HomeMy WebLinkAboutPermit Backflow Test 2000-10-19
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I Job# 00-01565-01 I
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Page 1 of2
TRANS#:01-0003527
DATE:OCT 19 2000 i
AMT RECD:2 $ 22.00 '
CHANGE:
CASHIER:059
CITY OF SPRINGFIELD, OREGON
225 North Fifth Slreel
Springfield. OR 97477
Location Of Proposed Site: 4223
Assessors Map#: 17023232
Lot: Block:
Owner:
Address:
Rick Burns
4223 Main Street
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01565-01
Office: 726-3759
Inspection Line: 726-3769
Main St
Spr
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Addition:
Tax Lot #:
Subdivision:
01900
Phone Number:
City/State/Zip:
New
Springfield, OR 97478
Value: $0
Scope Of Work: Backflow Device
Closest address to backflow devices
Contractor Type
Plumbing Contr
Registration # Expiration Date
Contractor
right-way plumbing
po box 70526. eugene, OR 97401
Phone
541-484-3787
Office Use
Quad Area: Land Use: # Of Buildings:
. '" It" .
# Of Units: ZOning Code: fO/lo \ . 'l-,\ Occupancy Group:
VV rUI ~ ,,-
Constr. Type: Bedrooms: 'Votir;c e~ a(fOOt~' O'i H!lat Source:
Water Heater: Range: ::: OAR ~'g~' E,entel ~~~!' thtS8~J~::O~~g!l;L
-V<;IU, Yn" . -vl-U070t;;-" fUleSi'!" .. Vl/llty
To request an inspection call the 24 hour recording at 726i,~.~8~.';IiIlHn~p',%\i9.rfS'ir~qUS}.l~~~ef6[~1?:00
a.m. will be made the same working day, inspections requ,l(,l!,1rd"after';?'i9P a.m?iwill)?~made).th~l!91!owing
working day. ,..'or the Ore'"Vote: the t ,Inl!'! rUles b\,
,,~.~... '9on U'I'I't e ephon Y
R . dl t" .,""- (,IlIA,... A
eqUlre nspec Ions '. 'I?? '-""Cat'
-??AA IOn
I Plumbing I .....).
Backflow Device -After device is installed but before backfilling trench.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
L Main: Accessory:
Fee
Minimum Plumbing Permit Fee
NOTICE_
iHIS PE -
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# Of.~tories;IZt:D ,.,LL t:XPI,~!ight (feet):
curfent, .Units:,~ UNDER 7iL'/SPrlf=posed,Units:
"~""~fl q 'p . "vHK
Cen'sus ;Code: DotG'nbl aRply 't:Rfvl/i IS.,
"V UA V Or-- '. ''-O''''IDO.'<- '.Or
-qlD\). "cDFOR
Total: I
Paid On Receipt#
Plumbing
10/19/2000 3527
Value/Quantity
Fee Amount
$,00
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Job# 00-01565-01
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Page 2 of2
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Paid On Receipt#
Plumbing
10/19/2000 3527
10/19/2000 3527
10/19/2000 3527
Value/Quantity
I
Fee Amount
Fee
State Surcharge For Plumbing Permit
Backftow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signing Ihis permiVapplication. I agree to call for an inspection once the backftow prevention
device has been installed and is visible for inspection (726-3769). I also state that all information on
this permit application is true and correct.
~ ~rC-.P t'O-,LC;-.d8i
Signature Date
2
$1.40
$20,00
$,60
$22.00
$22.00