HomeMy WebLinkAboutPermit Plumbing 2001-6-5
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BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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TAX LOT *: 0 Z 90-0
JOB LOCATION: /;)'17 e A-/JR-'L ~r
.' ASSESSORS MAP *: 170"3 '3 LfZ"3>
OWER: V d?i7~ 13:?,A ~ 1<-/
ADDRESS: 15LI?CA-wl1-L- <<'
CITY: -Sfr r~j:; / ---.U ()/L STATE:
BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.50
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CONTRACTOR: ~ ( k1?-
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STATE:
CONSTRUCTION CONTRACTORS REGISTRATION *:
PHONE *: 3 if / - '70 "0
tJf( ZIP: 97177
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PHONE *: .SZff -t::;e;g - -203;
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EXPIRES: Z. - Z <6 - e> 2-
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BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
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"51GNATURE ~
FOR OFFICE USE
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DATE
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DATE OF APPLICATION: .. . (;};{.., / 7:.. 0 /
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RECEIPT *:
ISSUED BY:
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TOTAL AMOUNT COLLECTED:
JOB #: O/-OOS/g--O J
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Job# 01-00598-01
Page 1 of 2
TRANS#:01-0005783
DATE:JUN 12 2001
AMT RECD:2 $ 16.50
CHANGE:
CASHIER:061
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00598-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1547 canal St Spr
Assessors Map#: 17033423
Lot: Block: Addition:
Tax Lot #: 02900
Subdivision: River Trails
Owner: John Bailey
Address: 2679 Sunnyview Lane .
Scope Of Work: Backflow Device
Phone Number: 541-687-2242
City/State/Zip: Eugene, OR 97405
New Value:
Backflow device
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00598-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1547
Assessors Map#: 17033423
Lot: Block:
canal St Spr
Owner:
Valerie Bailey.
1547 Canal St
Tax Lot #: 02900
Addition: l?.Un'Th~u9~ivision: River Trails
Phone Nu'~be'Ii:I~!54~'.:3'4~ /!3ID6-eXPIRE IF THE WORK
I' IIU ~ 1_.\ d\",.j~ I ...,..f -'" . ,
CitY/State~~!p.':rlOPS:pi:ii1gfier~f0Rl-!W47~HM1T IS NOT
New COMMENCECV~n.~~ AE'(d'.JDONED FOR
ANY 180 DAY PERIOD,
Address:
Scope Of Work: Backflow Device
Backflow device
Contractor Type
Plumbing Contr
Contractor Registration # Expiration Date
Star Landscape
93066 River Rd, Junction City, OR 97448
Phone
541-998-2039
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
.^:TTENTION:Oregon law requires you to
follow rules acnrtp.rl by tl:le Oregon Utility
N 'f' t' C # Of-BUlldmgs: re set forth
otl Ica Ion er leI. Illutit: II.:: ,t::d a
in OAR 952-001 ~Ct,C.'t~f.\!l9..YgB'3>~P.:9~W&ni.ng
0090. You may tJ~flJl,~Qy~~g3 of the rules by
calling the ce.~,g~lf~Q!c!g,e.he ,tel~~ho~e
numoer TOr me uregon UlIlIlY I\lUlIlllOi:1l1UII
Center is 1-800-332-2344).
~,
1
(VN) Wood Frame
I Job# 01-00598-01
Office Use
land Use:
Zoning Code:
Bedrooms:
Range:
Page 2 of 2
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
# Of Buildings:
Occupancy Group: Dwelling
Heat Source:
Sq. Footage:
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.
Backflow Device
Required Inspections
I Plumbing I
-After device is installed but before backfilling trench,
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
-Area (Sq. Feet)
Main: Accessory:
Accessory Structure
# Of Stories: Height (feet):
Current Units: Proposed Units:1
Census Code: New SF - attached
Total:
Fee
Paid On Receipt#
Plumbing
06/12/2001 5783
06/12/2001 5783
06/12/2001 5783
06/12/2001 5783
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
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/7~it_~. ~lic._at. /iO~ is>>u.e e ~ aodd correct.
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Signature Date
1
$5.00
$1,05
$10.00
$.45
$16.50
$16.50