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HomeMy WebLinkAboutPermit Mechanical 2001-11-13 Job# 01-01253-01 Page 1 of 2 TRANS#:Ol-0007241 DATE: NOt) 13 200l AMT RECD:l $ 51,75 CHANGE: CASHIER:061 PUBLIC PERMIT . City Of Springfield Community Services Division Building Safety Job Number: 01-01253-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 location Of Proposed Site': 525 Mill St, Spr Assessors Map#: 17033523 lot: Block: ' Addition: Tax lot #: 04500 Subdivision: Owner: Springfield School District 19 1890 42nd Street Backflow device Phone Number: 541-744-6375 City/State/Zip: ~r...ingfield, OR 97478 New ~ ~ Value: $0 ({~-~~ ~ ~ ~- ^<< l~ ~<;. ~~ Contractor ' .;y~~~n # Expiration Date Grants Landscape Service . ~~ Q4f ~~11..\lp Q.30 -01.- Po Box 221, Springfield, OR 9~_~ca ~ ~ ,,<)'\NJ c., \ .~ ~~. 6' ~ i<.~ IVv..N' , 0ff~<<IJ~. ..~ f' ~ ~v 13'''I~ ~ land U~ ~ ~ ~<)~ Zoning ciiJ.& ~ ' () ~ . Bedrooms: *' Range: Phone 541-746-8482 Address: Scope Of Work: Backflow Device Contractor Type Plumbing Contr Quad Area: # Of Units: Constr. Type: Water Heater: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: To request an inspection call the 24 hour recording at 726-3769, All inspections r~~~Et~te:8'b..efore 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will)I;):~r;Ii~deihe following , VJ 0'" 'I.) 'V' working day. .~0 ~ c;~!lI "t;p ~ ~ 0 nt,J .~ 0 ^' . .o~ "'...0 ~ ~J ~ ~ ..& . ReqUired Inspections ~. ~ 0"'J ~ YJ oN- q,.- $- ~0:s 0 ~ 0""'~ 'I Plumbing I ~ ~ 0~ ~ ~ ~ ~ -After device is installed but before backfillira9?tr~~ffi>. ~d' .~C:) ~rp t ~ cf # ~ ~ d<..ri)' ,~ If;> ~. 0"" k ~ v ""'. ~ n~ ~ ~ <0 .....~ _,'" 'J n..V /::9 qj ~ <S> ~.~ ~ rjJJ ..." 00, rip ...: 'S:) ',' ~ s::s .~:SV~O~~~ . j~.V ~".~ nf3 ~ 0(;f- 0 ~ /... ~- ~ !i:>v ~ v 0 0 ~ ~ vr'fi OJ ..... ~~' i..~ , # Of Stories: ,0 ~ ~ ~FI~'gb-t (!~'et): Current Units: ~O,A,O ~. ~P.rapc(seed Units: '~. ~J rr'fi';;;..} . Census Code: Does not a-pply) ~ (;f- Backflow Device Accessory: Total: Fee Paid On Receipt# Plumbing 11/13/2001 7241 Value/Quantity Fee Amount Minimum Plumbing Permit Fee $31.00 " r Fee State Surcharge - Plumbing Backflow Prevention Device Administrative Fee - Plumbing Total Plumbing Grand Total Job# 01-01253-01 Paid On Receipt# Plumbing 11/13/2001 7241 11/13/2001 7241 11/13/2001 7241 Page 2 of 2 Value/Quantity Fee Amount 1 $3.15 $14.00 $3.60 $51.75 $51.75 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). I also state that all information on this permit application is true and correct. sJ{.~ ~ I//;~/o/ D~t' / / c ., V" BACKFLOW PREVENTION DEVICE PERMIT APPLICATION . CITY OF SPRINGFIELD COMMUNITY SERVICES DMSION - BUILDING SAFETY . 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 S-d-,~Jn.L '-I! Assessors Map #: I rO ~ ~5 Z "3 O~e!: :C:;p K?-J rJC9>-Pl~ /-1 Set! ffO / {){ff . Address: ~~l\M / I j Job Location: Tax Lot#: C> Lf~G a Phone#: 7-:rt.- :S~2/t9 . . City: ,<( f) -f!--) t,~~p.: tj State: /J P . , Zip: BACKFLOW PERMIT IS $51.75 (includes Pennit Fee, State Surcharge & Administrative Fee) -' Contractor:6 :Pz.()tlJ[2; ?0 ~ 5GAr--e ~---1) jCe4-, . Address: Po rRxX ~. / . Phone#: 7t( (. <z' Ll f j..- City: 5(JVJ:I,-&~/e?i State: c) te.. Zip: ~r '7 V I J , . . Construction Cv.ul.....ctors Registration#:_ ~~ 3 ( S:-- . Expires: Ie) /0 ~. By signing this pennitlapp1ication, 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 pennitJapplication is correct. .I1LubJ. f'0/~~ ~./ ~TY7' i/ /9/0 / . Datl . . .'- FOR OFFICE USE . Date of Application: .! I ~ :>.hl I I . Checked for Delinquencies: Job#:C.Oj-O/ZS-J -0 I 72'1\ Checked for Historical Status: VALIDATION: . :c... . ~~ t:~ ~a :1."')::1> :;rJ --I Z rr, Pl U) . C''J .. ::/:-."1: C-) ';:::I ....~ ::I:> In It C5 C) Ci) /-..... <'~ !-.L =1:::: .i I-'~ C'J {4 f-..L C) . rf1 ::c: Gl ,::;:) ;:0::1>(...'11 (;) rl t: Z r"l. r-o..) ........1 c) CiJ. c:;; t...;) C~" rll --:] C) ..p-. 1-.... ." t.r; 1-" t--'-