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Home My WebLink AboutPermit Backflow Test 2004-5-26 _~~~1.."!9~~3< ,. . \ . . ._ U 1 :f Vi' ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00621 ISSUED: OS/26/2004 APPLIED: OS/26/2004 EXPIRES: 11/26/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541.726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1134 Delrose Ct ASSESSOR'S PARCEL NO.: 1703234409900 TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backflow Owner: SIEGMUND SCOTT D & AMY J WEST-SIEGM Address: 744 EDGEMONT WAY SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Landscape Contractor GRANTS LANDSCAPE SERVICE License 10250 Expiration Date 10/31/2004 Phone 541-342-1835 VN BUILDING INFORMATION I # of Stories: JTENT\ON: Oregtl\>l:l5).r;elequlres you ~ Height of Str~ctur'\I0W roles adopte't9tJ\1 ~IlIlloogon Utility Type of Heat. 'f! ti Center ~8~~'II!1l!lPote set forth Water Type: Notllca 9~~-001-Q(iti!l~~~Af\ 952-001- Range Type: In OAR bt R b ~~@I"1W3s by Energy Path: 0090. .You may 0 q.~b~~'Wfe telephone Sprinkled Building: calling tRill centoerO.!CUraOliLop..ctitification _..~h"dnrthe rej;lor ULlUY I DEVELOPMENT INFOWTION-tfter is 1-BOO-3;;"(-i,,j'l'l). REQUIRED PARKING # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R.3 Frontyard Setback: Side I 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: I'tU II"~' THIS PERMIT ~.!IU.aLlcr~I?,{f1f'JPI'Ol$t1 AUTHORIZED UNDER THIS PERMIT I:) NU \ COMMENCED OR IS ABANDONED FOR ANY 160 DAY PERIOD. Sidewalk Type: DownspoutslDrains: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page I of2 . . CITY OF ~rKll'\j\.J1'lJ!.LJJ . Status Issued Building/Combination Permit PERMIT NO: COM2004-0062I ISSUED: OS/26/2004 APPLIED: OS/26/2004 EXPIRES: 11/26/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fp.p.~ P.aid I Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $3.15 $14.00 $31.00 5/26/04 5/26/04 5/26/04 5/26/04 1200400000000000806 1200400000000000806 1200400000000000806 1200400000000000806 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 be made the same working day, iospections requested after 7:00 a.m. will be made the following work day. I Reou~)p."tions I 1 Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, 1 state and agree, that 1 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 constru . . //Af" L t!~ rc;?&,-o,/ Owner or Contractors Signature Date Page 2 of2 225 Fifth Street Springfield~ Oregon 97477 541-7~ji-3759 Phone . 8g.~_!~.9I:1~; ,.. ._ '.' ~. , --", ..~.'.- I . ..,. .ty of Springfield Official Receipt Whelopment Services Department Public Works Department Job/Journal Number COM2004-00621 COM2004-00621 COM2004-00621 COM2004-00621 Payments: Type of Paymeot Check " 5/26/2004 RECEIPT #: 1200400000000000806 Date: OS/26/2004 Description + 7% State Surcharge + 10% Administrative Fee Backflow Device Minimum! Adjustment Plumbing PaId By REXIUS Item Total: (;heck Number Authorization Received By Batch Number Number How Received djb 54442 In Person Payment Total: Page I of 1 11:00:41AM Amount Due 3.15 4.50 14,00 31.00 $52.65 Amount Paid $52.65 $52.65