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HomeMy WebLinkAboutPermit Backflow Test 2008-5-7 '. 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line SCANNED a:ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00642 ISSUED: 05/07/2008 APPLIED: 05/07/2008 EXPIRES: 1110712008 VALUE: Status Issued SITE ADDRESS: 1595 RAMBLING DR ASSESSOR'S PARCEL NO,: 1703252209400 Springfield TYPE OF WORK: Backnow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backnow device Owner: RICHARD J MASER TRUST Address: 1595 RAMBLING DR SPRINGFIELD OR 97477 Contractor Type Landscape I CONTRACTOR INFORMATION' Contractor License ScHELSKYS LANDSCAPE AND 1RRIGATI 12170 BUILDING INFORMATION' Expiration Date 08/31/2008 Phone 541-744-7135 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft OCher: Occupant Load: R-3 nla I DEVELOPMENT INFORMATION , Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: ATTENTION: Oregon law requires you,to Notes: follow rules adopted by the Oregon Utility NnTIr.E: 'I' .,~--,,-- I"onlor T~,nse rules are set forth THIS PERMIT SHALL tXt"IKt 1r 1m: "L~~ ('6AfJ952_001-0010througl1UAHl:IO~-VUI. AUTHORIZED UNDER THIS PERMIT IS ~1\J~:tjon Descrio2ion lieu may obtain cepi~s of the rules blf COMMENCED OR IS ABANDONED FOR $ P S F S calli(lg the center. (Notei.l.he ~~~~~~:R DeAYW'~f>'lJ DAY If~P'Il(9rx::onstruction or ':~lti~li:r o~WJhf~~;::: ~~~g~;~). Date Calculated Pa2e 1 of 2 . .ITY OF ~rKll'l\.>t<lJ'.LD Building/Combination Permit PERMIT NO: COM2008-00642 ISSUED: 05/07/2008 APPLIED: 05/07/2008 EXPIRES: 1110712008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Backtlow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt N umher $5.00 $6.00 $2.50 $16,00 $34.00 5/7/08 5/7/08 5/7/08 5/7/08 5/7/08 2200800000000000609 2200800000000000609 2200800000000000609 2200800000000000609 2200800000000000609 Total Amount Paid $63.50 , 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. L.~,r.i~llim~ Ul'rtions I Backtlow Device: Prior to covering and provide a copy ofthe 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 he 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 furtber 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 ti~r1q)~::ction, ~___. ~/7/0g< r- ---- Owner or Contractors Signature '" -::> Date Paee 2 of 2