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HomeMy WebLinkAboutPermit Backflow Test 2000-6-9 ... ....\' . I Job# 00-00914-01 I .,- " Page 1 of2 TRANS#:01-0002098 DATE:JUN 09 2000 AMT RECD:2 $ 16.50 CHANGE: CASHIER: 061 , CITY OF SPRINqFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-00914-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 ~~~~:"L~;,:~::769 . Location Of Proposed Site: 757 Mckenzie Crest Dr Spr Assessors Map#: 17032343 Lot: Block: Addition: 3 Owner: Future B Homes Phone Number: 541-744-2660 City/State/Zip: Eugene, OR 97401 New Value: $0 Address: P,O. Box 7425 Scope Of Work: Single Family Residence backflow device install Contractor Type Plumbing Contr Contractor Hunter Irrigation and landscape 25226 Strawberry lane, Veneta, OR 97487 Registration # Expiration Date Phone Quad Area: # Of Units: Constr. Type: Water Heater: 1 (VN) Wood Frame Office Use land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Dwelling Heat Source: Sq. Footage: To request an inspection call the 24 hour recording at 726-3769. All ins~C:tiQr\Cr.e.quested before 7:00 a.mk. .willdbe made the same working day, inspections requested after 7:0A,'6npE'A\I).jl~8..t~7.:~~in!1HEWORK wor mg ay, AUTHORIZED UNDER THIS PERMIT IS NOT Required Inspections COMMENCt:LJ UH I::; AtlAI~UUI~t:U r-un I Plumbin!! I ANY 180 DAY PERIOD. Backflow Device -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) I Main: Accessory: Store # Of Stories: .i 'Height (feet)':'.... .,' ,'"c '-. ; "., C t U 'ts follo'p" ro II0C "~d^Unt'1tsd "lv the OrsClon Utili! . urren m : ropose . m: I' r"' ,~, fO' IntifiC?tlfJ:1 t~enil7r I nOSf fll as .-1 _ ,.0' - Census Code: Does not !!~~~R 8ti2-00"-llLl'Ill ''',Guy,; Uf..\,';02-UO' I 0090. You mal.' obtain copies at the ;ules b Total: callinu the canter. (Nota: thp 1~'I:'j.l:l0i1e ... . ...... ... ,.,t, _ _..~__ Fee Paid On Receipt#I"''''~:''Vah:'e/Q'i1aiitltY'',14\. Fee Amount I Plumbin!! 06/09/2000 2098 $5.00 Minimum Plumbing Permit Fee , , . Job# 00-00914-01 . Page 2 of 2 Value/Quantity Fee Amount Fee Paid On Receipt# Plumbin!! 06/09/2000 2098 06/09/2000 2098 06/09/2000 2098 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 signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Signature Date . :, . . BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 06-oo9fL(-01 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 JOB LOCATION: "2r? nr.",~_,....,!.,. C~~.s-;-- ASSESSORS MAP ~: TAX LOT ~: OWNER: IdA }--r:<,~ J-JAu..L2--<- ADDRESS: 7<.J"? h-\-G~..r:%__ cA'''S''7'''''' PHONE ~: 73'~- J"u-'7 ~ CITY: sp/f':",r, ..f,,"~ STATE: ,<:')/f. ZIP: 9?~?" BACKFLOW PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CONTRACTOR: .J-JW_^,7i."< -;r/~<:~-:., ./ k~u~ ?-""c, ADDRESS: o <-:I....2-/' <>r~~~A,/ 2",/ PHONE~: 9. 7,r-3':v..$- CITY: J/--C~/_7A- STATE: 6JrP ZIP: ~7Y.r:? CONSTRUCTION CONTRACTORS REGISTRATION ~: ) J ,77 '? EXPIRES: _Y -.Y&_ t:'1 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 PERMIT/APPLICATION IS CORRECT. 1L2 b-J- ,(>&J DATE FOR OFFICE USE DATE OF APPLICATION: JOB #: ~ ..... RECEIPT ~: ISSUED BY: ..... 35 ii: :::0..... ::z mmCl) TOTAL AMOUNT COLLECTED: n 9 c..:. '!'!' D ..C::O' en "':z::....... -----------------------------------------------------------------------------~~iRO~ rT'1::I: ....co :;:OD...... 0: .. Zo--tVt'\J 001. 00 0-- m U'1 C:hO .........ooco