HomeMy WebLinkAboutPermit Plumbing 2007-7-17
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2007-01057
ISSUED: 07/17/2007
APPLIED: 07/17/2007
EXPIRES: 01117/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1196 Delrose Dr
ASSESSOR'S PARCEL NO.: 1703234409600
Springfield
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backflow device
Owner: PAUL ROTH
Address: PO BOX 70468
EUGENE OR 97401
Phone Number: 541-
I CONTRACTOR INFORMATION I
Contractor Type
Landscape
Contractor License
SCHELSKYS LANDSCAPE AND IRRIGA TI 12170
BUILDING INFORMATION'
Expiration Date
08/31/2008
Phone
541-744-7135
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
# of Stories: Lot Size:
Height of Structure: Sq Ft 1st Floor:
Type of Heat: AI I cNTION~@> lilWWiqU1re8 you to
Water Type: follow rules a aSOrtw6:0regon Utility
Range Type: NotificatIon C R f. CJBWftJI6a- set forth
Energy Path: I OAR 952- MlIlmough OAR 952-001-
Sprinkled Building: ~oe6'?liyou m 88iWddplis of the rules by
ni{'JUng inf.l WIIlI:II. ii ~...l.., it..: 1eI:'r:~ ;\",~
1 DEVELOPMENT INFORMA TI~er for the Ore(lo!, _~~i!t~C!..tificatlon
Center is 1~.ARKING
R-3
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
NCTI~~=
THIS PERMIT ~f)tMtl
AUTHORIZED UNDER .
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e 1 of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
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
Total Value of Project
Fees Paid I
Amount Paid
Date Paid
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01057
ISSUED: 07/17/2007
APPLIED: 07/17/2007
EXPIRES: 01/17/2008
VALUE:
Receipt Number
1200700000000000926
1200700000000000926
1200700000000000926
1200700000000000926
1200700000000000926
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.
$5.00
$2.50
$4.00
$16.00
$34.00
7/17/07
7/17/07
7/17/07
7/17/07
7/17/07
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
$61.50
I Plan Reviews,
I Reouired Insoections I
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
timG~Ctio..~
'--" ,-
Owner or Contractors Signature ~ ::>
~
Paee 2 of 2
( /(71 0 7
f ,
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-0 1 057
COM2007-01057
COM2007-01057
COM2007-01057
COM2007-01057
Payments:
Type of Payment
CreditCard
cReceint I
RECEIPT #:
1200700000000000926
Date: 07/17/2007
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
DARREN SCHELSKY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 016796 In Person
Payment Total:
Page I of I
1:51:26PM
Amount Due
16.00
34.00
2.50
4.00
5.00
$61.50
Amount Paid
$61.50
$61.50
7 II 7/2007
SPR~NGW'~ELO
~.
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 · FAX: (541)726-3689
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City Job Numberr6..vt ? 007 - 0 I 0 S"" 7
Job Location I ! 9 ~y 012 j) ~ ~ 7Y7
Assessors Ma~ I 70 J Z 3' t{ L{
Owner 4..../ /0 ~
Address
City
, Tax Lot
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BACKFLO'V PREVENTION DEVICE PERMIT FEE: $61.50
Contractor Information
Contractor
Address
"'S,-h.(5k~ ~ L.~",'sc~~ y- Tr'1'7c..-b~
;) 0 ;SOl< 7 tCf S-
.:rv....L'
7 L/tj-7fS S
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City C,:/ ......c
, State
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Zip '7 ?~ 0 I
Expires 2 /2 ~?
Construction Contractors Registration #
6 SSO
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.
Signature
~~
}~~
Datp ~/I 7 ! ~ 7
For Office Use
7~~-'
I {
Date of Application
~--
, Checked for Historical Status
Checked for Delinquencieo;:
Shared Drive (T:)/Building Fonns/Backflow Prevention 7-07.doc