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Home My WebLink AboutPermit Backflow Test 2004-2-27 . . CITY OF ~nuNGFIELD Building/Combination Permit PERMIT NO: COM2004-00229 ISSUED: 02/27/2004 APPLIED: 02/27/2004 EXPIRES: 08/27/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1805 PIONEER PARKWAY EAS Springfield TYPE OF WORK: Backfiow Device ASSESSOR'S PARCEL NO.: 1703262302001 TYPE OF USE: New Commercial PROJECT DESCRIPTION: Backfiow device Owner: T ABA T A FAMILY TRUST Address: PO BOX 943 CARLSBAD CA 92018 Contractor Type Plumbing I CONTRACTOR INFORMATION I Contractor License ACE EQUIPMENT & SPECIALTY SERVICE 154093 BUILDING INFORMATION. Expiration Date 01/24/2005 Phone 541-485-8930 # of Units: Primary Occupancy Group: Secondary Occnpancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Height uf Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: I DEVELOPMENT INFORMATION. SETBACKS Frontyard Setback: . :', 'i:)(,PIRE. Ii' 1~Wa~~t: Side 1 Setback: ~ \'t\\N\\\ SI'If>.ll 1\-\IS P'i:RNlISt~e~~rees Rqd: Side 2 Setback: \ \1\ uORIIE.O U~OE.R Q~"Oo~OOmlbrive Rqd: p.,Ul" OR IS f>.u"" Rearyard Setback:i)\'fI\'IIE.~CE.O 1'1100. % of Lot Coverage: Solar Setbacks: ~\II'1' 1 'DO 0f>.'1' PE. REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEM.E~:rSI-ION:Oregon law requires you, ~o , , ._._ d ,-"the Oregon Utility follow rules ,S,dewalK Type: I e set fort ., t' c~nter Those ru es ar ~otlflca Ion ownsp'outslDrains';)AR 952-00 OAR 952-0 ,-uu, v "" "..".. ~090. You may obtain copies of the rUI~~ I calling the center. (Note: the tel~~ho . f the Oregon Utility Notification number or . ___ ~~, A) (.........,......... . - ., I" .. . ~ ~..- , Notes: I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page1of2 ~i*. . . CITY OF :SrJ:Or~ul'lJ<..L1J Building/Combination Permit PERMIT NO: COM2004-00229 ISSUED: 02127/2004 APPLIED: 02127/2004 EXPIRES: 08/27/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L.F~~s P.'lidJ Fee Description + 10% Administrative Fee + 7% State Surcharge Backfiow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $3.15 $14.00 $31.00 2/27/04 2/27/04 2/27/04 2/27/04 1200400000000000246 1200400000000000246 1200400000000000246 1200400000000000246 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 he made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~uired TnsD~~tionsJ I Backfiow Device: Prior to covering and provide a copy of the test report un 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. a'L~pJ fl ~A<-'-" 2'-27-&V Owner or Contractors Signature Date Page 2 of2 225 Fifth Street ..' Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00229 COM2004-00229 COM2004-00229 COM2004-00229 Payments: Type of Payment Check -."~""''''~''~' ': ~.. , ..... i '. , . , "_n_"- -._._" - .._"""". - Receipt #: 1200400000000000246 Description + 7% State Surcharge + 10% Administrative Fee Backfiow Device Minimum/Adjustment Plumbing Received By djb {;heck Number Batch Number Authorization Number Paid By ACE EQUIPMENT AND SPECIALTY 2338 <::ity of Springfield Official Receipt Development Services Department ~' Public Works Department Date: 02/27/2004 9:47:50AM Amount Paid Item Total: 3.15 4.50 14.00 31.00 $52.65 How Received In Person Amount Paid $52.65 Payment Total: . $5Z.65 .