HomeMy WebLinkAboutPermit Backflow Test 2001-5-1
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I Job# 01-00443-01 I
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Page 1 of 2
TRANS#:01-0005112
DATE:MAY 01 2001
AMT RECD:2 $ 16.50
CHANGE:
CASHIER:061
SPRINGFIELD
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CITY OF SPRINqFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00443-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
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location Of Proposed Site: 781
Assessors Map#: 17032343
lot: Block:
McKenzie Crest Dr Spr
Addition:
Tax lot #: 02000
Subdivision: River Glen
Owner:
Future B Inc
Po Box 7425
Phone Number: 541-744-2660
City/State/Zip: Eugene, OR 97401-0017
New Value: $0
Address:
Scope Of Work: Plumbing
backftow
Contractor Type
landscape
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 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 Plumbinll I
-After device is installed but before backfilling trench.
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. Feet)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Accessory Structure
Height (feet):
Proposed Units:1
Total:
Fee
Paid On Receipt#
Plumbinll
05/01/2001 5112
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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Job# 01-00443-01
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Page 2 of 2
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Plumbinll
05/01/2001 5112
05/01/2001 5112
05/01/2001 5112
1
$1.05
$10.00
$.45
$16.50
$16.50
State Surcharge - Plumbing
Backftow Prevention Device
Administrative Fee - Plumbing
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 herein 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. I further state that only contractors and employees who are in compliance with
ORS 701.05 will be used on this project. I further agree to ensure that all required inspections are
requeste the oper time and that the project address is readable from the street.
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Signsture
Date