HomeMy WebLinkAboutPermit Backflow Test 2000-6-30
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I Job# 00-01036-01 I
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TRANS#:01-0002412
DATE:JUN 30 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 011
CITY OF SPRINGFIELD~ OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01036-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3904 NORTH ST Spr
Assessors Map#: 18020611
Lot: Block: Addition:
Tax Lot #: 05700
Subdivision:Jasper Park
Owner:
Address:
Cozy Homes
P.O. Box 237
Phone Number: 541-747-8704
City/State/Zip: Springfield, OR 97477
New Value: $0
Scope Of Work: Single Family Residence
backflow device
Contractor Type
Landscape
Contractor
Harris Irrigation
po box 1297, Springfield, OR 97477
Registration # Expiration Date
Phone
541-746-6444
Office Use
Land Use: # Of Buildings:
Zoning Code: Occupancy Group: Dwelling
Bedrooms: Heat Source:
Range: Sq. Footage:
di_ ....: -. {_ :,,~l,~q'i
To request an inspection call the 24 hour recording at 726-3769. All inspections requested be,(ore 7:00 ."" d,: .
a.m. will be made the same working day, inspections requested after 7,:00 a.m. will be made the following
working day. . u,
JOC\. ,. :1'-\'
Required Inspections ~u""
I Plumbin!l InumJ;;i'~"l~"' I
-After device is installed but before backfilling trench~r-t.'. ,- "....., ;~ .. ,,' '.
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
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Backflow Device
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
I Main: Accessory:
Accessory Structure
# Of Stories: Height (feet):
Current Units: N@.~~d Units:1
Census Code: New SF - deta.Gh:~.<PERMIT SHALL EXPIRE IFTHE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
Total: COMMENCED OR IS ABANDONED FOR
. ~1\Jr..lt)vUJoA' 1"':::1::1""':"1""'. .
Paid On Receiptlf Value/Quantity
Plumbin!l
06/30/2000 2412
Fee Amount
Fee
Minimum Plumbing Permit Fee
$5.00
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Job# 00-01036-01 I
Paid On Receipt#
Plumbing
06/30/2000 2412
06/30/2000 2412
06/30/2000 2412
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Value/Quantity Fee Amount
-
Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signature. I state and agree, that I have carefully examined the completed application and do
hereby certify that all information hereon 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 pertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will be used on
this project.
I further agree to ensure that all required inspections are requested at the proper time, that each
address is readable from the street, that the permit card is located at the front of the property, and the
appro~ set of plans will remain on the site at all times during construction.
(:I fJ-h.tAJr f}flA"rx b -SO -6::)
Signature Date
1
$1.05
$10.00
$.45
$16.50
$16.50