HomeMy WebLinkAboutPermit Backflow Test 2008-5-7
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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
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.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