HomeMy WebLinkAboutPermit Backflow Test 2000-6-26
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I Job# 00-01004-01 I
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Page 1 of2
TRANS#:01-0002313
DATE:JUN 26 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01004-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 839 Royaldel Ln Spr
Assessors Map#: 17032343
Lot: Block: Addition: 2
Tax Lot #: 02102
Subdivision: River Glen
Owner:
Address:
George Larson
839 Royaldel Lane
Phone Number: 541-744-6673
City/State/Zip: Springfield, OR 97477
New Value: $0
Scope Of Work: Single Family Residence
backflow device installation
Contractor Type Contractor
Landscape Douglas Landscaping
1955 Fairmont Ave, Salem, OR 97301
Registration # Expiration Date Phone
503-581-5911
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# 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"",- j00
a,m, will be made the same working day, inspections requested after 7:00.a'rn. will'be'rTlade'the~f6110wingf:or. Utiiit.
working day, "iT. " .f "..; " '
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Required Inspections VvU ';"":l 11'-'" U ,T:' :';1;, ':\: .r .,1- ," !':"s C'
I Plumbing I cu,l'r,~ I'I~"" ,'. :. "':, ",:;..(;1
Backflow Device -After device is installed but before backfilling tlEtri'ch~1 for ,il.: 8::'['2:11 'ti::' I\'u'::i::ation
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Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
Fee
Store
# Of Stories: Height (feet):
Current Units: ~roposed Units:1
Census Code: New SF - detaclieP neE:
THIS PERMIT SHALL EXPIRE IFTHE WORK
Total: AUTHORIZED UNDER THIS PERMIT IS NOT
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Paid On ReCe!e~111~~Y.i'H~9\1:lJR'tiiY,uul''F~&'~ount
Plumbing I "-, ,,--,
06/26/2000 2313 $5,00
Minimum Plumbing Permit Fee
By signature, I state and agree, that I have Carefully examined the completed application and do
hereby certify that all information hereon is true and correct, and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of
the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without permission of the Community Services Division, Building Safety, I further
certify that only contractors and employees who are in compliance with ORS 701,055 will be used on
this project.
I further agree to ensure that all required inspections are requested at the proper time, that each
address is readable from the street, that the permit card is located at the front of the property, and the
approve t of plans will remain on the site at all times during construction,
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Job# 00-01004-01
Paid On Receipt#
Plumbing
06/26/2000 2313
06/26/2000 2313
06/26/2000 2313
Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
Signature
C/
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Page 2 of2
Value/Quantity
Fee Amount
1
$1,05
$10,00
$.45
$16.50
$16.50
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Date