HomeMy WebLinkAboutPermit Backflow Test 2006-6-1
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1038 Diamond Street
ASSESSOR'S PARCEL NO.: 1703342103300
PROJECT DESCRIPTION: Backl10w device
Owner: JONATHON DRISCOLL
Address: 1038 DIAMOND ST
SPRINGFIELD OR 97477
Contractor Type
Landscape
Contractor
OWNER
# of Units:
Primary Occupancy Group: R-3
Secondary Occupancy Group:
Primary Construction Type VN
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
-.
.'CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2006-00668
ISSUED: 06/0112006
APPLIED: 06/0112006
EXPIRES: 12/0112006
VALUE:
Springfield TYPE OF WORK: Backl10w Device
TYPE OF USE: New
Residential
Phone Number: 541-726-3679 wk
. .'1'1. Uf0'c:on 1:11\1 reo'
I CONTRACTOR INFORMATlON"'h ,Wes you to
-."V", ,-,"',ler Th e Oregon Utility
In O......:J [)r.:2 0' ; ase ru/os ,q.J:lo ~'.. I
'" ;J - 01-I"Icense Exptrahori'iOate Phone
OOSO, You may obt ,- .." oUgh UI-<.H 952-001_
_ ... am cnnll::t.C' ",l u.
BUILDlNGJNF()RMATiON ,Note:, (he tei;~/~~~~e uy
Cente '- -,~"i:>n UI/i1ly Notific'ltion
# of Stories: r IS 1-800-332-234..~?t Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft GaragelCarport
Energy Patb: Sq Ft Other:
Sprinkled Building: nla Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Dist:
NOTII ~fr~et Trees Rqd:
THIS'la~M,Hfi'::,eH~?f r
AUTh{'~fNIJ fiNverage:XPIRE IF THE WORK
COMMFNr.m f1nO,~R; ~HIS PERMIT IS Nnr
I PUBDIGJIMPRO,\lEMENTS',u/VtU FOR
Sidewalk Type:
DownspoutslDrains:
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I on
.
. CITY OF ~rKm'-'I'I"'LD .
Building/Combination Permit
PERMIT NO: COM2006-00668
ISSUED: 06/0112006
APPLIED: 06/0112006
EXPIRES: 12/0112006
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
~
Fee Description
+ 10% Administrative Fee
+ 8% State Snrcharge
Backl10w Device
Minimum/Adjustment Plumbing
Amount Paid Date Paid Receipt Number
$4.50 6/1106 2200600000000000706
$3.60 6/1106 2200600000000000706
$14.00 6/1106 2200600000000000706
$31.00 6/1106 2200600000000000706
Total Amount Paid
$53.1 0
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 7:00a.m. will be made the following work
day.
IRp.~
Backl10w Device: Prior to covering and provide a copy of tbe test report on site at the time of inspection.
.....--"'-
By signature, I state and agree, tbat I b,,,,,.fcarefully examined the completed application and do hereby certify tbat 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, ond
that NO OCCUPANCY will be made of ony structure without permission of the Community Services Division, Building Sofety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further ogree to ensure that all required inspections are requested at the proper time, that each address is reodable from the
street, that the permit card is located at the front of the property, and the approved set of pions will remain on the site ot oil
times during.construc' .
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, / CITY OF SPRINGFIELD, OREGON
22" nrn-l STREET. SPRINGFIELD, OR 97477 . I'H:("41)726.37":, . rAX: ("41 )726<,689
City Job Number
C.OW\Z-OOb _ oObb8'
lo38' btAlM-o-,J.
~_7!3 p~O~3"l1.4Z-1
Tax Lot
0336~
Job Location
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Assessors Mar
Owner
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Stat"
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Phon"
/~/J-?,L7a5-567'y
97 t.r '7"7
Addres<
0:1<
Zip
City
I. _
BACKFLOW PERMIT IS $53.10 (includes Permittfee,-State Sur~harge & Administrative Fce)
if} O'~";''qti;~' ~ (70'0.~-;POr; IqrA. .
'1A 9 ...e J.-1c(j b 'v re
0090 " 02:00 I)te, If. ~'the qUires
'.roll "0,0 'Ios Ore YO,.
Cqllil) tnq JOt e rll~ '90fl ': 10
flUtnb '!] Ihe /- Obtqii) hr01l9h es qre ,Utility
e;, fOr th~~e, (A,:OPies ~?,<jA 9:~t fOrth
."flle ,~/e(') -''': fI-- "Ie r - vUl
r IS ,,01) U - 'Ie 1 I 1I1es .
1-80n Illit<, e'eph ,by
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Zip
Contractor b(formatioll
Contractor
O~dJ-.
Addres~
City
State
Construction Contractors Registration #
Expires
./"orICE:
By signing this permit/application, I agre.9l~,gall?,~9ha,.n.inspection once the backflow prevention
devise has been installed and is visible fQ1:}nlP'ei;~i~ri (72(jif769). I also state that all infonnation on
this permit/application is correct. AN::/~ENCE% UNDE~ ;XPIRE IF
a tJ 80 DAy OR IS A HIS PER THE W. '
, / A A ~ &:1\ PERIOD SANDON MIT /S OR/( 6: 1 W
Signature ,/ / V~ ' . 'ED r:i)p~?r /I/v,=
, ~. __ __---' I
-For Office Use
Date of Application
6/~b
v---
Checked for Historical Statue
v--
Checked for Delinquenci"<
Shared Drive (T: )/Building Fonns'Backnow Prevention 1..Q6.00c
225 Fifth Street
SpriD~eld:Oregon 97477
541~726-3759 Phone
Job/Journal Number
COM2006-00668
COM2006-00668
COM2006-00668
COM2006-00668
Payments:
Type of Payment
CreditCard
cReceint 1
RECEIPT #:
.
-~... _ ''',III.D,'._"
Ilk ..
, ,
, , .- ~ .
<;;II of Springfield Official Receipt
.Iopment Services Department
Public Works Department
2200600000000000706
Date: 06/0112006
Description
+ 8% State Surcharge
+ 10% Administrative Fee
Backl10w Device
Minimum/Adjustment Plumbing
Paid By
JON DRISCOLL
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 04741B In Person
Payment Totol:
Page 1 of 1
11:19:IIAM
Amount Due
3_60
4,50
14,00
31.00
, $53.10
Amount Paid
$53,10
$53.10
6/112006