HomeMy WebLinkAboutPermit Plumbing 2000-10-30 (2)
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SPRalELD
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
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: IL\85 G.t~~ ~tlld
ASSESSORS HAP fI:
OIlNER: ,C\p lC'.f _L . ~ iYl.9..C>
ADDRESS:;q l3 75 "tn bv ~ 2d
CITY: F.l '5 -f' [)P.
TAX LOT #: - -
PHONE fI: -34lj -30 7L
STATE: () Q ZIP:Q7t../c8 '
BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) +.4SJ;(ADMIN. FEE) = $16.50
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CONTRACTOR: '(.]).1\ -l~, fJ/ 4.. _ HORI"~_ HA.Ll J::',,_
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ADDRESS: .YlJ ,PYrX l/2()40 A'P.HONErvi'::al!i!fF~..z'3) Il-tcWO '
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CONSTRUCTION CONTRACTORS REGISTRATION fI: I/J~ EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV 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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FOR OFFICE USE
ISSUED BY:
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JOB fI: OO-OI()OJ...~O/
DATE OF APPLICATION:
RECEIPT fI:
TOTAL AMOUNT COLLECTED:
16<50,DO
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Job# 00-01602-01
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Page 1 of2
TRANS#:01-0003644
DATE:QCT 30 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 059
INDUSTRIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01602-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1485 Glenwood Blvd Spr
Assessors Map#: 17033432
Lot: Block: Addition:
Tax Lot #: 00600
Subdivision:
Owner:
Address:
Masons Supply Company
1485 Glenwood Blvd
Phone Number: 541-744-6696
Scope Of Work: Backflow Device
City/State/Zip:
New
Eugene, OR
Value: $0
Contractor Type
Plumbing Contr
Contractor
Kent Oakley
PO BOx 42046, Eugene, OR
Registration # Expiration Date
Phone
541-461-4375
Quad Area:
# Of Units:
Constr, Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
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:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq, Feet)
1 Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Plumbing
10/30/2000 3644
ValuelQuantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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Job# 00-01602-01
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Page 2 of2
Value/Quantity Fee Amount
I
.
.'
Fee
Paid On Receipt#
Plumbing
10/30/2000 3644
10/30/2000 3644
10/30/2000 3644
1
$1.05
$10.00
$.45
$16.50
$16.50
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
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 permit application is true and correct.
Signature
Date
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