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HomeMy WebLinkAboutPermit Backflow Test 2001-6-27 -. I Job# 01-00655-01 I . Page 1 of2 TRANS#:01-00059B4 DA TE : JUN 27 2001 AMT RECD:2 $ 16.50 CHANGE: CASHIER: 061 ~ CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety 225 North Fifth Street Springfield. OR 97477 Location Of Proposed Site: 841 Old Orchard Ln Spr Assessors Map#: 17032343 Lot: Block: Addition: 3rd Owner: Address: Future B Inc Po Box 7425 Scope Of Work: Backftow Device Backftow device Job Number: 01-00655-01 Office: 726-3759 Inspection Line: 726-3769 Tax Lot #: 02102 Subdivision: River Glen Phone Number: 541-744-2660 City/State/Zip: Eugene. OR 97401-0017 New Value: RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety 225 North Fifth Street Springfield. OR 97477 Job Number: 01-00655-01 NonCE: . O~ce: 726-3759 THIS p~nspectlon Lme: 726-3769 A RMIT SHALL EXPIRE IF Old Orchard Ln Spr UTHORIZED UNDER THIS THE WORK COMMEr.fx:CO,M:iS AlfAR6~ERMIT IS NOT Addition: 3rd ANY 1 BOSubdlvision' River GI~fiD FOR . -, I/Dr' Location Of Proposed Site: 841 A,;sessors Map#: 17032343 Lut: Block: Owner: Address: Marlyn Thompson 841 Old Orchard Ln Scope Of Work: Backftow Device Backftow device Contractor Type Plumbing Contr Contractor Hunter Irrigation and Landscape 25226 Strawberry Lane. Veneta. OR 97487 Quad Area: II Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: 1 (VN) Wood Frame Phone Number: City/StatelZip: Springfield. OR 97478 New Value: $0 ...., 'ENT/nll,. Registration !#ule~xpir'ati9nll;>J1.tere . Phone .Notification C adOPted by the JUtres You to to OAR 952'00etter. Those rUle;egon Utility 0090. You ma -0010 through 0 are Set forth Ca/Unh". Y Obtain "nh', AR 95:>.on. nUmbe;i~';t;,:~er. (Note: t;;ev;:~e rUles by C reann II.", ephone ente '# O"B 'Id" .... 'I '. " "',~ UI mgs. ot,f,cat,' . V"'V-lj~::>a""'~" , On . Occupancy'GroUp: Dwelling Heat Source: Sq. Footage: . 1 (VN) Wood Frame I Job# 01-00655-01 Office Use Land Use: Zoning Code: Bedrooms: Range: . Page 2 of2 .- /" Quad Area: # Of Units: Constr. Type: Water Heater: # Of Buildings: Occupancy Group: Dwelling Heat Source: Sq. Footage: To request an inspection call the 24 hour recording at 726-3769, All inspections requested before 7:00 a,m, will be made the same working day. inspections requested after 7:00 a,m, will be made the following working day. Bacltflow Device Required Inspections I Plumbing I -After device is installed but before backfilling trench, Construction Types:(VN) Wood Frame Occupancy Groups: Dwelling # 01' Buildings: # 01' Bedrooms: Handicap Access? 0 ,Area (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Private Garage/Carp/Stor Height (feet): Proposed Units:1 Total: Fee Paid On Receipt# I Plumbing 06/27/2001 5984 06/27/2001 5984 06/27/2001 5984 06/27/2001 5984 Value/Quantity Fee Amount Minimum Plumbing Permit Fee State Surcharge - Plumbing Backftow Prevention Device Administrative Fee - Plumbing Total Plumbing Grand Total 1 $5,00 $1,05 $10,00 $.45 $16.50 $16.50 By signing this permiUapplication. I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). 1 also state that all information on thispe Z~ct. I#ture , ,j" - ;)..';1-tJ> / Date . . BACKFLOY 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: ?~/ t9Lt:J tJ/?C/;I#-/f'LJ ASSESSORS MAP #: 1703'7-'343 TAX LOT #: DZ(Oz.. OYNER: m.4,{J lvM T)"/,,~J"".v ADDRESS: ;:-,//"':>0\ D&rfj)a{\ CITY: oJ 41',:,,,; (]~ 1'<<") STATE: PHONE #: C!?/. ZIP: , C;I',y? '7 BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CON1'RACTOR: Jr/.....^/I....f' r."f"f1,~~:.., ~ .IA_,/1,ScAA. ~,,.. ~ ADDRESS: Ls-J.2f .s77f'~L,.('~/ 1-.-- PHONE #: 9.rf-3.2./..r- CITY: J.,/.c.",.......'"'T79- STATE: tSJ~ ZIP: ;7tl~? CONSTRUCTION CONTRACTORS REGISTRATION #: //7' '? ? EXPIRES: ~ -.?.a..a. Z BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BAOCFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. ' p.~ DATE ;;-.:2 7-c:l'/ FOR OFFICE USE DATE OF APPLICATION: 0 b '2 7 0 / <;,9551 JOB #: 0/-0 ObSS-D( TOTAL AMOUNT COLLECTED: :D =-: .... ....0:;0 :D:D ::::O-lZ rrl fT1 to (""]..# ("') l:::Ic.....,.. D .. co ___.__________________________________________________------------------------~- I'.J Z 7 .......C"')~r-.JO rrl =c -.J 0 ;:::O:DI--l 0 .. :z ct-. I'.J U1 OQ. 0...0 Ct"'-n1c..noco I--L" ot-'--P- ISSUED BY: ---r-.t1 RECEIPT #: Ih r:'