HomeMy WebLinkAboutPermit Backflow Test 2005-1-18
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. CITY OF SJ?IUNGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00065
ISSUED: 01118/2005
APPLIED: 01118/2005
EXPIRES: 07/18/2005
VALUE:
..
Status
Issued
225 Fifth Street, Springfield, O'R
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 4197 FRANKLIN BLVD
ASSESSO'R'S PARCEL NO'.: 1703344300100
Eugene
TYPE O'F WO'RK: Store
TYPE O'F USE: Alteration
Commercial
PRO'JECT DESCRIPTIO'N: Install backtlow.
O'wner: SHELL OIL PRO'DUCTS US INC
Address: POBO'X 4369
HO'USTO'N TX 77210
I CO'NTRACTO'R INFO'RMATIO'N I
Contractor Type
Plumbing
Contractor
TWIN RIVERS PLUMBING INC
License
17695
Expiration Date
03/1112005
Phone
541-688-1444
I BUILDING INFORMATION I
"'~v s ,-
# of Units: 'f.v ~ # '\ ~;PfStories: Lot Size:
Primary O'ccupancy Group: ;{3.~ <:(X-'X' ~'\) <;; Height of Structure Sq Ft 1st Floor:
Secondary O'ccupancy Group: 'v\: ,*,"0 '1;)'0"" Type of Heat: ,:,,0 :\ Sq Ft 2nd Floor:
Primary Construction Type ':0~\; ~ "\ ':?-"" Water Type: '" ~O \)~~ ~Sq Ft Basement:
Secondary Construc~.n T~P~~~'\)\:S ~ Range Type: &~e; 0<::- e;"O(~Ji'F;t Garage/Carport
# of Bedrooms: ~\'\J :X.,~~ ~ '0~ '\ -fJ'\)' Energy Path: ~ \e; O\e;C$?!>e; \<;,'1: ~.9(Ft Other:
~~ ,"0 <:( ~,,\:.Yv'\) <:(X-'X' Sprinkled Buildi!!.t~ >:s-e; ~rtn/af?:' \JOc~UI)ant Load:
,0.'\ . ,('\ .,(, .j ^O ..-.1 <v () .." ..0 .<\
'~~~~\<:::, W' I DEVELOPMENl'W~ORM:iTION~'10'~,~e.1cr'
" ~ '\ ~\V '/>v ~J. <;) v 0"1 . 'S' ~O. REQUIRED PARKING
~~ vt<-'S' ,~:t:Je;<:< ~<;)" .~ v_,o'e.',~~-.I, r1'......
'l'!.v'IJ~V!::l' ~,'I> ~ ~"V ~'!;
.~...o;~t$ee~'R <1;0 ^,e;\' n~O ",,:>':>
iP'~.~.C 01~ "e;" 0\" S)v
P~xe!i'~veo :e;v e; ,~
%'ii~~tS~e~g.:\'S' i{'.>
\1 (;)<;)<1l &,-$' \,0 ~,e;
v~ .::-'Oe; (,e;
I PUBLIC IMPROVEMENTS I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback: .
Solar Setbacks:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer A vailahle:
Special Instruction:
Sidewalk Type: .
Downspoutsffiralns:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footnge
or.Bid Amount
Value
Date Calculated
Paee 1 of2
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00065
ISSUED: 01118/2005
APPLIED: 01118/2005
EXPIRES: 07/18/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, O'R
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fp.p.~, P3W
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backtlow Device
Minimum/Adjustment Plumbing
Amount Paid
$4.50
$3.15
$14.00
$31.00
Date Paid
1/18/05
1/18/05
1/18/05
1/18/05
Receipt Number
3200500000000000022
3200500000000000022
3200500000000000022
3200500000000000022
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, inspections requested after 7:00 a.m. will be made the following work
day.
~rp.d Tn'illP.~tiomJ
Backtlow'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 O'rdinances of the City of Springfield and the Laws of the State of O'regon pertaining to the work described herein, and
that NO' O'CCUPANCY 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 O'RS 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 construction.
~6~
tjff/os
Daf I
O'wner or Contractors Signature
Paee 2 of2
225 Fifth Street
,Springfield, Oregon 97477
'541-726-3759 Phone
Job/Journal Number
COM2005-00065
COM2005-00065
CO'M2005-00065
COM2005-00065
Payments:
Type of Payment
Check
1/18/2005
.
RECEIPT #:
~
--. -~
JIily of Springfield Official Receipt
"elopment Services Department
Public Works Department
3200500000000000022
Date: 01118/2005
1:57:46PM
Description
Backtlow Device
Minimum/Adjustment Plumbing
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
TWIN RIVERS PLUMBING,
INC.
Received By
jmp
Page 1 of I
Item Total:
Check Number Authorization
Batch Number Number
25298
Amount Due
14.00
31.00
3.15
4.50
$52.65
How Received
In Person
Amount Paid
$52.65
Payment Total:
$52.65