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HomeMy WebLinkAboutPermit Plumbing 2001-12-19Job# 01-01402-01 RES!DENTIAL PERMIT Gity Of Springfield Community Services Division Building Safety Page 1 of2 SPRINGFIELD ntli t\h,[i{ililGE : $ nAall if fF! irnLJl:iL!\ 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 2680 Viewmont Ave Spr AssessorsMap#: 17032441 Lot: Block: Addition: Job Number: 01 -01402-01 Office:726-3759 lnspection Line: 726-3769 Tax Lot#: 00113 Subdivision: ctTY oF SPRfiNGFIELq OREGON Owner: Don Gray Address: 2680 Viewmont Ave Scope Of Work: Backflow Device Phone Number: City/State/Zip: New 541-741-2988 Springfield, OR97477 Value: $0 Contractor Type Landscape Backflow device Contractor SCHELSKY'S P.O. BOX 7945, EUGENE, OR 97401 iration Date Phone Quad Area: # Of Units: Constr. Type: Water Heater: # Of Buildings: Occupancy Group: Heat Source: Sq. To request an inspection call the 24 hour recording at726-3769. All inspections a.m. will be made the same working day, inspections requested after 7:00 a.m working day. Required lnspections Plumbin Backflow Device -After device is installed but before Construction Types: Occupancy Groups: 7:00 following # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq. Main: # Of Stories: Current Units: Gensus Code: Does not apply Total: its: Accessory: Fee Paid On Receipt# Value/Quantity Fee Amount Plumbing Minimum Plumbing Permit Fee 1211912001 7570 $31.00 {r^ ,'y-'ot .il,' Land Range: (feet): Job# 01-01402-01 Page 2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount State Surcharge - Plumbing Backfl ow Prevention Device Administrative Fee - Plumbing Total Plumbing 1211912001 12t19t2001 12t19t2001 7570 7570 7570 1 $3.15 $14.00 $3.60 $51.75 Grand Total By signing this device has this Signature correct. once the backflow prevention I also state that all information on $51.75 ol is / Date sP'T'NGFIELt, LIHAIJEI i l! I 'tl.j r-rn'J BACKFL OW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD C OMMI.INITY S ERVICES DTVIS ION . BIJILDING SAFETY 225 Fifth Street Springfield, Oregon 97 477 Office: 726-3759 INSPECTION LINE: 726-37 69 Joblocation, L6@ Q.'-q*o,.l frV{ Assessors Map *: | 7 03 Zx ct ( ,,,r Lo#:71 Ot t 3 =pfd State: O,< .7 tt/z I BACKFLOW PERMIT(!.-U]".]J Gu"tirdes Permit Fee, State Surcharge & Administrative Fee) Scr 5../, Q o, 6-* 7?4f Phone#7L/4-7/3 s Ciry: Ewor.-r starc: C"1 zip: f ?+o t' Construction Contadors Registration# :433 o By signing this permit/application, I agree to call for an inspeclion once the backflow prevention device has been installed and is visible for inspection (726-3769). I also state that all information on ttris permit/application is correct. iz Signature Date FOR OFFICE USE Conaacbr: Address: Z /?2CJO t Job a.,+.o/-o)t(oz*olDate of Checked for Delinquencies VALIDATION: Checked for Historical Status: :Ui JOI.r {, I Address: ZGYO v'-'-**trnf Pnone*: 77-6-7/77