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HomeMy WebLinkAboutPermit Plumbing 2000-10-30 (2) ., . 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 -------------------------------------------------------------------------------- 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 /J-tIS Pt, ... C:: \ I rv... \, ^ A.U" AMI1 S CONTRACTOR: '(.]).1\ -l~, fJ/ 4.. _ HORI"~_ HA.Ll J::',,_ () --.) vU/,ll11/t; -~'-' Y/'iJr;- .. ''fC:,~ ADDRESS: .YlJ ,PYrX l/2()40 A'P.HONErvi'::al!i!fF~..z'3) Il-tcWO ' , I . 'tJODAy "Q8AM), ....7/'l/,j'j 1=I,( CITY: f~ )t,-Pf\Q., STATE: OC PtAlorZIP:'1:;7.fltJ,...Z~IVO~ 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. ,_. ' "" _.~ . -I lJu _ --reO '''"" "t 'ule o"Url'I' ''1 6.. I, ---"" ,...I"UfT" ~'€'s~' .. , -"",- .""'O/lD "lfO" "'- ,~OD'I'1< ,.,....952 \/"1 ')1 fhrc ' '00 I. ..,/t;.,.tZ-iJl,;-;:m&s b" DATE'" 'I .,":"u/le OtJfJc"'t. "., <<Ion FOR OFFICE USE ISSUED BY: If). ~6 C-t ) ..A. JOB fI: OO-OI()OJ...~O/ DATE OF APPLICATION: RECEIPT fI: TOTAL AMOUNT COLLECTED: 16<50,DO . Job# 00-01602-01 . 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 ~ . Job# 00-01602-01 . 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 ~