HomeMy WebLinkAboutPermit Backflow Test 2007-10-2
225 FIITH STREET . SPRINGFIELD, OR 97477. PH:(541)726-3753 . FA-X: (541)726-3689
~l _014''(
~ CilyJobNumberJ,O""'" z..oo 7
.~ Job Location W-,~g, c,rE>+t-<; 61e4\
~ Assessors Mar J 7 C> '3 -z 7/ ?
.~~~
" I;
~-'.Il
~
~:~
I~
."~4
~l
~l
~
~l
~
~1
~
~
..J~~
>
~
~
~;
~i
~
..)~~
I':'-~)
~
~
~
~
~;
~l
~
0)
~~:~j Date of Application /0 ~ z. -0 -r ~'
u) Checked for Delinquencir< Checked for Historical Statue
arJJ
~\
or ,
.',-:1- " ,
, /'.
.
.
SPRINGFIELD' .
n /\!\_~/"-..J
: '-:~- ----,
l' ? ~<.
I . .'" Ij;g:JYI '~
CITY OF SPRINGFIELD, OREGON
SCANNED
Tax Lot
C> l{ rOC,)
Owner DrrL TQ(~<' <Y\ -SU \[\ OU If c.,+
Address \ ,2,PI Cf H W~ q t.~\~ t~~n~~-p -; Zq ~gt 80
~..nh~' VI"'''' ,\\0 Y' 0 Qs\ {dl\W
. ~ /J A" p..'ift'" r:.: ~dotl,ed 'O'/~. ~ gS2..oo\o ~ \.../ 00
City 'C/flO 1,.",..,u\e8_ r,,,,.1t\~ ~ J,--- Zip -r I
- ,,1.- ~\Ol\v"'" 0\1" d1\t\~' ~~
~o,~c: ""'2..()01~~,,, COtl\~." .o\9P~...,.
\1\ v"r. o\IlI\S'i ,,~,- ~ ~.O\ll' ..... o~....
BACKFLO'\lO~~ijN'P~~;~IT FEE: $61.50
ij\1A~et ~Wl \Il 'I
Contractor Information
Conlractor ?A L-Uct! \ ace- ~ ,Q..f'Lx' l~u--JX <fHVt~d-
Address Z q 30 C? (i {e.-fl-A/ /a - kQ [j! Phone /cxCl ~ l.j. ~
City ~ ~ a '>tatp dE- Zip Cf I V () L
(.,p 17q LC-B Expires ~i~O ~
~\~\ ~\~~ .
B ' '!hi .tJ I' 'I II Ii ' '~~~~~~~~~ , ,
Y slgnmg s pemu app Icalion, agree to ca or an ~~ctlO\~ ~1I4i: ~reventlOn deVice
has been installed and is visible for inspection (72~r~~~:\~ ~ nnation on this
pennitJapplication is correct. ,y.\~ V ~~\t'(.~ Q~ \~ ~
J fo.\},\\'i ~'(.~~'(.~ fl'f;.~'J
C ' ~Q\N \'O'i) ~ 0 ~ 0 7
Signau>Tp' I'~ Datp I 2 - .
Construction Contractors Registration #
For Office Use
Shared Drive (T:)/Building FormslBacJcllow Prevention '-07.doc
.
.ITY OF ~rKll~ld'II!.LD'
Status
Issued
Building/Combination Permit
PERMIT NO: COM2007-01494
ISSUED: 10/02/2007
APPLIED: 10/02/2007
EXPIRES: 04/02/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 438 SCOTTS GLEN DR
ASSESSOR'S PARCEL NO.: 1703271304500
Springfield
TYPE OF WORK: Backflow Device
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Backflow device
Owner: SUNBURST CONTEMPORARY HOMES
Address: 1399 HWY 99 N
EUGENE OR 97402
Contractor Type
Landscape
I CONT-&o\C.~N.EORMAII~ ~ \.'@
~ ~~~ WiOO Oregon UtIIKv
Contractor ~Caltcr, Thbi!SltOlebm~>>Mmion Date
EUGENE LANDSCAP~}m~jft~@~~tl~ OAR es2.(JOOaIl2008
IBijft~i1pKi,~~A.~I=:O~
~"1Po.f!~~~~~ize:
Height OtSlriicture: Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
Phone
689-5455
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
VB
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Pave!!"p,!'9'e Rqd: . !;;ompact:
o~&l~~~verag,e.:.n. Q \DWl1\~ W ~ WOl'l"-
THIS PERMIT linHY> S -RMIT IS \130'\1'
~'lf-)='''''' IIMi\E:~ 1t1' 1"& ...
",~, . -."ff:.J'.!. - . "a.ll.l\\ng~v\l""
IrUDLI~ ' l ~ ~\=::,I
, Am 100 DAV . ~ Sidewalk Type:
DownspoutslDrains:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of2
.
_ITY OF SPRINt.t< IJ<..LD
Building/Combination Permit
PERMIT NO: COM2007-01494
ISSUED: 10/02/2007
APPLIED: 10/02/2007
EXPIRES: 04/02/2008
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Tntal Value nfProject
L.Fp.p.s P,'lid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Minimum/Adjustment Plumbing
Amount Paid Date Paid Receipt Number
$5.00 10/2107 1200700000000001264
$2.50 10/2/07 1200700000000001264
$4.00 10/2/07 1200700000000001264
$16.00 10/2107 1200700000000001264
$34.00 10/2107 1200700000000001264
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.
I UNI!. ired hSl)el~tinn. .
(illlr I 11flr r Irll flllllillii11W
Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 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 ofany structure without permission of the Community Services Division. Building Safety.
1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1
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.
S\l
/,,1- '2 ~O J
Owner or ctntractors Signature
Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726~3759 Phone
.~..
Wit- "
CiW Springfield Official Receipt
D~pment Services Department.
Public Works Department
Job/Journal Number
COM2007-0l494
COM2007-01494
COM2007-01494
COM2007-01494
COM2007-0 1494
Payments:
Type of Payment
Check
cReceiotl
RECEIPT #:
1200700000000001264
Date: 10/02/2007
Description
Backflow Device
Minimum/Adjustment Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
EUGENE LANDSCAPE AND
IRRIGATION
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
3855
In Person
Payment Total:
Pal(e I of I
I :54:23PM
Amount Due
16.00
34,00
2,50
4,00
5.00
$61.50
Amount Paid
$61.50
$61.50
1012/2007