HomeMy WebLinkAboutPermit Backflow Test 2000-6-9
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I Job# 00-00914-01 I
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TRANS#:01-0002098
DATE:JUN 09 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
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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
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Job# 00-00914-01
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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
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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 #:
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RECEIPT ~: ISSUED BY: ..... 35 ii:
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TOTAL AMOUNT COLLECTED: n 9 c..:. '!'!'
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