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HomeMy WebLinkAboutPermit Backflow Test 2001-9-14 -. Job# 01-00998-01 ~ Page 1 .of 2 TRANS#:01-0006699 DATE:SEP 14 2001 AMT RECD:2 $ 51.75 CHANGE: CASHIER:061 225 North Fifth Street Springfield, OR 97477 . RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00998-01 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 823 Old Orchard Dr Spr Assessors Map#: 17032343 Lot: Block: Addition: 3rd Registration # Expiration Date \,\.0 . C'" 'l~ ..;i\''I n (>.0')\ ~ 0'" ~.. I,O~\' \,>l'!'~ ';e~ ,Q;\ \ r::i" .....n'(\ '-'" ~':\3 0 ~_ 'r.:.,'J :"(...'2...0 _" . _....,J..)p ~ec"" ..... (,,)\' ~~\' - \}\0'J Office Use (\\v' 'o'J' '.\a"'~ \,\\0 \-~' f:\0 ~Y;.~ ('_~;;' ~'~.. .~\ \ " ~o~'i.. . Q\ \: , .~'(\o L"' :(\ Land Use: t<:\ \ ,\"s- r,,""-'.\\I:"" _#.Of BUlldmgs:'o r" ~l \.~ '\\J :,....l'" \'(\'#" - 'f"\\\" Zoning Code: \cI\~ ~I:''J'' JVu\'\'..,\i'\'. "Occupancy' Group: . \.\c I. 2.: u'.) \..~... .\\'\'.) ......\.:4,. Bedrooms: ~o\' _:.>-S" A\~~ ,,\'2\. ,l:teat,Source: o ~ .1 \} \.. ". <>\j" oj"" Water Heater: Range: \1' ~o. ,a ,."eG,'eO''-' al?q. Footage: _r'\~ .,~n.,~ .I"f\; ......0 ... c'lr"" o?1 \U' ('Jt \J Ta request an inspectian call the 24 haur recarding at 726-3769."filINnspec:tians requested befare 7:00 a.m. will be made the same working day, inspectians requested 'after 7:00 a.m. will be made the follawing warking day. Owner: FUTURE B HOMES PO BOX 7425 Address: Scope Of Work: Backftaw Device Backftow device Contractor Type Landscape Tax Lot #: 08500 Subdivision: River Glen Phone Number: 541-744-2660 City/State/Zip: New Eugene, OR 97401 Value: $0 Contractor Hunter Irrigatian and Landscape 25226 Strawberry Lane, Veneta, OR 97487 Required Inspections 1- --P[iiinbing I -After device is installed but befare backfilling trench. 'i:- ~O?>'f., \'f "VI ~O" j..?\?>'t. ~~ \'0 ~O'\\C~~\" 'O\\f>.\.\. ~ ,,\\\'0 ?'t.:~'V 'fO?> _ o;:'?' . '>l.\)€ ,,~\\)a Accessory'Str,ucture ,.. ...'01"" ".' C,\......- ~<\\."I" # Of Stories: ", ~\\O<' ,..Helgtit (feet): "'v "~vt...... ...0\\)'..... Current Units: O'~W.::, p"roposell Units:1 r 1\'" "",,,,' Census Code: New S~~1e.tach'ed '1 Quad Area: # Of Units: Constr. Type: 1 (VN) Waod Frame Backflow Device Construction Types:(VN) Waod Frame Occupancy Groups:Dwelling # Of Buildings: # Of Bedrooms: Handicap Access? D ,Area (Sq. Feet) I Main: Access.ory: Fee Minimum Plumbing Permit Fee Phone Dwelling Total: Paid On Receipt# Plumbinj:! 09/14/2001 6699 Value/Quantity Fee Amount $31.00 " . Job# 01-00998-01 . Page 2 .of 2 Value/Quantity Fee Amount I , ~ Fee Paid On Receipt# Plumbing 09/14/2001 6699 09/14/2001 6699 09/14/2001 6699 1 $3.15 $14.00 $3.60 $51.75 State Surcharge - Plumbing Backftaw Preventian Device Administrative Fee - Plumbing Total Plumbing Grand Total By signing this permit/application, I agree ta call far an inspectian .once the backflow prevention device has been installed and is visible far inspectian (726-3769). I alsa state that all infarmation on this per~~ica~n; t~u:n~arrecl. / ~/(. /~ 9-/ y- 0> / Signitirt'e Date $51.75 . . SPRINQFIELD " BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DMSION - BUILDING SAFETY 225 Fifth Street Springfield, Oregan 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Jab Location: . 8.23 19l/J t9/c//~A",<J Assessors Map #: (70"3> Z 3 L( 3 Owner: klZZA ~ ~ r'4 ~~ ...s ~(L Tax Lot#: O;i5 ~ 0 Address: Phone#: City: State: Zip: BACKFLOW PERMIT IS $51.75 (includes Pennit Fee, State Surcharge & Administra~'v Fee) . . '-/~ ( 7 % g Y. - "- Contractor: J-/......r';7<.~ ;::C-f,-{'9A/'~'., ..I ;>A~v:l.sc~-<-. ...I'"-vc, Address: :;. S- ~;1. ,{' ~#~~/fv )../ City: Jk"'-<-/ A State: d/ Phone#: 9'.3 P J .;U.5 ~ Zip: 9-'7 YS' P Canstructian Contractors Registratian#: 1/3"7:2 . Expires: ':/-Y.:>-61 '2 By signing this perrnit/applicatian, I agree to call far an inspectian .once the bacldlaw prevention device has been installed and is visible far inspectian (726-3769). I alsa state that all infarrnatian an this perrnitJapplicatian "~/LZ' SignatUre /-/ Y-.9 / Date FOR OFFICE USE Date .of Applicatian: 0 Y / C( 0 ( Job#" Of -00 ? 9-r~O ( . Checked far Delinquencies: ~ Checked far Historical Status: ,...-- VALIDATION: . :D :x -i ..=-n:::J ::0 :D :D ;u -i :z: /'T1 /'T1 C!) 1:")..# C'"J t::::Hi)" ::D ..mo (I) I'J I'J ~ ::I: I '--H''''J ~ ~ 0 m::c ~o ;:::O::Dr...n 0 .. :z.......I".Jo-. om- 00-. er-. rr1 -.J (::) ....0 t--'- .. (J1........ ...0