HomeMy WebLinkAboutPermit 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
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Construction Contractors Registration # 190017
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(;I;.j Date of Application / - I 0 - ;) ~ 7
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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.
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SPRINGFIELD =. .-:~"
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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