HomeMy WebLinkAboutPermit Backflow Test 2000-6-9
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I Job# 00-00913-01 I
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Page 1012
TRANS#:01-0002097
DATE: JUN 09 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER:061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00913-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 776 Old Orchard Ln Spr
Assessors Map#: 17032343
Lot: Block: Addition:
Tax Lot #: 02102
Subdivision: River Glen
Owner:
Future B Homes
Phone Number: 541-744-2660
City/State/Zip: Eugene, OR 97401
New Value: $0
Address:
P.O. Box 7425
Scope Of Work: Single Family Residence
backflow device install
Contractor Type
Plumbing Contr
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: Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspecti&\Q~~ted belore]x~~E IF THE WORK
a.m. will be made the same working day, inspections requested after 7:00 a.rTH\ililP6i\M\I~fil%.'tdflowlllg MlT IS NOT
working day. AUTHORIZED UNDER THIS PER
. . _ ' u ._. ,N"'" no Ie:: ARANDONED FOR
ReqUired Inspections \Jv""..~l.---
I Plumbinll I ANY 180 DAY PERIOD.
Backflow Device -After device is installed but belore backfilling trench.
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
iArea (Sq. Feet)
I Main: Accessory:
Garage/Shed
'. 'l..'u.ld..' Juo. '
Heig~t:(fit~i)':;~~~'~~~ b:i;~- OrN~O~ U~i\ii.
tOIlO,^,TU\t.:~c;.. . . _'_ . '''', '," ..., 'I,
P.roposed,Units:1,j ,""'_;~ t'., . ~ ,0
IOld'-,'(" - .' \,' :;",,-, ,f'.-t.:l'
0] ~'I' \\ II>' .0 .... 0
",Oi, - L:'~~.Il 1-' ~. . . .,',. ...,,...,,.. ('
14' ' .. ..... '"'. cnnlf'C' 0' - oJ,
'090 YOLlilla," 0.,\ali1 . . "1 u ",
I.)' . r I"" +." 'h'.' , j .....0.1
all'p,' ',\' ""n': . ."C .. .... t'\C"
C ,",.., O:1lll"ih ,"Q,),i::a
__L-......4.....r ~h'" l..rpn. " ,"
# Of Stories:
Current Units:
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Plumbing
06/09/2000 2097
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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...
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Job# 00-00913-01
Paid On Receipt#
Plumbing
06/09/2000 2097
06/09/2000 2097
06/09/2000 2097
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Page 2 012
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 carelully examined the completed application and do
hereby certify that all inlormation hereon is true and corre~t, and I lurther certify that any and all work
performed shall be done in accordance with the Ordinances 01 the City 01 Springfield and the Laws of
the State 01 Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made
01 any structure without permission 01 the Community Services Division, Building Salety. I lurther
certify that only contractors and employees who are in compliance with ORS 701.055 will be used on
this project.
I lurther agree to ensure that all required inspections are requested at the proper time, that each
address is readable Irom the street, that the permit card is located at the Iront 01 the property, and the
approved set 01 plans will remain on the site at all times during construction.
1
$1.05
$10.00
$.45
$16.50
$16.50
Signature
Date
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SPRINGFIELD
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
oo-ooCf/1 ~O I
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
JOB LOCATION:
77/
tJLtt:J d,f'c:...#41?<1
" ASSESSORS MAP 1I:
OIlNER: ';:::;J./u~-( /' ,.,{ " "",,-.s
ADDRESS: 776' t9l# <?"f'e#......tP~
CITY: S-a""/'-P.......L~ STATE:
TAX LOT 1I:
PHONE 1I: 7yc,l~ ;Z~C'-;;;
4I~
ZIP: '7'741';> ?
BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.50
CONTRACTOR: /-Iu~//U 'J?4'A1'9;P/~_
ADDRESS: Q~A:::Ltf ..S'~~&.A'V' .1_
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CITY: ~../.{/ __ STATE:
.r Lrl-~~c~"""'" ~c.,
PHONE 1I: '7 ;Y~J'>>~
~~ ZIP: ;?~~:/
CONSTRUCTION CONTRACTORS REGISTRATION 1I: J /.? 7.'7_
EXPIRES: ~1&J~/
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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DATE
SIG
FOR OFFICE USE
--------------------------------------------------------------------------------
DATE OF APPLICATION:
JOB 1I:
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RECEIPT 1I: ISSUED BY: -<5555
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TOTAL AMOUNT COLLECTED: c-J g ~ '!'!'
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