HomeMy WebLinkAboutPermit Backflow Test 2000-12-13
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I Job# 00-01782-01 I
Page 1 of2
TRANS#:01-0004021
DATE:DEC 13 2000
AMT RECD:2 $ 16,50
CHANGE:
CASHIER: 061
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Job Number:-OO o+";,ef 61
CITY OF SPRINGFIELD, OREGON
225 North Fifth Street
Springfield, OR 97477
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 788 McKenzie Crest Dr Spr
Assessors Map#: 17032343
lot: Block: Addition:3rd
Tax lot #: 02102
Subdivision: River Glen
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Owner:
Future B Inc.
Po Box 7425
Address:
Scope Of Work: Backflow Device
backflow device
Phone Number: 541-744-2660
City/State/Zip: Eugene, OR 97401-0017
New Value: $0
Contractor Type
landscape
Contractor
Delta Landscape Irrigation Inc
Po Box 40217, Eugene, OR 97404
Phone
541-688-9144
Quad Area:
# Of Units:
Constr. Type: (VN) Wood Frame
Water Heater:
Registration #
119285
Expiration Date
1/6/2002
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 insRections requested before 7:00
a.m. will be made the same working day, inspections requested after 7-:oQT.I;1H.I~ill\lie'maa€ine'following you to
working day. follow rules adopted by the Oregon Utility
Notification Center. Thuse cules are set forth
Required Inspectiol]~ LJ1\t1 ::Iot:-uu I-UU lumrullgnu~t1 ~::>~-UU1-
I Plumbing OU~O. You may obtaill capias of the rules by
Backflow Device -After device is installed but before backfillin(jftiWricti~e c;entm. ,1'Jotd: tha telephone
nwnbdrforthe Oragon Utility Notification
C~i"tl..r if i -?"'. J-:1~:2.. ~844).
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
Fee
Minimum Plumbing Permit Fee
Accessory Structure
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: New SF - detacn,ebTICE:
Total: I THISPERMITSHALLEXPIREIFTHEWORK
ft""" .".....___..."_ ___
Paid On Receipt#.1MENLVll!u~!q~~!1!jtymnl\lI:If!l,e;~_mo~nt
Plumbing ANY 180bAYPERIOD.
12/13/2000 4021 $5.00
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Job# 00-01782.01 I
Page 2 of2
Fee
Paid On Receipt# Value/Quantity
Plumbing 1
12/13/2000 4021
12/13/2000 4021 1
12/13/2000 4021
Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
$1.05
$10.00
$.45
$16.50
$16,50
By signing this permiVapplication, I agree to call for an inspection once the backflow prevention
aV' ha.s been installed and is visible for inspection (726-3769). I also state that all information on
t . pe mit application is true and correct.
ty'4 j7...-7 / Z rf. l' -&C?
Signature / I / Date
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DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
JOB LOCATION: 7-t7f 1I'Y\rY../l'/?,'C- /Y'r-jT (7L
ASSESSORS HAP #:
OYNER: Q,L~ I .,..~I", uJ
ADDRESS: tlfJ< n' ,,~,-f'/ t7l7fJ-.
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CITY: EVf~ STATE:
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TAX LOT #:
PHONE #:.izjfb -:4f7 ~
I9L ZIP: 4 ?Z/t::J5'
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BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + .45 (ADMIN. FEE) = $16.50
CONTRACTOR: 0'-1_"'''4 /..ftN(}~ftI'E
ADDRESS: "C't./I!_lL<J P'O Pvrl< tlt'J:?-/?
CITY: r::::. v5~ Y'-C STATE: Ct;1!...
CONSTRUCTION CONTRACTORS REGISTRATION #: IIL.t-It:J
PHONE #: !_?~ "''YJt/Cj
ZIP: ~ 72.JtY/'
EXPIRES: //- ~ZotJl (
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTIO~ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION -.
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT. .
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SIGNAl:9RE /
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DATE
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FOR OFFICE USE
DATE OF APPLICATION:
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JOB #: Do- 017 8'Z-o I
RECEIPT #:
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ISSUED BY:
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TOTAL AMOUNT COLLECTED: