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HomeMy WebLinkAboutPermit Backflow Test 2001-5-17 . . (. I Job# 01-00503-01 I Page 1 of2 TRANS#:01-0005416 DATE:11AY 17 2001 AMT RECD:2 $ 16.50 CHANGE: CASHIER: 061 .v CITY OF SPRINGFIELD, OREGON COMMERCIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00503-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 3444 main Sl Spr Assessors Map#: 17023131 Lot: Block: Addition: Tax Lot #: 00800 Subdivision: * r '" Owner: Steve Thomsen 3444 Main Slreet Phone Number: City/State/Zip: Springfield, OR New Value: $0 Address: Scope Of Work: Backflow Device backflow Contractor Type Plumbing Contr Contractor Twin Rivers Plumbing Inc 1525 Irving Rd, Eugene, OR 97404 Registration # 17695 Expiration Date 6/1/2002 Phone 541-688-1444 Office Use Land Use: # Of Buildings: Zoning Code: Occupancy Group: Bedrooms: ATTENTION:Oregon law rE.Ij~i!t~5>>.!!!<;~: Range: follow rules adopled by the ~~,IfL~9!!19";' Notification Center. I nose rUlas are S81 lOHlI To request an inspeclion call the 24 hour recording al:ir.~.:.~?9!!2~I~i.n~p'e<;ti9nslr~questedJbef6r'e'7:00 a.m. will be made the same working day, inspeclions (,evlW9.s\E1.<L'lf1!!.'i 76Q9..l~;'1]o~iULblllrnadeJhe. fojlowing working day. calling the center. (Note: lhe telephone R . tlr.I,'",hor It"r th'l Orpnnn Iltililv Notification equlre nspec Ions.' 1 800 3r.2 2344) t~,o,n',o,rl~ - - v - . I Plumbinll I -After device is inslalled but before backfilling trench. Quad Area: # Of Units: Constr. Type: Water Heater: Backflow Device Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 iArea (Sq. Feet) I Main: Accessory: # Of Stories: NOTICE: Height (feet): Current Units: THIS PERMITPtWo~e'it'<iimG!F THE WORK Census Code: DO~\J1!=!tll!Ppl\ED UNDER THIS PERMIT IS NOT CmjMENCED OR IS ABANDONED FOR Total: ...vl1RO DAY PERIOD. Fee Paid On Receipt# Plumbinll 05/17/2001 5416 Value/Quantity Fee Amount Minimum Plumbing Permit Fee $5.00 . i. Job# 01-00503-01 I Paid On Receipt# Plumbing 05/1712001 5416 05/17/2001 5416 05/17/2001 5416 .- Fee Slale Surcharge - Plumbing Backflow Prevenlion Device Adminislrative Fee - Plumbing Total Plumbing Grand Total . Page 2 of 2 Value/Quantity 1 By signing lhis permillapplicalion, I agree 10 call for an inspeclion once the backflow prevention device has been installed and is visible for inspeclion (726-3769). I also slale lhal all information on this permit application is lrue and correct. ~~~ Signature Fee Amount $1,05 $10.00 $.45 $16.50 $16.50 s- II 7 /z-a, c> J Date I . . , '~ 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: '31.f-4-4- ~ J.;;t 'T~ ~ . ASSESSORS MAP #: )702-3/31 TAX LOT #: 008'00 O\INER: ~ d- ~ T~ ADDRESS: '3'lf'ltl' . /#.4(/1/ CITY: oS P,c2::, 5--r-- STATE: PHONE #: oL .-- ZIP: '77'f7R' BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.50 CONTRACTOR: 'I' ~ ~ ADDRESS: (S"2..5 ~ { ~ 7 PHONE #: (,88 - ( '+<+'-{- ZIP: 17<t= 2- EXPIRES: c., / Z-60 2- / CITY: ~ STATE: ~ CONSTRUCTION CONTRACTORS REGISTRATION #: i'7(Pq~ BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION 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. ~(3~ SIGNATURE c;; It 7/'ZPO, ( DAY; FOR OFFICE USE DATE OF APPLICATION: 051'7 al RECEIPT #: 05/7 0 I ISSUED BY: 1: /~. ro , JOB #: O/-Od s-o J -0 I TOTAL AMOUNT COLLECTED: D ::<: -l -l '=' ;;0 DD ;:>) -l :z: /'T1 ITl (fJ ("") .. ** I L.l 0=<:" . D .. DO ----------------------------------------------------------------------------~- ~~-<~ ::c I t-I("')<ER.......O fT1 ::c -J a ::::0:0....... C) .. :z Cl' I"..J t.T1 om- O~ Cl' m (J1 c::q.~ .........0.......0-. 'De