HomeMy WebLinkAboutPermit Plumbing 2002-7-29
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I Job# 02-00913-01 I
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TRANS#;Ol-G010080
DATE:JUL 29 2002
AMT RECD:2 $ 51:75
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CASHIEF: ~ 061
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
-Community Services Division
Building Safety
Job Number: 02-00913-01
225 Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4423 Camellia St Spr
Assessors Map#: 17023234
Lot: Block: Addition:
Tax Lot #: 04417
Subdivision:
Owner:
Darryl Hendron
4423 Camellia Street
Phone Number: 541-726-9071
City/State/Zip: Springfield, OR 97478
New Value: $0
Address:
Scope Of Work: Backflow Device
Install backflow device
Contractor Type
Landscape
Contractor
Decker landscape and irrigation
PO Box 87, Alvadore, OR 97409
Registration #
6746
Expiration Date
9/30/2002
Phone
541-688-7991
Office Use l\'\E ~Q~~
Quad Area: Land Use: ~01\t~... S\-\~\..\.. t~fl#P&I'lf\i~~a\
# Of Units: Zoning Code: 1\,\\5 ptRW\\1 \.\~OtR 1\'\\ic~: f~oup:
Constr. Type: Bedrooms: 1\\.\1\'\OR\1.t.OO QR\S M\t.M ource:
Water Heater: Range: COW\W\~~C~ PEi\\OU. Sq. Footage:
llN'I10\.J O{~
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
working day.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main:
Required Inspections
I Plumbing I law reqUires you. t.o
-After device is installed but before backfillingt!.~~rn0f.il.N:Oregodnb\1 the Oregon Utl"tyrt\
/4.' ' dopte' t to 1
tolloW rules a ih~se rules are set"J 0001 _
. center. OAR 95,-- ,
Notitica~~~_001_00~Othro~gh t the rules by
in ~~:YoU may obtain c~f~~~~ telep.ho~e
o ca\\~Qo. tbe center. (N Utility Not\i\cat\on
# Of Stories: f1~}!fnHf~regon -2344).
Current Units: num~ronn.~:ed :t.hlitSQO-332
\55f1\:-. ~
Census Code: Does not apply
Backflow Device
Accessory:
Total:
Fee
Paid On Receipt#
Plumbing
07/29/2002 10080
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$31.00
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1~'
,
Fee
Job# 02-00913-01
Paid On Receipt#
Plumbing
07/29/2002 10080
07/29/2002 10080
07/29/2002 10080
Page 2 of 2
Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
Grand,Total
$3.15
$14.00
$3.60
$51.75
$51.75
By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been installed and is visible for inspection (726~3769). I also state that all information on this
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TRANS#:; 01-{lO1.0080
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Am' F{ECD:; 2 $ .51. 75
CHANGE:
CASHIER:061
225 FIITH STREET. SPRINGFIELD, OR 97477 - PH:(541)7Z6-3753 - FAX: (541)726-3689
City Job Number 0 Z -00 9/3 -0 I
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Job Location
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Assessors Mar
j 702 '3 z '3 '--(
Tax Lot
OL('{/7
Owner \)O\r.r ~ \ t-\t.V\ Jf'O'"
Address Lf L{ ~ 3 ~ tJ\ e, \ \ \ '"
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BACKFLOW PERMI~51~des Permit Fee, State Surcharge & Administrative Fee)
Conuacwrlnformauon
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Contractor \. )tc~ ~~~sc- fL \- J.- r- ('\ ,t:A.hl)~V~ t'i;~~~ -Q~_
Address?D. 60"'-. "", ~ ,""\0 \\~~~~~~~ - 7~ ~ I
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Construction Contractors Registration # -1n I L{ ~f Expires ~ I-)O~
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible. for inspection (726-3769). I also state that all information on
this permit/application is correct.
Signature ~ /
--....- -
Date of Application
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Shared Drive (T:)lBuilding FonnslBackflow Preventionl-02,doc