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HomeMy WebLinkAboutPermit Backflow Test 2004-5-26 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspeetion Line . _ CITY OF ~rKll'\juJ'1l!,LU Building/Combination Permit PERMIT NO: COM2004-00625 ISSUED: OS/26/2004 APPLIED: OS/26/2004 EXPIRES: 11/26/2004 VALUE: SITE ADDRESS: 2171 RANCH CORRAL DR ASSESSOR'S PARCEL NO.: 1703244305400 Springfield TYPE OF WORK: Baekflow Deviee PROJECT DESCRIPTION: Backflow TYPE OF USE: New Residential Owner: JEAN S FOSTER LIVING TRUST Address: 2412 RANCH DR SPRINGFIELD OR 97477 I CONTRA'-luluNFORMATION I Contractor License SCHELSKYS LANDSCAPE AND IRRIGATI 006330 BUILDING INFORMA nON I Contractor Type Landseape # of Units: Primary Oceupaney Group: Secondary Oeeupaney Group: Primary Construetion Type Secondary Construction Type: # of Bedrooms: Frontyard Setbaek: Side 1 Setbaek: Side 2 Setbaek: Rearyard Setbaek: Solar Setbaeks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Deseription Type of Construction Expiration Date 02/2812005 Phone 541-744-7135 R-3 # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: ~~.ft 2nd Floor: A'rrl~'1~m:, Oregon law requIres yo 1'/,j<t Basement: f~'b~~~Ji~J!,e.!.dopted by the Oregon ~'ilt...Garage/carport Ener~ath:nter Those rules are ses l'Other: N('s~fi~" ~d -'1~~!.I~:0 throughtGAR 95e -ant Load: In OA.K ::>" uu . _ _ _, .h.o. rlIIQ~ b _ _ "--- _';1":""_'" '-h."_'__ I DEVEEOPMENTlNEORMAiJ:ii:>N-ha telephone , II'.' ,,1 'f' tion '"~.... '" . unty Noli lea REQUIRED PARKING umber for the Oregon II 8verlaYIY~\ler is 1-80Q-332-2344). # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: VN Total: , Handieapped: Compaet: I PUBLIC IMPROVEMENTS I Sidewalk Type: MOTICE: l EXPIREIlp"ml!ot#lJ)'Mins: THIS PER~i~ ~~~~R THIS PERMIT IS NOT ~~~~~~CED OR IS ABANDONED FOR _::'1 n'3 ,;^V DIORIO\). I Valuation DescriDtion I $ Per Sq Ft Square Footage or multiplier or Bid Amount Value Date Caleulated Total Value of Projeet Paee I of2 . _ CITY OF .snul'l'-..1<IELD Building/Combination Permit PERMIT NO: COM2004-00625 ISSUED: OS/26/2004 APPLIED: OS/26/2004 EXPIRES: 11/26/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspeetion Line I FI'I'~ I:lWU Fee Deseription + 10% Administrative Fee + 7% State Sureharge Baekflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $3.15 $14,00 $31.00 5/26/04 5/26/04 5/26/04 5/26/04 1200400000000000812 1200400000000000812 1200400000000000812 1200400000000000812 Total Amount Paid $52.65 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. I Rl'ouirl'rl Ul'dions. I BaekOow Deviee: Prior to eoverlng and provide a eopy of the test report on site at the time of inspection, By signature, I state and agree, tbat I have carefully examined the eompleted applieation and do hereby eertify that all information hereon is true and eorreet, and I further certify that any and all work performed shall be done in aecordance with the Ordlnanees of the City of Springfield and the Laws of the State of Oregon pertaining to the work deseribed herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Serviees Division, Building Safety. I further certify that only contractors and employees who are in eomplianee with ORS 701.005 will be used on this projeet, I further agree to ensure that all required inspections are requested at the proper time, that eaeh address is readable from the ~~2>>}; 2~'''''''.' ,..~,.. u, "..w....J..j~m.... <>....,.. ~ Owner or Contraetors Signature / Date Pa~e 2 of2 225 Fifth Street . , Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00625 COM2004-00625 COM2004-00625 COM2004-00625 Payments: Type of Payment CreditCard 5/26/2004 . RECEIPT #: ."~_~I""!!!~,,~' _. - ,,'. ~, ~.; ~ of Springfield Official Receipt ""elopment Services Department Public Works Department 1200400000000000812 Date: OS/26/2004 Description + 7% State Surcharge + 10% Administrative Fee Baekflow Deviee Minimum! Adjustment Plumbing Paid By MARK SCHELSKY lIem Total: Check Number Authorization ReceIved By Batcb Number Number How Received djb 000394 844203 In Person Payment Total: Page I of I 1:38:15PM Amount Due 3,15 4,50 14,00 31.00 $52.65 Amount Paid $52,65 $52.65