llJloyer1S
who are in compliance with OAS 701.055 will be used on this project.
I (urther agree to ensure that all required inspections are requested at the proper time, Illat proiect address is rC<Jdal)le IrOfll IlIe
street. that the permit card is located at the front of the property, and the npprovetJ set of plans will remain on the site al all
limes during construction.
Siunalure
l);lte ___._
nEGEtPI" J/:_
- 75"
J':;J'
-1-6/3______
DAlE I"AID: _~~_~/7'~_
IlFCI.IV[IJ IW: "I~:Z::;:' I
VALIDATION:
AMOUNT RECEIVED:
l