HomeMy WebLinkAboutPermit Backflow Test 2001-10-1
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Job# 01-01068-01
SPRINGFIELD
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Page 1 of2
TRANS#:01-0006852
DATE:OCT 01 2001
AMT RECD:2 $ 51.75
CHANGE:
CASHIER:061
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COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
# Of Buildings:
~Qccupancy Group:
G ~O Heat Source:
~\, ":0.'
_G.~ .,-,;\S~Sq. Footage:
-t?',. rc'i'-...' G.OY'
To request an inspection call the 24 hour recording at 726-3769,,<AII in$p~ctionSlrequested before 7:00
a,m, will be made the same working day, inspectio,~"';eque~fe~' aft~1.'f'o0'f~:" will be made the following
working day, ~t:I"\. c'\,,~~' 'U~'O., ~~"iS"
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'Requirea;lnspections~
~:- ,r-~ ''r',-
I ~"'p'lumliinll~Y~ I ~\o
-After device is installed:btit before 'backfilling trench, .~e'" ,\00\)\\\,\ ~:~
r$.<;' . eo..-u' "o~ e\ \0 \.
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Census Code: Does ncifapp,ly .IO-U ~ e c.<?f" O\0~r::,r::,''?i
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Paid On Receipt#
Plumbinll
10/01/2001 6852
225 North Fifth Street
Springfield, OR 97477
Location Of Proposed Site: 1396 Main St Spr
Assessors Map#: 17033632
Lot: Block: Addition:
Owner:
Julie Johnson
1396 Main Street
Address:
Scope Of Work: Backflow Device
Backflow device
Contractor Type
Plumbing Contr
Contractor
Roto Rooter Service
445 River Ave. Eugene, OR 97404
Office Use
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Land Use:
Zoning Code:
Bedrooms:
Range:
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[Ar~a (Sq. Feet)
_ Main: Accessory:
# Of Stories:
Current Units:
Total:
Fee
Minimum Plumbing Permit Fee
Job Number: 01-01068-01
Office: 726-3759
Inspection Line: 726-3769
Tax Lot #: 03501
Subdivision:
*'
Phone Number: 541-747-7679
City/State/Zip: Springfield.. OR 97477
New Value: $0
Registration # Expiration Date
Phone
541-689-1711
Value/Quantity
Fee Amount
$31,00
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Job# 01-01068-01
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Page 2 of2
Fee
Paid On Receipt#
Plumbing
10/01/2001 6852
10/01/2001 6852
10/01/2001 6852
Value/Quantity
Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
1
$3,15
$14,00
$3,60
$51.75
$51.75
By signing this permiVapplication. I agree to call for an inspection once the backflow prevention
device h~S b n installed and is visible for inspection (726-3769), I also state that all information on
this per~, plication is tru~ correyj /J ' , / /
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BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Job Location:
/37C
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Assessors Map #: i7CJ33b:32
2: /' 7~/(
Owner: .' I .,~ ,)=.;r.
1390 51.
Address: -9;P~
City:
State:
.
SPRINGFIELD
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Office: 726-3759
INSPECTION LINE: 726-3769
Tax Lot#: 0 "3. SO I
,J:Je (J;'~/7~~
Phone#: 7c(7 - 76, 7 I
Zip:
BACKFLOW PERMIT IS $51,75 (includes Pennit Fee, State Surcharge & Administrative Fee)
By signing this pennitlapplication, 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 this pennitlapplication
is correct. -, ..Y
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contractor:?olv - Pool-v-
Address: '11f'S J}~ /lv-e
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Construction Contractors Registration#:
City:
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t'O I} / / h ';;<'Expires:
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State:
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Signature
FOR OFFICE USE
Date of Application: I'~r (
, Checked for Delinquencies: ......-
Phone#: 6/tc;- /?Ij
Zip:
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Date
Job #:' Of - OloG 0.0 I
Checked for Historical Status:
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VALIDATION: '
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