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Permit Building 2002-6-5
Job# 02-00663-01 Page'1 of 2 ~/ ,. SPRINGFIELD ~. RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety TPANS#;. 01,-00094.06 DA TE : JUN 05 200~: At1T RECD:2 $ 51: 75 CHANGE: CASHIER:061 Job Number: 02-00663-01 225 Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 location Of Proposed Site: 2099 Otto St Spr Assessors Map#: 17032443 lot: Block: Addition: Tax lot #: 02310 Subdivision: Owner: Address: Leonard Freitag Phone Number: 541-747-6509 2099 Otto St Install backflow device City/State/Zip: Springfielkd, OR 97477 Value: $0 ~\O . ~e<O 'Io\)\~\\'I ~'(\ _D.o.>)" ,..0(\ _'< \0 "J \"~. 0:\"'''' e'::>- R)'V' .,...;0: ',0 ~~ <'...?: '0'1 Registratio.n"#'"" 'ExpJr~ation,l[)ate~~ Phone 0\"''' 0. -,)1 \y' oP-' ~\),,, Decker landscape and irrigation 67\"t6)~' o.o~\e -<;.'{\09r89~'O~~ee~'{\O(\~~~1-688-7991 PO Box 87, Alvadore, OR 97409 ,,(\I(:..~ \}\e.~c'(j.e,\~e'\~,\).~ o~\eS,^e'\l.e~ ~~\c'3-~ r ,,,'~ _ J . (\'v .^vr.'~' ~o Office Us~O\\'~ ;..9I.\\v:'J:\j\J:, o'O\.o-".~O"0\~\"\.\'!JtJ.M' ~o\\' ~ '0":) ~'3-" ~\e~ ~O(\ ().,~?; land Use: \(\O~\).-{O\) ~ece eO~e!tl@l'BUildings: Zoning Code: ()d~ c~\\(\~~\O~\:e~\S 'Occupancy Group: Bedrooms: (\'V~'<j Ce'\" Heat Source: Range: Sq. Footage: New Scope Of Work: Backflow Device Contractor Type Landscape Contractor Quad Area: # Of Units: Constr. Type: Water Heater: 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. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: Required Inspections I Plumbing I ~\)~~\ -After device is installed but before backfilling trench\~ '\~~ 'CO ~\) . ti--~'~~~~~~ ~\}~ ~\.\. ,\~,CO r;:J~~~ . ~~\~'l;~~,\ CO~~~~~ ~~~~\) ~ ~ ~~ ~1.t~ I\)~ :\.(\~. # Of Sto1i~K~I\)~ ~\)~~ ~~\'FI"eight (feet): Current U~~~~ ~ ~~ Proposed Units: Census co~~~~not apply Total: Backflow Device Accessory: Fee Paid On Receipt# Plumbing 06/05/2002 9406 Value/Qu.antity Fee Amount Minimum Plumbing Permit Fee $31.00 Fee State Surcharge - Plumbing Backflow Prevention Device 8% Administrative Fe,e - Plumbing Total Plumbing Grand Total Job# 02-00663-01 I Paid On Receipt# Plumbing 06/05/2002 9406 06/05/2002 9406 06/05/2002 '9406 Page 2 of 2 Value/Quantity Fee Amount 1 $3.15 $14.00 $3.60 $51.75 $51.75 By signing this permit/application, 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 ~iC~ is true and correct. (~/[/: /aL----' Signature ;;~:;-.-OJ- Date 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)7Z6-g75g . FAX: (541)726-."1689 ~~ ~~ o City Job Number e" '1","-14 t \) Job Location m~ "'~ ~ Assessors M::1p e,,~ ~,i '~i,~ Owner Le_n,^",rJ F f~~ \-O'\~ ~\ V;'" !, Ii Address ~ ~~_J> .",~~ E'.'--'~ r.~ . \-~ ~~ .~ ~ ~ ."'..-.4 > ~ 0) .,,~ ~ e~ ~ ~ ~ ~4 ~~. ~~ ~ o r;: 14 .J~. ..I~ UA t,..,"~~~ ~) ~ ro .. TRANS#~Ol-0009406 DATE:JUN 05 2002 AMT', REeD: 2 $ 51,75 CHANGE: CASHIER:061 02. -00b63 -6 ( 20 c:r ~ ST OITO 17():) Zl.{L{] Tax Lot 0 z"3 ( 0 City ~o'1<>t m-\-o . C:' Sfr\V\5 ~,~\~ 14/- hC)O'1 ~\- Phonp Stat~ OR Zip Cj 7 L{ 77 BACKFLO'V PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee) Contractor Information . ,0 n " ~~o-'>,;~~ ~ Lt>... "',). S c. 'f'L .;, ~:~r{\i.\cr~,~t\~ ~ ,\00<.0\!)- e ~b1:\)- 'Q~ <?? 7 ';)..7 3 s..dj~\~<;,1~:~~~~~ _,~L{ 1- (, ~ '6 -74 '1/ ..,0',<0':) 0-'" ro0' r\~"V' ~ '(\'. ~\- ~O" '",,' ~\.e; "'~o o-.>"},.-eP ~e; .~\V~ /:l City 4 { f/c.. J (')~. /" ~.:.~\9 ~ '^~if"'S~tatt~~0'\"o~. Zip '1 7C( () '1 .~~'(; ,,~e;~oJ ~~ \\' 0\.0 ~~ r}f>t'1 1/ / \('- ,~~ . 0 }..) ~ . ~ \J fl) Construction Contractors RegistratiOll':\1!..r# --: N~~~<\.O\'_ 'f).,'Of}; Expires 9. 5 () () ';}- '. ,,~'_ <A ~- ., \" c-lC>' ('".... -nC\'J ( ~- or- ~v- ~'" ~<o . ~ "''' .~ ~Oj~'~~~ ~".o'\ ;.,.0".... ~ B . . h' 't/ I' . I <:) v~ ~'()e;l fiv0~' . . h b kf'lfl,~\\~",1.a . Y sIgnmg t IS permI app IcatIon,. agree t~~C(H or an mspectIOn once t e ac ~~~~~ntIOn devise has been installed and is visible for inspection (726-3769). I also state~~~~rmation on this permit/application is correct. ~~v.,~v.,~~~ ~\j ~\" ~ ;(".~~ ~~~ ~.. ~~~~~<<.,~ ~~ / - S~ 0 Z .('~. ~~ ~,~,~ t~ b ~"-f<,~""'~~-~~'~ . . ~ ~~ ~ ~~~ ~~~ ~~~ "\: ) ~~ ~f~ ^~ For Office U'~~ ,'b~ y ~, Contractor D e..:c.....\<-t..r Addres': P_O.. B of... .Signatu~ .-/.--a. p_ Date of Application D<SC5S-oZ Checked for Delinquencip" c..--- ~ Checked for Historical Status Shared Drive (f:)/BuiJding FonnsIBacktlow Preventionl-02.doc