HomeMy WebLinkAboutPermit Backflow Test 2006-10-23
."
-Wi"
.
.ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01363
ISSUED: 10/23/2006
APPLIED: 10/23/2006
EXPIRES: 04/23/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3220 RALEIGHWOOD AVE
ASSESSOR'S PARCEL NO.: 1703221318400
Springfield TYPE OF WORK: Backflow Device
TYPE OF USE: New
PROJECT DESCRIPTION: Backflow
Owner: CUSHMAN SUZANNE & MARK A
Address: PO BOX 1514
SPRINGFIELD OR 97477
Contractor Type
Plnmbing
I CONTRACTOR INFORMATION I
Contractor License
DECKER LANDSCAPING & IRRIGATION
BUILDING INFORMATION I
Expiration Date Phone
541-688-7991
# of Units:
Primary Occupancy Group:
Secondary Occupancy 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 I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
AI I 1:1\1 I IUN:Uregon law R.~Q!;I!I!JYQl!'l\.RKING
Fr~~~If~~tback: RE IF THE WORK Overlay Dist: follow rules adopted by thif~iil1gon Utility
Si~IS.tt1l~MIT SHALL EXPI IS NOT # Street Trees R9a,tification Center. Those rHundiC'iippeti:fOrtt
Si~~1\qt\')l.~~ED UNDER THIS PERMIT Paved Drive Rqd: OAR 952-001-0010 thrOULGbmpuCl952-001
RetQ;u!!^~ett'l..C/l:OR IS ABANDONED FOR % of Lot Coveruge:JO. You may obtain copies of the rules b~
SOI~~WI~~~~AY PERIOD, caHing !hecen~er. (Note:.t~e teleehone
................. ...... ...... _....~""'.. .........1 ,......u................"
I PUBLIC IMPROVEMENTS. Center is 1-800-332-2344). '
Street Improvements: Sidewalk Type:
Storm Sewer Available:
Special Instruction:
DownspoutslDruins:
Notes:
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e I of2
.
aITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-01363
ISSUED: 10/23/2006
APPLIED: 10/23/2006
EXPIRES: 04/23/2007
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
F..... p"uu
$4.50
$2,25
$3.60
$14.00
$31.00
1 0/23/06
1 0123/06
10/23/06
10/23/06
10/23/06
Receipt Number
2200600000000001479
2200600000000001479
2200600000000001479
2200600000000001479
2200600000000001479
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Miscellaneous Plumbing
Amount Paid
Date Paid
Total Amount Paid
$55.35
I 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.
IR..n~l~
Backflow Device: Prior to covering and provide a copy of the test report 00 site at the time of inspection.
Fiual Plumbing: When all plumbing work is complete.
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 descrihed 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.
c;?& ~~??
Owner or Contractors Signature
$- :;;-3- Cl b
Date
Paee 2 of 2