HomeMy WebLinkAboutPermit Backflow Test 2000-10-16
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I Job# 00-01543-01 I
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RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
TRANS#:01-0003487
DATE:OCT 16 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
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CITY OF SPRINGFIELD, OREGON
Job Number: 00-01543-01
225 North Fifth Street
Springfield. OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 771 Old Orchard Ln Spr
Assessors Map#: 17032343
Lot: Block: Addition: 3
Tax Lot #: 02102
Subdivision: River Glen
Owner:
Future B Inc.
Phone Number: 541-744-2660
City/State/Zip: Eugene, OR 97401-0017
New Value: $0
Address:
Po Box 7425
Scope Of Work: Backflow Device
backflow device
Contractor Type
Landscape
Contractor
Hunter Irrigation and Landscape
25226 Strawberry Lane, Veneta, OR
97487
Registration # Expiration Date
Phone
Office Use
Quad Area: Land Use: # Of Buildings:
# Of Units: 1 Zoning Code: Occupancy Group: Dwelling
Constr. Type: (VN) Wood Frame Bedrooms: Heat Source:
Water Heater: Range: \\\O,.ICE: Sq. Footage:.._ ,~.,.uc:\Mn1=lK
. . . . "'Ljlcr:>I=RMITSHALLt:l\nn~:'" ISNO;r
To request an inspection call the 24 hour recording at 726-3769. All inspections requested.befor,~ 7.:o0MIT
a.m. will be made the same working day, inspections requested after 7;Qg~a:mF'Wiif:b'e!.l\l'Mfijihe'foIl0~j~9)FOR
working day. COtll",MENCED OR IS Al:lI\\~UU
R . dl . ...^^".vpI=RIOD.
eqUlre nspectlons 1-\'" ,~--
I Plumbinq I
Backflow Device -After device is installed but before backfilling trench.
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
''I' "-'QJH'O: 'J~"
ATIENTION:Oiegr,l, '~'h: Oreaon Uli\i\
Accessory Structu%w rules adOpleD o. . rules are sel 101
IVI ,... Ie' fhoSE 00
# Of Stories: Nt!!!!ght'(feet):11 "1othrOughOAR952-
C. - . - n~'" nU(\1-00 It"" 'ules b
urrent Units: irRroposed' . nlts:1.ail1 COpi3~ 0 ".'
Census Code: New SF - detadlieBO. 'jou ~a~,,~~~r. (NotA th, t313'phOl1l'~'
calhl1gt"e, ~ Orego;, Jlility o\loltllca I
. I l1un1bl'lrlonhe, "..,.,
Total. r"'''''''
Fee
Paid On Receipt#
I Plumbinq
10/16/2000 3487
Value/Quantity
I
Fee Amount
Minimum Plumbing Permit Fee
$5.00
,
.
.
Job# 00-01543-01
.
Fee
Paid On Receipt#
Plumbinq
10/16/2000 3487
10/16/2000 3487
10/16/2000 3487
Page 2 of2
Value/Quantity Fee Amount
I
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signing Ihis permiVapplication, I agree to call for an inspeclion once the backflow prevention
device has been installed and is visible for inspection (726-3769). I also state that all information on
this permi pplication is true and correct.
/ /~ /tJI-Tt6-67'D
1
$1,05
$10.00
$.45
$16.50
$16.50
Sig~lture
Date
.
'~
.
.
BACKFLOV 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: 77/ t9 t.b/ fIJA ~h'A /?LJ
ASSESSORS HAP II: 17037.31.{::>
OIINER: Pu.171 ~-< ;(j' j,J'......--..5
ADDRESS:. tf.~. ~ ~. '/ <-/ :7-.1-
CITY: ~r'/f:~J<j+,'...t,:)
TAX LOT II: 02/02
STATE:
PHONE I: ? ',/0/ -:;I. 6"/ /J
I!J/? ZIP: 97 Y7P
BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: "'-I u-~/r .uf' T,f'/f'; 9/P7';;", .1/ Lw-14 d' Lri-/-<. r",u..
ADDRESS: ;l-J1:J...~ S//f-a",~,f/f>, 1~/
PHONE II: 9 3s-=3~/J-
CITY: 1/< d -<- ---r:+
STATE: d/
ZIP: , 7'/87
EXPIRES: V-Yd-<f'1
CONSTRUCTION CONTRACTORS REGISTRATION II: 1 / ;]7::1..
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT. '
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10-/6'- tl EJ
DATE
FOR OFFICE USE
--------------------------------------------------------------------------------
RECEIPT II:
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ISSUED BY:
JOB II: Oc?- O(543,-Of
DATE OF APPLICATION:
TOTAL AMOUNT COLLECTED:
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