HomeMy WebLinkAboutPermit Plumbing 2001-4-30
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I Job# 01-00437-01 I
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Page 1 of 2
TRANS#:01-0005094
DATE: APR 30 2001
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
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SPRINGPIELD
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CITY OF SPRINqFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00437-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 6947 Glacier Dr Spr
Assessors Map#: 18020222
Lot: Block: Addition:
Tax Lot #: 05100
Subdivision:
Owner:
Wolfgang Langholz
6947 Glacier Dr
Phone Number: 541- -
City/State/Zip: Springfield, OR 97478
New Value: $0
Address:
Scope Of Work: Backflow Device
backflow device
Contractor Type
Plumbing Contr
Contractor
Harris Irrigation
po box 1297, Springfield, OR 97477
Registration # Expiration Date
Phone
541-746-6444
Office Use
Land Use: # Of Buildings:
Zoning Code: Occupancy Group:
Bedrooms: Heat SDurce:
Range: ., "''''''1'1\\1 Sq. Footage:
" ~. "HALL E"'f'lfI~ Ir -;-;;;: ':J~R~
To request an inspection call the 24 hour recording at 726,3769. All inspections requested bef?{eI7':00IT IS NOT
a.m. will be made the same working day, inspections requested after k99 a,m, will b'eII11'a~ej ffi'e {olrowing OR
working day. , ,"" '-'''0 OR IS ABANDONED r
CO,""\~"""'-
Required InspectionsA~Yll\U u,,; ;-::-::":'''
I Plumbin~ I
-After device is installed but before backfilling trench,
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. Feet)
I Main: Accessory:
A:rTENTION:Oregon law requires you to
t d by the Oregon Utihty
follow ~ules adop eThose rules are set forth
" ,....--!,n" Center. 952 001
# Of Stories: H.eigl\t'(feet)2001,0010 through OAR ' -
. .n , lAM ;I::>.. . . f the rules by
Current Umts: ProposelllJUmts:obtain copies 0
OU;:lu. Iv '''~1 t I phone
Census Code: Does not apply calling the center. (Note: the e ~f ron
number for the Oregon Utility Notllca I
Center is 1,800,332,2344).
Total:
Fee
Paid On Receipt#
Plumbin~
04/30/2001 5094
Value/Quantity
I I
Fee Amount
Minimum Plumbing Permit Fee
$5,00
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Job# 01-00437 -01
Paid On Receipt#
Plumbin~
04/30/2001 5094
04/30/2001 5094
04/30/2001 5094
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Page 2 of 2
Fee
Value/Quantity
Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
1
$1,05
$10,00
$.45
$16.50
$16.50
By signing this permiVapplication, 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~application is true and correct.
rI Fl-At /I c/ 17 f2 /1f11 t.../ ~~OJ - 0 I
~atu're ~- ---, Date '
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SPRINGFIELD
BACKFLOV 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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JOB LOCATION: (OJ '-17 'f.,L.4fo 7---FJ< .PIt[; D./'J '
, ASSESSORS MAP I: /XOZ022Z- TAX LOT I: 05/60
OIINER: UJl)U:; -hANh L4A)(, J./-i)1-.1'
ADDRESS: ,-it ?-;''7'-17 e, CAr::z..~ ~~/} . PHONE I:
CITY: _S<.fJr::-J-n STATE: ZIP: c:yj Ln 'Y
BACKFLOV PERMIT IS $15.00 + 1. 05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.50
CONTRACTOR: f-!..4.f2~'2. '- .::z..0t?, '7J; 4T .::L7J ,J
ADDRESS: ,p'{J /2,7J'x /~q7
CITY: L <:::;;::JPLI1 STATE:
CONSTRUCTION CONTRACTORS REGISTRATION 1I: (oct ~:3
PHONE I: )"/ fa - (,.L/'-IV
ZIP: qrL(;1
EXPIRES: -S - "3) - ~
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR I~SPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS
CORRECT.
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(7 ~Itt/lsk O~/J>t./
SIGNATd1lli
~ -c-5(') - 0/
DA1'E
FOR OFFICE USE
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DATE OF APPLICATION: OcpY-:, JOB I: O/-DOCf"!, 7-0 I
RECEIPT 1I: S-o 9'( IS1:D BY: )P ~o;a
J:> J:>
;0 --l :z:
TOTAL AMOUNT COLLECTED: I t, ~ t!:J ':':l ~
1 0 OJ:>"
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