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HomeMy WebLinkAboutPermit Building 2002-7-2 v '1':"11 ( ... ~ '>- ~, Page 1-bf 2 TRANSI:OI-0009805- DATE~JUL 02 2002 AMT RECD:2 $ 51:75 CHANGE; CAC:!-lTcr;, dlj?1 " \..hl..,\,LI-..a\";UJ.. I Job# 02-00793-01 I SPRINGFIELD ~. , CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 02-00793-01 225 Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 location Of Proposed Site: 854 Mint Meadow Way Spr Assessors Map#: 17032343 lot: Block: Addition: 4th Taxlot#: 2102 Subdivision: River Glen Owner: Address: Future B Iric Po Box 7425 Phone Number: 541-744-2660 City/State/Zip: New Eugene, OR 97401-0017 Value: $0 Scope Of Work: Backflow Device Install backflow device ,,0 .. ,& ~~'1~~'....., Registration,'#f "I\Exp, ir.ation Date -J.l'.. 0'" ~ v' .~0 0' c; 0' r., 11372~ 0C$ ~0 ct~q~20Q3 ~ ,0 0" qj 9:- ,'-' ol::::';.,p ~ 00 ~ ~0 ~ W ....co- :<:;-0 ~ 0 ,,~' ~'<.~ r-.' _,~ 5: ;S: & ,,0 ~ ~..J "y' c.,- ,)-J!? 0 ~- ~ Office Use , &:,...)JlJ\.......~~O ~0 .~.'~ $ \,) &' ... ~' 0 0"~ ci~ ' Quad Area: land Use: o"~,, &> O:;'r-.:~ .~(j.:::..~ .:;s,!#;6f Buildings: qj ~ (.~J r{j ~ ~ (k # Of Units: 1 Zoning Code: .(<~ 00 (,0 ...:v ~ ....<:.. ~ ~'Occupancy Group: /S~ s:::> o~ Qi c.'. Constr. Type: (VN) Wood Frame Bedrooms:~v ~~ .&'(',}J r~ ~ 0" "C{}' Heat Source: Water Heater: Range: '\r ~o .~~ ofY.;::,~ ~G 4P ~.Ep Sq. Footage: .('\ _\t.~ /'to- ^ ~ J: '~.' . "...~-""''\f ""'~^'0':::-o CI~' To request an inspection call the 24 hour recording at 726:~769?'~Jrigspe.8tions requested before 7:00 a.m. will be made the same working day, inspections request~ affer.':.7:00 a.m. will be made the ~wing working day. ,I''::! ~'5 ~' Required Inspections , ~,,~t' ~ I Plumbing I ~ $' ~<i. -After device is installed but before backfilling trench. ' ~~C:Jq,,<iJ # 'v~~ ~ #' ~ ~~ C3 ~ ~ ("00,.- , ~ .. ~ 'S'" ~ ~v Private Gar~~'79.~ # Of Stories: ~~~~(Jr>>J:. Current Units: ~ ~1~~~~ Units:1 Census Code: New SF - detOo\#'~~ ~ ~ Total: Contractor Type Landscape Contractor Hunter, Randall 25226 Strawberry Lane, Veneta, OR 97487 541-935-3215 Phone Backflow Device Construction Types:(VN) Wood Frame Occupancy Groups: Dwelling # Of Buildings: # Of Bedrooms: Handicap Access? D ~Area (Sq. Feet) Main: Accessory: Fee Minimum Plumbing Permit Fee Paid On Receipt# Plumbing 07/02/2002 9805 Value/Quantity Dwelling Fee Amount $31.00 " Job# 02-00793-01 I Paid On Receipt# Plumbing , 07/02/2002 9805 07/02/2002 9805 07/02/2002 9805 Fee State Surcharge - Plumbing Backflow Prevention Device 8% Administrative Fee - Plumbing Total Plumbing Grand Total Page 2 of 2 Value/Quantity Fee Amount $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 i tailed and is visible for inspection (726-3769). I also state that all information on this permit catio, is true and correct. ,~~~ 7~.:2~ fSJ-Z Date ..... o"",",j; k",\; ~.," '> Y'-. '". ..,,~ tt), ' YA (I :';..~..:"::~i~ p)\ Ie '" :....l1 i ~v.~ oj) 't"~t1 "f~ili ~! f"~''i" ~w 001.:11 ~~ tl)~, f * P .~7 o&~i f~m~~ ~1 ~ ~ cau\i ,;,,,,,,;P ~T,',,(4 ~~,..'/ ~1 ~, .4) ~f1 ~~ f"!o; "',',"', ~ ~ 225 FIITH STREET. SPRINGFIELD, OR 97477 0 PH:(541)7Z6-::I75::1 0 FAX: (541)726-::1689 TRANS#:Ol~0009805 O ATt~" TUI 1'\1') 'J'UnO':f . I ---;I-U !...~ ~J,- "- I L. AMf RECD:2 $ 51.75 CHANGE: CASHIER:061 City Job Number 0 Z -00 7 9..s - or Job Location <65 ,-( Q1) (II'- +- W1 ~ w~ I Assessors MClp 170 323. '13 Tax Lot oz ( cz. Owner ':u--';";{'< f }.,4" -v-- ~ ...5 . .. 1>0 11>01' ?!i2~, Address~ro!./ ;4'~...., " lvL'-.:....1,p(J.~...5 Phonf' '7ut/ -zf:lbO CJ 7lfc) I Z. A r."" t'''7~ IP .. I; , ~ ,/ , City Sj?,rf:A.:,.-<;" ('.; -!-,'~ eu ,&&71/ f:!: Statf' 6// BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee) Contractor Information Contractor j/ u- ^" / <....-f" ..... , '7/fd'/~~//;>-oI d ./n'N.?1SC~-<'" ~ c - Addres~ ::J,er-~26 ':;;/~U..he:~AY ),.,,~ , Phonf' J 3" ~ 3'...:1../,5- ,~ 0'> ..;~\ ~ State ,[&\Af?,,!!.P~~~' \ Zip 97Y5-? ,'t - 0" C:J\(J !JI~ p:>VV'i , .....(5;. ~0CSj ~0 Cl>~ ~0 0 / /.J> ?,~~0 roC:; f(f....9:' ,." "~,_Q~..cExpires "1-.5 t:)- 6> -3 .,..;,.:;- .~' ,..::y- o'.;;:s.y ~Q'" _Ib-.... "c,j' "S~ e.' "'~. 0' riF .~- .0'0 0 &' .)"J ~ ~ ~ ,.;,:, ~'?j.t'<:' ~o '~0 ~0 ,~ ~. . ~....; ;~"'.., ~ o~ .~.~ ~ By ~igning this ~ermit/applic~tio~,.1 agree~t~~~~:~~'~?n'1~~~yt!oj~#~e the backflow preventi?n deVIse has been mstalled and IS VIsIble fOl';msn'eGt.lOO. :}7..fJ:6e;-(3769)..?-1 also state that all mformatIOn on "",. ",y~ ~v ~'" ~ ~!..' this permit/application is correct. ,,~ ~,.\:<. ~f {}; ,('.,1;\ 0<:' 0''<> cp ,l \~~~~I r:?) ,....'\.' 00,^-0 .c..'" t"\.~"'.c. " ~' ~. .0'" ~ ~'..:." ....\'V ,,' ~O O~ "\, ~~ ,0' ~. ~"",.... ~~ //' ~1::-,,~~c:'.:l'~~~ (Jf '-..~~.,~_~ z /h--C - v <J L<:' Datt'" ~~- I'~ ~~<?~~~'- ..\Y ~';...~:-$>~ ~'{. ~'(' 8>" For Office Use ~A ~~ CO.~~ '-~ ~ . ~(j~~q~~~~ ~~ ~ ~"'IJ <$> ~~ o 7 0 z.. c> Z ~ ;....~:~~ ~~~ <0.~ ~'..~~ ~ ~~.,~ ~ Checked ~~storical Status City J/-<./< J ~/ ~ Construction Contractors Registration # Signature Date of Application Checked for Delinquencie~ ~ Shared Drive (T:)/Building Fonns/Backflow Preventionl-02,doc