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Home My WebLink AboutPermit Backflow Test 2007-7-10 . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SCANNED . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01015 ISSUED: 07/10/2007 APPLIED: 07/10/2007 EXPIRES: 01110/2008 VALUE: Status Issued SITE ADDRESS: 5001 FRANKLIN BLVD ASSESSOR'S PARCEL NO.: 1803022003300 Eugene TYPE OF WORK: Backnow Device TYPE OF USE: Commercial PROJECT DESCRIPTION: Backnow Device Owner: WILDlSH LAND CO Address: PO BOX 7428 EUGENE OR 97401 I CONTRACTOR INFORMATION' Contractor Type Plumhing Contractor HARVEY & PRICE CO License 77 Expiration Date 10/31/2008 Phone 541-746-1621 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occnpancy 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 GaragelCarport Sq Ft Other: Occupant Load: nla 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: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Sidewalk Type: Storm Sewer Available: Special Instruction: DownspoutslDrains: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility f'\\WU~' WOR" Notification Center. Those rules are set forth ~. "A .....;~M'i" 4:l>4all EXPIRE If 1l:'~. I"" In_ <?!\R. 952-001-001 0 through OAR 952-001. p",... . -. H UNDER THI::i rtf'...... If. t._ - a~~~. 'vv ""'Y ""'''"l "'UI-'"'" vIlli" IU'".. oy MlTI-lOlllZED R IS ABANDOINWIffi\%on Descriotion I calling the center. (Note: the telephone COMMENCED 0 number for the Oregon Utility Notification .. .MV 1Rn DAV PERIOD: $ Per Sq Ft Square Footage Center is 1-800-332-2344). Descnpllon /'\I" TVife ortonstructoon . I' I' B' Value Date Calculated or mu tip Jer or Id Amount Notes: Paee I of2 ~~. IlL. . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01015 ISSUED: 07/10/2007 APPLIED: 07/10/2007 EXPIRES: 01110/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project F~~. P.'lUU . Fee Description + 10% Administrative Fee + 5% Tecbnolngy Fee + 8% State Surcharge Backnow Device MinimumlAdjustment Plumbing Amount Paid Date Paid $5.00 $2.50 $4.00 $16.00 $34.00 7/10/07 7/10/07 7/10/07 7/10/07 7/10/07 Receipt Number 2200700000000001103 2200700000000001103 2200700000000001103 2200700000000001103 2200700000000001103 Total Amount Paid $61.50 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. Backnow 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 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 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 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. Owner or Contractors Signature Date Paee 2 of2 225 Firm STREET . SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)726-3689 ~~ ~l ~ .~~~ l~ ~J ~ ..~~ " I( ~\ ~( ~\ ~~ ~: l~~ ..~~: ....- ~ ~4 :....( ~. f'\ It' ~ (QJ ..s: ~ Q\ Construction Contractors Registration # 190017 ~~ ~4 e.> ..~. I~ ~~ ~~ ~ ~ ~ ~~ f,'I~4 ~ ~ (;I;.j Date of Application / - I 0 - ;) ~ 7 ~( ~ ao~oI f~ 1><""'_"'- ~ ." HIS PERMIT SHALL EXPIRE IF THt I/Vun . UTHORIZED UNDER. THIS PERMIT IS NOT ~ OMMENCEO OR IS ABANDONED FOR ANY 180 DAY PERIOD. . . SPRINGFIELD =. .-:~" , ---Ii -i f\A /_'c_ t ~ B\I.';" _' ",""" '--"> &1 ,"""",,,,<"'-l'4~"';--"'<;''''--:';:''''E''''' ;"~ ~,-;'=.;~..;;~,~'/iL:::;;,' ';';:" . ~'< CITY OF SPRINGFIELD, OREGON City Job Nnmber ()syn 1-t507 - 0 I 0 I 5 Job Location 5-00 \ hGlw!j if'.> 5\,:,J.~. Assessors Mar I <?: 0 3 D d d no . Tax Lot ~3 0-0 Owner W 1\ & \~~ . Address .(J. 0 . B ox. I t..t;}-<g City ~~ . Phonp b 'B3- 771d--. . Stata 0 f2.... Zip C17t.-fQ I BACKFLOW PREVENTION DEVICE PERMIT FEE: $61.50 Contractor Information Contractor ~ +- D.f>C-e-- I Addrers :;;)0 \ '3 N ~ City ~lAJ're u--k-'I I Phona t!f'1 b - \ b '&-\ e>fZ- T 97,-/03 ,IP Expire' 10 - 31 - 00 <;tata By signing this permit/application, I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). I also state that all information on this permit/applica . on is correct. ' ~ Datp ;-/0 _Or For Office Use ATreNTlON: Oregon taw r8mJIru you to """NIl ...1... ....~~r8d-I:j' ~~-~;a:1 ~:ti t4otil1cat1on Center. Those rules are set forth ~ OAR 952-001-0010 through OAR 952-001. 1lll9O. Ya!lmll\'ftbt"..,C'OpIB"'~"l-""', O8IIlng the center. (Note: the II!eIlIlont - ____ CheCked~~~ Sham:! Drive (f:)lBuilding FonnslBackflow .- __. __..:_.. 7-07.doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2007-0 1015 COM2007-0 I 0 15 COM2007-01015 COM2007-01015 COM2007-01015 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Backflow Device Minimum/Adjustment Plumbing + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By KATHY A. ROSS/HARVEY & PRICE ~..... ~ ... of Springfield Official Receipt 'lJrvelopment Services Department Public Works Department 2200700000000001103 Date: 07/10/2007 Item Total: l:heck Number Authorization Received By Batch Number Number How Received njm 010164 In Person Payment Total: Page I of I 8:46:43AM Amount Due 16.00 34.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 7/10/2007