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HomeMy WebLinkAboutPermit Backflow Test 2001-5-10 - . ,,,. SPRINGPIELD ~- I Job# 01-00485-01 I e. Page 1 of 2 TRANS#:01-0005271 DATE:MAY 10 2001 AMT RECD:2 $ 16.50 CHANGE: CASHIER:061 CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00485-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location o'f Proposed Site: 789 Old Orchard Ln Spr Assessors Map#: 17032343 Lot: Block: Addition:3rd Tax Lot#: 02102 Subdivision: River Glen Owner: Future B Inc Po Box 7425 Phone Number: 541-744-2660 City/State/Zip: Eugene, OR 97401-0017 New Value: $0 Address: Scope o'f Work: Backflow Device backflow device Contractor Type Landscape Contractor Hunter Irrigation 25226 Strawberry Lane, Veneta, OR 97487 Registration # 11372 Expiration Date 4/30/2000 Phone 541-741-7618 Office Use Quad Area: Land Use: # o'f Buildings: # o'f Units: 1 Zoning COdl!:.,--,,,,.,-,"C ," - _" ,,", ".,o.ccupancy Group: Dwelling Constr. Type: (VN) Wood Frame Bedrooms: f~'I:O; r~i~3 6.~<1)t8d :)y .,13 CHejltSCiure,e: Water Heater: Range: No",icat'cn r.3nlar. ';',os: rul:Sq: F.00tage:1 . _ _ _,_... ,,1'\'" in 0/-\:; S;';i!.UU1.UU Il.' 1IIH....!!:.!II_n.. '>,Iv<- ....... To request an inspection call the 24 hour recording aJci':J!9:~~6.9'11P..!1 ilispections:req'uestealbefo're 7:00 a.m. will be made the same working day, inspections re9Y.'?~!g<f:!!.ft!lnI7':00 ~,in!lwillibe:rhaaEi:the following working day. numbsr for the Oregon Utility Notification _ r,"':1;9r is 1-800-332-2344). ReqUired Inspections I Plumbinq I Backflow Device -After device is installed but before backfilling trench. Construction Types:(VN) Wood Frame Occupancy Groups:Dwelling # o'f Buildings: # o'f Bedrooms: Handicap Access? D rArea (Sq. Feet) Main: Accessory: NOTI~&essory Structure # Of Stof'~~:PERMIT SHALL EHeigiitrfe~t):WORK Current ~Di,~,bRIZED UNDER 'Pr~RP:O~iJtlIUriitS::OT Census Code:poes.nO.l\apRIy.'ABANDONED FOR GUNlNlt:I~Vl:U vr. ,., To~~IY 180 DAY II'ERIOD. Fee Paid On Receipt# Plumbing 05/10/2001 5271 Value/Quantity Fee Amount Minimum Plumbing Permit Fee $5.00 4 e , Job# 01-00485-01 e Page 2 of2 Value/Quantity Fee Amount .' Fee Paid On Receipt# I Plumbing 05/10/2001 5271 05/10/2001 5271 05/10/2001 5271 1 $1.05 $10.00 $,45 $16.50 $16.50 State Surcharge - Plumbing Backflow Prevention Device Administrative Fee - Plumbing Total Plumbing Grand Total By signing this permiVapplication, 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 per 't application is true and correct. J /' ./r,~ /~ ~ c.S '-/p_.,/ Date ... . . BACKFLOV PREVENTIO~ DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 ------------------------------------7------------------------------------------- JOB LOCATION: '7 ;r~ (!!)LLJ ~~/MA".L2 ASSESSORS MAP 1I: j "70"32 '3'Cf '3 OIINER: 'r:./~/f-<:.. 6" ~__<> ADDRESS: ~ 6 'is' Q K 7<f 2 t;; TAX LOT 1I:_ D 2-( 02- CITY: C3. <:-( G c=/'f c::-- STATE: PHONE 1I: r--,L 7CfL( - Z6b() ZIP: 97f.(O( BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.50 CONTRACTOR: J.J U.N 7< ~ .1- 'v("A? <>d /".: _' ~ ..... ~~~.r1"Ay L...,,, 2 A~,dsc.-?.P'"",- ADDRESS: :J,<;~~AC: < CITY: /A...-.."7/7l- STATE: tOA? CONSTRUCTION CONTRACTORS REGISTRATION 1I:..2 c6 ~ /13"7 2.. PHONE 1I: !7'f'<?-32/ r ZIP: 97Ylr7 EXPIRES: ~?"'_'" 7 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 . ~ SlGNIl'JURE /' ~ , J::.../ d~ ~ / DATE FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: JOB 1I: 0/ - 0 0 4 F;<) -0 ( TOTAL AMOUNT COLLECTED: ISSUED BY: '/-,/( ~o;;:: ~ ~~ CJ I t, >..:::- j'g ;:;:1 t5 to..... C"") 0:3:-- :D ..:00 ---------------------------------------------------------____________________~_ N~~ :c I ........C")(fll-l-O rrl ::c 0 0 ;o:Cq..4 0 ..::Z:O"r0tn QCi'). 0".,) 0-. m CJ1 O-J .......... 0................ RECEIPT 1I: