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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' . / ) ~~p3 '-o;;;;~r Contraf;;'r..s(g~ 0/~ Date Paee 2 of2 :( g;:: e; .~r..-t1 l~~ ~J (Q) -.) .;:l~ " I, ~l ~ ~r-.- l r 1 " 4 l~ .'~~l .-----1 f- 4 .- ~ ~ "'\ ' ~l ~ ~ .,~ ~ (Q\ g:l ~j e; .,e!!"4' l~ g:: ~ ~ ~ ~~ ~\jj ~ ~ r-r-:~ ~ (Q) ~; . ~ ~l . .{ . SPRINGFIELD r::---=--=, r ,^, ^ /'---- : ; , , ," .~----,~ /' I - ", ' '"' -- , '::..:..-. :-; -..~ < I \ ""-, ~, -.--- ~.--- '::,. . , / 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 ~+- Assessors Mar Owner ::::::0 IV ~ \2-, ~ c C'\. <- /OJ?3 O:O~J 5J>;Q Stat" s~ 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 , Plion"?~- J' N~.-_ On_ --~-<!(44).""Cqlio~ 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