HomeMy WebLinkAboutPermit Backflow Test 2007-2-26
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4tCITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00285
ISSUED: 02/26/2007
, APPLIED: 02/26/2007
EXPIRES: 08/26/2007
VALVE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1096 Diamond ST
ASSESSOR'S PARCEL NO.: 1703342102700
Springfield
TYPE OF WORK: Backnow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backnow device
Owner: DJS INVESTMENTS LLC
Address: 2860 MARTINIQUE AVE
EUGENE OR 97408
I CONTRACTOR INFORMATION I
Contractor Type
Landscape
Contractor License
SCHELSKYS LANDSCAPE AND IRRIGATI 12170
BUILDING INFORMATION I
Expiration Date
08/3112008
Phone
541-744-7135
# 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:
n/a
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Anl::l~llu
~_" I\I.Vlt::'cltll",
I PUBLIC IMPROVEMENisl'~~t"'OUll:lCS adOPted by th~ O;;;g' "0" YUQU [0
" n enter Th n l,.'y
1/1 OAR 9t&!dre-a!kl(j;(I'Pe:hose rules are set fo',;
0090 v -, v ,ur roughOA '
. . rOtbOWUspdl/tsfl1r!\-~' R 952-00 1
cal/mg the cente~'(Nw t as of the rules b
number for the Or~ 0:: e:, t,he telephone
Center is IloD JUtlllty Notification
- 32-23441.
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
1(0 rl.
'litis C(;.
l' /),....
JIlt, <'11l1.
'" C04141~RI?f;r Sltl/t I Valuation Descrintion I
4'y 4'Ct; U4'O L E..IJ
, T r 8.1;,~ 0. (It" 8.'flhlt,' iOSOIer Sq Ft Square Footage
Description ype 01' pnst""c Ion (, 'I.'" '1: n' 'li\ie B'd A
Pt; 1 48. ~uP!;:UIt"lt r or I mount
RIOO ~4'O/'l R41lr /1tOR,
. <.I4'fO ISM If
FO!> Or
IT Pa2elof2
Notes:
Value
Date Calcnlated
.
_CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00285
ISSUED: 02/26/2007
APPLIED: 02/26/2007
EXPIRES: 08/26/2007
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
F..... P~irll
Fee Description ,
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backnow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
$4,50
$2.25
$3,60
$14,00
$31.00
2/26/07
2/26/07
2/26/07
2/26/07
2/26/07
Receipt Number
2200700000000000247
2200700000000000247
2200700000000000247
2200700000000000247
2200700000000000247
Total Amount Paid
$55,35
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
L.R"'lIIir..rl ~
Backnow Device: Prior to coveriug and provide a copy of the test report ou 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
informatiou 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 Commuuity 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 tu ensure that all required inspections are requested at the proper time, that each address is readable from .he
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 construction.
Q, ~ - .---'
- - - '~
Owner or Contractors SIgna ure ~
L-h {,/" 7
Date
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-7,16-3759 Phone
.
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Caof Springfield Official Receipt
.Iopment Services Department
Public Works Department
Job/Journal Number
COM2007-00285
COM2007-00285
COM2007-00285
COM2007-00285
COM2007-00285
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
2200700000000000247
Date: 02/26/2007
Description
Backtlow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
DARREN SCHELSKY
Item Total:
L'heck Numbe~ Authorization
Received By Batch Number Number How Received
IIh 45918 In Person
Payment Total:
Page I of I
10:50:22AM
Amount Due
14,00
31.00
2,25
3,60
4,50
$55,35
Amount Paid
$55.35
$55.35
2126/2007