HomeMy WebLinkAboutPermit Backflow Test 2000-7-18
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SPRINGFIELD
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION ~
225 FIFTH STREET OFFICE: 726-3759 "
SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769
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" ASSESSORS MAP 1I: ) 70 J Z J L( <-
OVNER: ~ l\\t;tl( r/hMIf
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TAX LOT 1I:
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CITY:
STATE:
PHONE 1I:
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ZIP:
ADDRESS:
BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: fti.o:D!-i\ QJ~I:J ~12i gfrflfJtV
ADDRESS: ~ -q~ H~p . PHONE 1I:_fA?fi.- tal
CITY: f) 7~ J . . STATE: fJtJ ZIP: q0Lp7."....
CONSTRUCTION CONTRACTORS REGISTRATION 1I: \ 7..Z-.f;2, EXPIRES: Z - z.J?..-(j I
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV 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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SIGNATURE
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FOR OFFICE USE
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RECEIPT 1I:
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ISSUED BY:
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DATE OF APPLICATION:
TOTAL AMOUNT COLLECTED:
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I Job# 00-01118-01 I
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Page 1 of 2
TRANS#:01-0002608
DATE:JUL 18 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01118-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 862 Mckenzie Crest Dr Spr
Assessors Map#: 17032343
Lot: Block: Addition: 2nd
Tax Lot #: 05800
Subdivision: River Glen
Owner:
Rodney Chase
708 blackstone st
Phone Number: 541-746-6973
City/StatelZip: springfield, OR 97478
New Value: $0
Address:
Scope Of Work: Backflow Device
backflow
Contractor Type
Landscape
Contractor
Hidden rivers irrigation
3487 hawthorne, eugene, OR 97402
Registration # Expiration Date
Phone
541-688-1131
Office Use ATfb\i I !UI~:UI d<i"! .a.i ":;Cjulre,} j.Ju h.
Land Use: follow ru'e:#;OfIBuildlngs:; r.r::por Utility
Zoning Code: Not'fi,:" 'Oi::i::~paiti:y Gro~p: DweiliMg>"\i,
Bedrooms: 'n 0,..,-, <.~.:- Heat-Source: '.. d,",.; ...~-\]iJi'
0090 Y'lll r~\1 ro"''''' I -". ." 0 ,.. '1,'05 b)
Range: . -, Sq. Footage':' '",,~,
...~:Ii.... . ..H' ... '",.:"\~1e
. ""mhp-rlor l'h-~ () ',~C1fl:1 Uii:i;". l\'otificatior.
To request an inspection call the 24 hour recording at 726-3769. All inspeclions requestea before.7:00,.",)
a.m. will be made the same working day, inspections requested after 7:00 a.m. ~iIFbir;nade Hie 'foilowiri'g' .
working day.
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
Backflow Device
Required Inspections
I Plumbing I
-After device is installed but before backfilling trench.
Construction Types:(VN) Wood Frame
Occupancy Groups:Dwelli[lg
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
rArea (Sq. Feet)
Main: Accessory:
Store
NOTICE:
THIS PERMIT SHALL EXPIRE IFTHE WORK
AUTHOR/ZED UNDER THIS PERMIT IS NOT
H7R~A~~~~~D OR /S ABANDONED FOR
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ProposedIUmts:1' . .
-
# Of Stories:
Current Units:
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Plumbing
07/18/2000 2608
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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Job# 00-01118-01 I
Paid On Receipt#
Plumbing
07/18/2000 2608
07/18/2000 2608
07/18/2000 2608
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Page 2 of 2
Value/Quantity Fee Amount
I
Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
1
$1.05
$10.00
$.45
$16.50
$16.50
By signing this permiVapplication, 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
thisper~Cr~is~ ~---l&-w
Signature Date