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: