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Home My WebLink AboutPermit Backflow Test 2005-6-8 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . UIl' OF SPRINGl'l~L1J Building/Combination Permit PERMIT NO: COM2005-00692 ISSUED: 06/08/2005 APPLIED: 06/08/2005 EXPIRES: 12/08/2005 VALUE: SITE ADDRESS: 4531.FRANKLIN BLVD SPACE 1 Eugene ASSESSOR'S PARCEL NO.: 1703344400301 TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Install 2 backflow devices Owner: SHAMROCK PARTNERS LLC Address: 770 TAMALPAIS SPACE 401 B CORTE MADERA CA 94925 Contractor Type Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . I CONTRACTOR INFORMATION I Contractor TWTN RIVERS PLUMBING INC License 17695 Expiration Date 03/1112007 Phone 541-688-1444 BUILDING INFORMATION I R-3 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: nla VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: \Cr: I DEVELOPMEN\fINFORMATION I "Q1 I'\J~M\1 S\1f1.L\.. '-'HIS I'tRM\1}~ I'U' "\\1\S OR\1.tO llNOtR"\ flQy,e.!i\~i\j)istlR fl.lll~ NCtO OR IS fI.\.\ # Street Trees Rqd: CONlM\ Ofl.'i I'tR\OO. Paved Drive Rqd: MI'i ,,\\ % of Lot Coverage: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Anilable: Special Instruction: Notes: Description REQUIRED PARKING Total: Handicapped: Compact: ATTENTI~JJIlLI~ IMJ'ROVEM~N~Slto follow rules adopted by the Oregon Utility Sidewalk Type: Notification Center. Those rules are set forth DownspoutslDrains: in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the OreQon Utili!)' Notification Cl'~~i~~t~:; ~;;c;f~;i~n I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Value Date Calculated Paeelof2 . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2005-00692 ISSUED: 06/0812005 APPLIED: 06/08/2005 EXPIRES: 12/08/2005 VALUE: 225 Fiftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project FI'I" PiWU Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid $4.50 $3.15 $28.00 $17.00 6/8/05 6/8/05 6/8/05 6/8/05 Receipt Number 1200500000000000805 1200500000000000805 1200500000000000805 1200500000000000805 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. I RI'ouirl't1 IlI'n~diOlW 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 ail information hereon is true and correct, and I further certify that any and ail work performed sbail 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 ofany 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 ail 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 ail , times dur.'ng construction. r=6il~~ ~~f.6~ Owner or Contractors Signature Date Paee 2 of2 225 Fifth Street Springfield.. Oregon 97477 541-72(j-3759 Phone v '! . ""iiiI-cu;tIl;LO' . WI.._.'...-......~ -..-......-........,.... I '" ..". '.. - . t. ...~. r ,. . ~. - . ... ...H............ ~ - , .JiJ..ty of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT #: 1200500000000000805 Date: 06/08/2005 11:40:57AM Job/Journal Number 1 COM2005-00692 CbM2005-00692 COM2005-00692 COM2005-00692 'I Payments: Type of Payment Check Description Backflow Device Minimum! Adjustment Plumbing + 7% State Surcharge + 10% Administrative Fee Paid By SHAMROCKPARTNERSLLC Item Total: l:beck N umber Authorization Received By Batch Number Number How Received Amount Due 28.00 17.00 3.15 4.50 $52.65 Amount Paid djb 1080 In Person Payment Total: $52.65 $52.65 ;~ . 'I i 'i ~ 'I , I i " , 6/8/2005 Page I of! . . SPRINGFIELD if" ,CITY OF SPRINGFIELD, OREGON ., 225 nrrH STREET. SPRINGnELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~. 0) .,~' ~:' ~: 0; ...~~ 'l--.J~ ~" ~, ~'I ~-' " ~ 'I , . . ~) ."E~: ......".. ~. ~ , (U) C_l~t~ ~\ .~ I"r"'''\, "-'J ...: l\-~h ~ ~ ~\ ~j ~~ ~ ...>~~ l.-~ ~I ~( ~ ~ ~ ~l I.'l, . ~l ~ o ~-j " .~1 ~~j ~1 l!:)) ~J ~l C ~-cD 6 a, z.. City Job Number OM 'Z.oO~ Job Location ~1.<)7, I fi Cl.M I: I;'" "Blocl Assessors Mop '7051 L.fl..( L( ~,Of?. 91'103 , Tax Lot DC) 0 ( Owner <)hG..vY\RCJ('( I{CU1-m}J:" U_G Address "l/0 I""m;illfl" ~llR. Sff>, 401-.& Cit~(2n ttl ffif' ~IC\ Statp (' ~ Phor P lffS-q LIs-a. "IiCJ Zin C\\.f<1&~ , . BACKFLOW PERMIT I($2~Udes Permit Fee, State Surch~rge & Administrative Fee) Contractor It" ,,'1' ;2., v~IL':rt,~ '^lnp,?C.......""" I".--~ ~IJ:'t_C~ ~l t'i.l'l\\t \~ :"\1 IS \'-\01 /' ~ "0\-1111 1 v, ,,," I't"QII/ Addresf ~...,' P\~" ...,c,,-'1ttt" '~~(\Q Phonp .....;:t\O\\IItU u,w - I\Bt<(-.\U'J\~c.J - {~,~~~nn . ~N~ ~80 DI"1 p-';'- Construction Contractors Registration # Contractor Information Cit:, State 0 tL 17b')J~ b (if{ - / 'T~lf' Zip 97f{()<.f' Expires 0 p ~ 7 By signing this permit/application, I agree to call for an inspection once the backflow prevention devise has been installed and is visible for inspection (726-3769). I also state that all information on this permit/application is correct. Signatur~~O ~AJ) ~ J ;,,p Date of Application b-%-O~ Checked for Delinquencip'o to. ~()regon'aw~~~ ,.. aoovlOd~ setfuTtl\ tlllCWtl fU\eS ntet lhose rules are 952-001. tlOti~~1.o010\hfO~g~ ~~" roles by For Offic~. ~u \'lIa,,-~~'n~:~7U,e tel~P~~~ calling Ul'l......r..- . on Utility I~u\if,- bar tor \he ore~^,,_ '>.<12-2344), I\UflI (;enter Ia 1-ouv- ~ - Checked for Historical Status Shared Drive CT;)fBuiJding FonnslBackflow Pre~entionl-03.doc