HomeMy WebLinkAboutPermit Backflow Test 2005-9-13
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.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2698 GARSON LN
ASSESSOR'S PARCEL NO.: 1703361109901
. LH i' uF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01251
ISSUED: 09/13/2005
APPLIED: 09/13/2005
EXPIRES: 03/13/2006
VALUE:
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: Backflow installation.
,'- '\1 CONTRACTOR INFORMATION I
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Contractor.; ,'~ )0'
MEDALLION LANDSCAPE SERVICE INC
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# of Units: "Vi-
Primary Occupancy Group:J~
Secondary Occupancy.Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Owner: ADSIT CHRISTOPHER B
Address: 28465 SIESTA LN
EUGENE OR 97402
,
. Contractor Type
Landscape
Frontyard Setback:
Side 1 Setback:
,. Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
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License
7118
Expiration Date
02/28/2006
Phone
541-933-2745
I BUILDING INFORMATION I ,0
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# of Stories: ,j.\e'" ~ -S ~ \O~ ,_ Lot Size:
Height of Structur~01 ~e~O\e ",e ~p() 'Q~q Ft 1st Floor:
Type of Heat: \7>~ K'e 0 s'1> 'S- oJ; ~eS 'Sq Ft 2nd Floor:
Water T~l1e2~ '0-4,'1 e \,j.e O'?' K'e \~ K'O~'S.!!Jt Basement:
Ranl!e.1'Ype:~o.<'(\os ,if 0\" e"e~. riSq Ft Garage/Carport
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Energy Path:\. ,,'S' ", ,'(\e _'0"'" Sq Ft Other:
\,\; Co v \It(': .'...., rQY ." .\..... ~
,\<..Spr~liIed~BulljlDg\" v O,e' . ~/a 1>1);,' Occupant Load:
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I DEVELOPMENUNFORMATION,-,
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." [\. 60'S' ~'S' \s
'iiverlay'Dist:\O ~e\
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# Stree~1rees Rqd:
Paved 'Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutslDrains:
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!e 1 of2
.
. \...11:r' OF ~rKll'\jld<lJi.LJJ
Building/Combination Permit
PERMIT NO: COM2005-01251
ISSUED: 09/13/2005
APPLIED: 09/13/2005
EXPIRES: 03/13/2006
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L.Ff'f'~ P9W
. Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid
Date Paid
Receipt Number
$4.50
$3.15
$14.00
$31.00
9/13/05
9/13/05
9/13/05
9/13/05
, .
2200500000000001257
2200500000000001257
2200500000000001257
2200500000000001257
Total Amount Paid
$52.65
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.
~~~tinn~ I
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 aU
information hereon is true and correct, and I further certify that any and all work performed shaU 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 wllI 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 ofthe property, and the approved set of plans will remain on the site at all
times during construction.
X_ f? y - ~ r - 1.3 - os-
Owner or Contractors Signature
Date
Pal!e 2 of2
~, 225 Fifth Street
, / Sprfngfield, Oregon 97477
i 541-726-3759 Phone
Job/Journal Number
COM2005-0125 I
COM2005-0 1251
COM2005-0125 I
COM2005-0 1251
Payments:
Type of Payment
CreditCard
;1.
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9/13/2005
.
RECEIPT #:
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.ity of Springfield Official Receipt
.velopment Services Department
Public Works Department
2200500000000001257
Date: 09/13/2005
Description
Backflow Device
Minimum! Adjustment Plumbing
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
KENNETH R CORNELIUS
Item Total:
Check Number Authorization
Received By Batcb Number Number How Received
jmp 066004 In Person
Payment Total:
Page I of I
9:30:35AM
Amount Due
14.00
31.00
3.15
4.50
$52.65
Amount Paid
$52.65
$52.65