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HomeMy WebLinkAboutPermit Backflow Test 1997-11-10 NOi\Ce.~ EXPIRE If iHE WORK 'iHI5 p~RM\i SH"LL iHIS PERMli ISNOi ' . , ' , IZED UNDER :M ,,: "UiHOR D OR IS "B"NDONii~C=KFLOII PREVENTIOli, DEVICE PERMIT APPLICATION " COMMENCE , CITY OF SPRINGFIELD · AN'f18tl OA'( ?~~IOD. BUILDING SAFETY DIVISION 225,FIFTH:STREET SPRINGFIELD OR 97477 <./ :::~ .? ....... :.! ,', .;'i ,,', ,''-'j ,:.:" .:.: .:!:'~ '.:;~j .:.,') "." ~.':,~ ~ :, . ",'J ',,' ", .... " . . , ) OFFICE: 726-3759 INSPECTION LINE:' 726-3769 ;~:-::::~:::~---:a;2;-5C{----bCiffiQ~--ffl-h-ffi-7J01f[------------- , ASSESSORS MAP 11:' '1")~tJ(1 ) TAX LOT 11: q trb I OIlNER: ~,i).< If < PHONE 11: ?~71- <;71' 7 /.)fR.. ZIP: 97~77 ADDRESS: / ~tJ I CITY: ,:<{ jJFr:J ;vJ'J:S.J",j ~..,-;,-:-~-r STATE: BACKFLOII PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) Q $16.20 , l' . CONTR.\CTOR: ()ez.-7'"q LA~/'),1'L~,t?C. ~ :J;:;1I!!'.<!u:!..""fL;"'/ ADDRESS: .'<)2 t:j' HD 12 rJ LAI PHONE' 11: STATE: /~ PZ.. ' //~o/'t? ::r /V' c: , 'i? ~1f-~/l/r ZIP: '177"t?-1 EXPIRES: /I-:~t? -"l'? CITY: ~ ' CONSTRUCTION CONTRACTORS REGISTRATION V: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE ,BACKFLOII PREVENTIO~DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS CORRECT. ',~ ' ~ ' , /C"-"'''',' ~~Ubl , '/7~ , f/ ,"," 11~/t7 -e97, l5A'Ll.' . FOR OFFICE USE -------------------------------------------------------------------------------- DA'l;E OF APPLICATION: l\.- lO- Cf, RECEIPT 11; O);'7Q {/J4 ISSUED BY: : - , TOTAL AMOUNT COLLECTED:J 10 7JD , JOB 11: qll Cond- o' . j . . () - f'naf.1A-.PL;/'( '\ :., -------------------------------------------------------------------------------- . .. . .. . . . .. . " , .~-u. ''''''~SPmNGFIELD UTILITY BOARD A,j,jACOBSON,F,E, C.ELL. "I'5'1-2;i(.<;) SI'EClAL PRUJECTS ENGINEER (541) 744.3717 . 726.2395 . FAX 726.2399 100/ MAIN STREET, SPRINGFIELD, OREGON 97477 VICINITY . ~ & ~ i [, N t .. .'rJ.::JL5 ..,. \ \ I I I , \ , 1 I I \ , I 1 \ I 1 1 , , I I I , , \ , 1 I I 1 I ~ Zj t ~! I ~I 1 01 , '\ 1 EI I ~i I ~I \ ,,"' I "!I \ I ,I I I \ , \ , , 1 , , 1 \ \--1 I I I 1 I I 1 1 I \ \\ . . .:~ . 1. !~' \. 1-:' ;...~.. " I ;") ., .- 11-,~'- ;....--" ./ \.... '~, . !C.'~__' ~ - ~ I \ 1 I I , 1 , , I 1 \ , I , , 1 , I I \ , I \ , \ I 1 1 I , , I , 1 I \ I t-- PROPOSED \ I \ I I , I N 90'00'00" -_.__.- -.--.--.--.--. 210.94' ---------------- CITY PARCEb '_srrt~nNC( rTALL OJ I " ~{)i I ,I, . .~-'l ~I H~ ~. r-i ~ ( ',' ", o(t) n.t..U1.,\ rr\,J ."\ / '~ <..' I'. ," 1: \. \~ r,J-_ ,-~' (j)(j)C) -10> (Tl{D-1 (j)(Tl -1~ ~~ o z ;.s j \ ,~: - '- J~L~ 15' EASEMENT , >=""" J ~ ~-~=--~- { y" _------ C~.~~><..:.. ;:-=.:..m---1 ." I ___~ ~ ..,....- -.=------. --. -. ...._.--.-21o~.(".-- -"'N"'SuWV\} ~'.o /'1, ",:./:.' .:;j -:::.' MAP Coll/III(rNOlIlDu.sT en"", AD . ~ e 3 ~~WAT ~ , - 35' ACCESS ROAD AND POw(R LINE [ASEIol[NT \ ';";:':-~ . ./ :....~~ " TAX LOT -... " oc-...""" \ ..... Ii ~ \1 " ~....; / i ~~,...", I ~ m ':'." "" ~WAT I N.T.S. NOTES' . ,. UNOCRCROuNO IRR1GA.llO'" TO a,:....;'PROv!OE:O. 2. ~PAR(O 8(05 wI 0 or ToPS:ltl/LOo.i.f, tlU.ED, A: S' Of" R(XIUS flA ~ OR S1wllJJl. J. .....("It) ~TlNC HOlCS. WItH J PARtS RElClUS c.utD(H COWPQST OR SIUlt.AA ANO I PART TOPSOllAOo\IoI. '. rtR'TlUZt P\...t.Ntlt.lCS WITH ACRIroRw P\.AHTWC TA8l.tTS OR S1Wru.R. IJS( J TA8L(TS fOR 5 CAL. PLANTS AHO 6 U&LTS fOR 2" tAL n:t(CS. TYPICAL - I ..-'~- 110J~ - PLANT LIST - KEY I COMMON NAME 0 10 Incense Cedor ~ 12 Redbud 0 15 Kouso dogwood 0 "2 Blue Pacific Shore juniper 0 ., Uoon9low Rocky Mountain juniper 0 9 VondewoU's pyromid pine ,0 .-' ~..\lI" U 00' J~ , ,'~' '> I -; .," /' -- Kinnikinnik \ // ~ 39 Austrion pine Scorlet ook .J 12 Jopanese snOwbeU /, ,/ /' /" / - '^"'>5C>P( WALL " TAU " '<~. -'.j 4' lNlOSCN"( WALL SPUT ria. CWU w/ eN' J .:t . BERM -QltlClk.I./. C'WlE '" "oPt NOT TO sc.o..:.E ;...I,;' 1_:;' , , ,',i aoTANICAL NAM[ REMARKS, SIZE MATURE HI. Colocedrus deeuirens B&B 5'-6' BO' ,'..'- .- Cercis canadensis -r -Col. - '. B&B 20' , Camus kouso ct.inensis B&B -r -Col. 20' Juniperus conferto container .3-Col. I' 'Blue Pocific' Juniperus scopulorum' B&B 5'-6' 20' 'Moon910w' Pinus flexilis "Vo'ldewo1f's B&B 4'-5' 20'-25' Pyromid' Pinus nigro B&B 5'-6' .30'-.0' Ouercus coceineCl 2.5- -Col. BO' B&B StyroJ[ joponieu$ -r -Col, 20' B&B Arctostaphylos U'1O-ursi 2.- -36"" O.C. -r Pot 0' (Y(AGR[[N SCRaNINC COWS/S'1'IJoIC << ROOCT WOUNTAIH JUNf'tR AHD AIJSTRIAH PN: SJARC:llINl)INC tKt SUBST....TION w/ ADl)l'J'IONAL (Y[JlCR(I1oi SCRE[N1NC ON NORTH .. 'II1:St SlOCS (sa PI.AH). KOUSA OOCWOOO, .woAH[S( SNOW8CU. AND RmBUO THRQUCHOUT SIT[ AS .ream """"""" """"'" .....ffffI'Ar'RtoI ~ ~ & WALL NC'l TO su.u: 2 SJIWoiD ~j(D 12 CUAC[ CAL '"~ (I+:AS(O IN RuB8(R PRO'l~CtOR ; l--."'= "lJ' STAKES 2 STAKCS 2" x 2" l)RlY(N (WIN. un rlRWl.Y MO SUBC:si.Arl! PRJOl' 10~.C StAK! A8QIIt flItSt BIlANCHE:S . Ji Of!: AS NEctSSNtt' roq nRlol '" SUPPORT rQRY S' WUl.CH ~ ""'" so TO.., 'OP '" ROO' """'~IJII illl<:-~ ir ~ "'" ~ ">...,,, TO<< mil' ',,'if ~ " :' I-I f11olISH[O QW)[ It:::ll : /1 : It-: BACICTU wI PI..AHtlNC w: - ~ .: . I 1 ,.... '0 Ai_ N' poc"", 31' ,3~" 31F." IElIE :1 .. I?' NOTE; ""El :I..!!m!!S1 STN<JIolC i,s-RCOUIR(O ..,11" ill;:;:;!LE;:'- ,.. SIAl([ TRHS ()fojlY IN HIGH -', I IIII'lNOARW ~ 2lL'a..u.0IA. PLANTIr\jG TYPICAL TR'EE NOt TO SCA:-(