HomeMy WebLinkAboutPermit Backflow Test 2001-8-6
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I Job# 01-00839-01 I
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COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of2
TRANS#:01-0006362
DATE:AUG 06 2001
AMT REeD:l $ 100.00
CHANGE:$ 48.25
CASHIER:003
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CITY OF SPRINGFIELD, OREGON
Job Number: 01-00839-01
225 North Fifth Street
Springfield. OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 5292 Main St Spr
Assessors Map#: 17023331
Lot: Block: Addition:
Tax Lot #: 06200
Subdivision:
Owner:
Frank J Walters-c/o Bell RE
630 River Road
Phone Number: 541-688-2060
City/State/Zip: Eaugene, OR 97403
New Value: $0
Address:
Scope Of Work: Plumbing
Installing back flow device
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
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.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
iArea (Sq. Feet)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
PlumbinQ
08/06/2001 6362
08/06/2001 6362
08/06/2001 6362
08/06/2001 6362
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
1
$31.00
$3.15
$14.00
$3.60
$51.75
$51.75
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I Job# 01-00839-01 I Page 2 of 2
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 7 .055 will be used on this ~oject. I further agree to ensure that all required inspections are
reque at the pro .~"r ~nd th t the project address is readable from the street.
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Signalure
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