HomeMy WebLinkAboutPermit Plumbing 2007-1-17
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
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BACKFLOW PREVENTION DEVICE PERlvlIT FEE: $55.35
Contractor b~formation
Contractor
'"$c le. (~ ~7
fJ, tJ, t5 () x.
~ ~~'RN5C-0/2 y: TVYi,~-h~iA Ti-tcI
~ ~I~ ,t"'ttiMI r SHALL EXPIRE IF THE WORK, '
7~9-T~RIZED UNDER THIS PF8MhDWNCt4 L.{--7135~
0UMMENCED OR IS ABANDQN@ FOR .
ANY 180 DAY P~iS'~~f€ 0 I Zip '1 ?'f 0 /
~SSO
Address
City
Et...-f~(
Construction Contractors Registration #
Expires
2;ZJ"'/O 7
By signing this pennit/application, I 'g11~tr1rH~lN'<wran]insi)~Gti'0n![@li1G~:yhejbg.ckflow prevention device
has been installed and is visible for ifis~~0tz0i\E'(tJ~~l.!J.7fr~(i)~P~I ti1s'o.:sta@J1ima~talhinfonnation on this
pennit/applicationis correct. ~ot'ficatIOi1 Center. Those rules are set fortt
(21 '~"''\ In OAR 952-001-0010 through OAR 952-001
, " 'j 0090. :Oll may obtain copies of the rules Q~
, S' t ' tnQ thA canter. (Note: the telephoA,Qt'" I 117/0 7
Igna ure ,______ ' - --:=;J - . . --' va f' / I
- Ii IIU'C.~,".. _' ~ I "'yun-ulIIny ''IlOllTlcation { (
enter i., 1-800~332~2344).
For Office Use
Date of Application
1-/7 -ZOo?
~.
Checked for Historical Status
...............
Checked for Delinquencit"<:
Shared Drive (T:}/Building FomlS/Backflow Prevention8-06.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00078
ISSUED: 01117/2007
APPLIED: 01117/2007
EXPIRES: 07/1712007
VALUE:
SITE ADDRESS: 6171 Fernhill Lp
ASSESSOR'S PARCEL NO.: 1702343407600
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backflow device
I CONTRACTOR INFORMA-?ifON I
\\-\t. ~v
Contractorr\=-, \ 't,'f...?\?t. W ~ \~t'e\se
SCHIDA~fsX:~.J~~S~P~A~U\~U~.!\:n\1170
,\-\\S "~i\~VCIOBui'tb\~GOCNP&itMlhoN I .
f\\y,f\ Ct.G IJI\ ,~
CQ~~\t.~ ~ ?'f.~'Sidries: Lot Size:
f\~,!3\ ~\) G ~ Height of Structure Sq Ft 1st Floor:
t"X Type of Heat: Sq Ft 2nd Floor:
VB Water Type: \0 Sq Ft Basement:
Range Type: \{as 'lOU, '\'1 Sq Ft Garage/Carport
Energy Pa~h: \'1.\l'J teCX~' 0(\ U\\\\ t\\ Sq Ft Other:
Sp'ri!t5t~~Uil~i{\g~ O{eg (e g/:a\ \00\ Occupant Load:
,_InN. . _A 'o'l . .\09. a _...f)~()
p~ \DEVji,~r>;FMi'~i'IN'FOR~'t\ ':'Ib~ ~.u\es ';;,
\0\\':" ~\O'{\ v'lJ" ~OO"\U \,\ " \eS U\ .' ~e?nO(\,e
NO\\'\~~ 96~e9~"\ lJiS~t~\(\ C~~e', \~e ~o\\,\ca.\\O(\
\'{\ O~. '(~I$~~tlj~esr.R%i\ U\\\\\~ 'jt\A) "
0090 '~\\~~"~~~~e){q~OO.'3~2/2.
ce: ~~llf<i5o\~q~ehge:
nU~ Ce(\.
Owner: ROBERT GUILD
Address: 1835 PRASLIN ST
EUGENE OR 97402
Contractor Type
Landscape
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Phone Number: 541-342-8659
Expiration Date
08/31/2007
Phone
541-744-7135
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutslDrains:
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Value
Date Calculated
Pae:e 1 of2
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00078
ISSUED: 01/17/2007
APPLIED: 01/17/2007
EXPIRES: 07/17/2007
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total V ~Iue of Project
Fees Paid'
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$4.50
$2.25
$3.60
$14.00
$31.00
1/17/07
1/17/07
1/17/07
1/17/07
1/17/07
2200700000000000067
2200700000000000067
2200700000000000067
2200700000000000067
2200700000000000067
Total Amount Paid
$55.35
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.
I Reouired Insoections I
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 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
CZ1 =truCtiO~_, II (7 /07
Owner or Contractors Signature ~ Date I '
Page 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Cj*-' qf Springfield Official Receipt
D iOpment Services Department
Public Works Department
Job/Journal Number
COM2007 -00078
COM2007-00078
COM2007 -00078
COM2007 -00078
COM2007 -00078
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000000067
Date: 01117/2007
Description
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Backflow Device
Minimum/Adjustment Plumbing
Paid By
SCHELSKY LANDSCAPE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 317113 In Person
Payment Total:
Page I of I
11 :32:20AM
Amount Due
2.25
3.60
4.50
14.00
31,00
$55.35
Amount Paid
$55.35
$55.35
1/17/2007