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HomeMy WebLinkAboutPermit Backflow Test 1998-7-31 . .. o C~: THIS PERMIT SHALL EXPIRE IF THE WORK ATTENTION:Oregon law requires you to AUTHORIZED UNDER THIS PERMIT IS NOT follow rules adopted by the Oregon Utility COMMENCED OR IS AB.al'4&~\Ie.'i!)/F@~VENTION DEVICE PERMIT I'MlHJdlIlM1~ter. Those rules are set forth , CITY OF SPRINGFIELD in OAR 952-001-001 0 through OAR 952-Q01- ANv 'P(1 1)0 I pr-Rlon BUILDING SAFETY DIVISIO~090. You may obtain copies of the rules by calling the center. (Note: the tele~ho~e mberfor~g~lln 11Q16ym~lcatl0n ~~SPE<ciM\~r Wt>J~GO-~23:V4l9 ~ 225 FIFTH STREET SPRINGFIELD OR 97477 ..' ~::-::::~:::~-~~---~~~-~~-~~:t--~~~------------------------ . ASSESSORS MAP 1I: II 03> ;;t?:. 30 TAX LOT 1I: dM)>r OVNER:~ '-:>{~~~ ADDRESS: J2510 f0/e;;fklAO II CITY: 5ori"'vld./;.~ JdI - / / Wd.y STATE: PHONE 1I: 91/. 7'Ltf 1/34'" 6J R ZIP: 97171 , BACKFLOV PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR: '~Ci>-I-f2 ADDRE~ CITY: / ~ .PHONE II: STATE: ZIP: -- ....... CONSTRUCTION CONTRACTORS REGISTRATION II: EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. ~~h~ FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: 7-3/- 9 '{(' RECEIPT #: n;;;oqq & ISSUED BY: TOTAL AMOUNT COLLECTED:Jh /0. {)1J \ JOB #: 97/7?sV 17, mrJfJnfldO -------------------------------------------------------------------------------- , , 16'(1,:,1 ~Y8 ~8: 3~ _..~~1~~~~. CALCULATIONS FUTURE B HOI-IEe ClI<NT fu Tu.. {LE- I ;J;, A PAGE tj'2 I:S lot u MI"_S "--::~~;:l~.'" r.. c' "":7"">_, , ' :to:.-~_ '..-;,.--"""7.....,.. . -..-:. W Il.-..I,,"~.,~_ ~r.~Yi..i;\~'" SHUT NO. 0' C.A.LClJLA TED BT DATE S'TRIJCTURAL BUILDINO OESIGN . 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JOd.:13)cc.SX: 9) J7 . 3.L 3~ 3.33 ..0,3;" -- (j;~}rS(3~J).1(.Sx.S) + IO( 5 <;7I'(,SX.9)] uS'uf="\" (,q01-4--"'>2~ ~ 1~J.j, 3.v7 ~ i/3J. -.;l.S78 ~ ,'OS;!.th "'f.~3 ^ 4'71 1- O...3'i ; 1..):'4 J'Y> - ') .3, ~ . IS =. ,1' .:':> -..'" /J.:J - ,,5'\l?S- 6)5 ~ ,;SOiUl 3,3.3 ,.IDLl)6vJNS ('KoL/r{Jl?[J .5~ 1:::/\ R- PAt>.}E..L. ~/1., 110 ~ %.S =- ~.S7' MI/'..J, (if) -<. 3. ~3' (SMI1LL.~SI ) pi Nk , 1"'P"'1. .c.... ...0... ,......n..... . ,/ ~5/08/1990 08: 39 541744. FUTURE B HO~'IE. P;'\GE El4 CUENT Fu Tu,...IC..E- R N-oMfO' :"._..,__. \,~ Fij ,1"", ,\ /., .~~:~:....' . li::7..,,; il,:'_.. "".' ';If iT~~::,~'.~.~.....~ " 't~i' "\f.."- 'n\I'.\'.._ CALCULATIONS SHH'f NO. ,,",, DJ. .f!, DATE OF CALCUlAT!:;:D BY STFlUCTulU.L BUIL1'::lING DESIGN. FIRE PROTECT10N cooe CONSUL'fAHT . Pl,AN CHECK1NG CONSTRUCTION INSPECTION CHECk-EO 8" DAT~ wo. It) ~'i :J LAT1'=4-A-L 0"-.) ,f)A~ Y-n ('IF N()U~F +F 1-1' PANEL.S A'(OVd0e-..a (iE-/'... 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