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HomeMy WebLinkAboutPermit Backflow Test 2001-5-1 ci' '" . I Job# 01-00443-01 I e. Page 1 of 2 TRANS#:01-0005112 DATE:MAY 01 2001 AMT RECD:2 $ 16.50 CHANGE: CASHIER:061 SPRINGFIELD ~. \ , 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 ~ , 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 ~ .... e Job# 01-00443-01 e 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. ~ J:;.-/-~ / Signsture Date