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Home My WebLink AboutPermit Miscellaneous 2005-5-10 . . CITY OF I)rKll'ihl'lJ!,LD Building/Combination Permit PERMIT NO: COM2005-00547 ISSUED: 05/10/2005 APPLIED: 05/10/2005 EXPIRES: 11/10/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2595 DEBRA DR ASSESSOR'S PARCEL NO.: 1703234404400 Springfield TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Install Backflow Device Owner: POTTER WILLIAM L & MARY S Address: 2595 DEBRA DR SPRINGFIELD OR 97477 Phone Number: 541-747-7409 I CONTRACluKm..ORMATION I Contractor Type Landscape Contractor LANDMARK IRRIGATION CORP License 6049 Expiration Date 02/2812006 Phone 541-686-9493 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla , DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: ATTFNTION: OreDon law reaulres yOU to . ,foll,OW rules adopt~d b~pim~e"M;ltb~MENTS I Isatlon Center, Th.._.. ..__ -. - - - - Street Improvements: ,,- ")2-001-001 0 through OAR 952-001- Storm Sewer Available: _ ~q,/ obtain copies of the rules by Special Instruction: .. J t "~nter. (Note: the telephone ,_ . ('rpoon Utility Notification -. ,5 I ,: 332-2344). Sidewalk Type: DownspoutslDrains: Notes: . : - .... '...;:;:. I\J .1\,..... THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDeR THIS P~R~~T_~S~NOT ;';' '1"llvltN\.,tu un I" "u,,"uu,,~u , v.. I Valuation Descrintion~IIY 180 DAY PERIOD, Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paeelof2 . . CITY OF SPRIl'i\.ot<lELD . Building/Combination Permit PERMIT NO: COM2005-00547 ISSUED: 05/10/2005 APPLIED: 05/10/2005 EXPIRES: 11/10/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Ff'f'~P,llW Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid $4.50 53.15 514.00 $31.00 Date Paid 5/10/05 511 0/05 5/10/05 511 0/05 Receipt Number 1200500000000000603 1200500000000000603 1200500000000000603 1200500000000000603 Total Amount Paid 552.65 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 be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~f'~tion~1 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 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 wlIl 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 tbe property, and the approved set of plans will remain on the site at ali times during construction. ~.IJ~) Owner or Contractors Signature'\) ~.lO.nc; Date Paee 2 of2 . . . .' CITY OF SPRINGFIELD, OREGON 225 !lITH STREET. SPRlNGI1ELD, OR 97477 . PH:(541)726-3753 . FAX: ('541)726-3689 ~ City Job Numbr- ~~. Y'/{1 ..~ ~ Job Locatior ~ ~ Assessors Mpp ..~ ~. ~:: Owner -< Addres< ~ City '~ ~ ~ Contractor Information ~ ~ Contractor ..~ > Addref~ Q Cit:' g "~ ~ ~ e Signature ~ ~ r,~ Date of Application ..~ CIi""'''' fo, D,Ii"q~ci~ M Tax Lot f\)o -lic-r- 2.$ '7 )" \J--e brA- S~ .(;...M Phon.. ~ IY/-/'10~ Zir crl'11 J Stat.. A< BACKFLOW PERMIT IS $52.65 (includes Permit Fee, State Surcharge & Administrative Fee) Construction Contractors Registration # ~,^1J~ (v'Y\rh-~ I 'S" ) ~ ~~~ /Let -tl= K Phone.-G ec., - 0, '-'A "3 Statp tS2/ Zip" ,4-0 I ~~1~ 0 CoOY~ <-.-h_e/06 . . Expires By signing this permit/application, I agree to call for an inspection once the backflow prevention devise has been installed and is visible for inspection (726-3769). I a1so.state that all information on this permit/application is correct. ~ ~I i~J0 Oat.. <: 1 ')/"\)( For Office Use Checked for Historical Stat"" Sbaml Drive (f:)lBuilding FormslBacldlow Preventionl-03.doc 225 Fifth Street 'Springfield, Oregon 97477 541-726-3759 Phone . it.- ~ity of Springfield Official Receipt .evelopment Services Department Public Works Department Job/Journal Number COM2005-00547 COM2005-00547 COM2005-00547 COM2005-00547 Payments: Type of Payment Check 5/10/2005 RECEIPT #: 1200500000000000603 Date: 05/10/2005 Description Backflow Device Minimum/Adjustment Plumbing + 7% State Surcharge + 10% Administrative Fee Paid By LANDMARK IRRlGA nON Item Total: Check Number Authorization Received By Batch Number Number How Received lib 1864 By Mail Payment Total: Page I of1 10:34:06AM Amount Due 14.00 31.00 3.15 4.50 552.65 Amount Paid 552.65 552.65