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HomeMy WebLinkAboutPermit Plumbing 2002-7-15 -r "~I .._......~.,.~_. ..~ ~ '!' "'" '..... I Job# 02-00832-01 I Page 1 of 2 mANS1t:cJl-0009923 DAiE:JUL 15 2002 AMT RECD:2 $ 51.75 CHfiNGE: CASHlm:061 SPRINGFIELD ~. CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 02-00832-01 225 Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 3397 Ambleside Dr Spr Assessors Map#: 17021943 Lot: Block: Addition: Tax Lot #: 08300 Subdivision: Ambleside Meadows Owner: Address: Steve Williams 7297 Holly Street Phone Number: 541-726-1525 City/State/Zip: Springfield, OR 97478 New Value: $0 Scope Of Work: Backflow Device Backflow device Construction Types:(VN) Wood Frame Occupancy Groups: Dwelling # Of Buildings: # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: Contractor Type Contractor Registration # EXP~' ~~<ri~e Landscape Schelskys - SLI 6330 ~~~ ~o& 541-744-7135 P.O. Box 7945, Eugene, OR 97401 ~~\~ ~<t;,~ <",'\) o:.c\)~ ., '" ,\c:.. c"'w..:, . . ~~,?-". "\<,1 ~v' Office U~. ~." ~~<t;,~ ~~~~ . Land use:~()~~ ~<t;,~'i<t;,~ ~ I\J~ \~ ~~. # Of Buildings: Zoning COd~\~~I\J~\,,<t;,~ ,~<t;,~ Occupancy Group: Dwelling Bedrooms: ~'0 ~~Y;. ~ ~~ !i~~~ Source: Range: ,,\S ~ ,\'0 Sq. 'Footage: ~~ To request an inspection call the 24 hour recording at 726-3769, All inspections requested befor,fO~:OO a.m. will be made the same working day, inspections requested after 7:00 a,m, will be mad~2tl:1e;lfo!l~v;.ing working day. ,,"\'l\I ~e~\> eQP'(\ \) '\ \O~\ \rl:",\;;;J> e O~ e se O\~ R . d I t' "d:;-&~ .--,! '\.'\1 . _c '3.~ _dJ'() . equlre nspec lonsu~\"""- 'e\}....' ,\>'- r-..~"- SV' . -; ~'- ~ oO~\. -r ose ~ Or ~~\e I Plumbmp\\~. ~.~\lhs '3' '(\\e\" \ '\I \\\\O'J~ 0\ \'{'.e 'K\O'(\~ -After device is installed but befOre\lia~~filllQg,fr~t;lr~P'\~'(\ CO~\~~'\Ie\e\e~\\c'3.\\O'(\ ~O~~~ 9~:~~'1 O~~~. \~~~\\X\\'J ~~;. \'(\ 90 :'iOv \",e ce'(\ Q\eC}O\ \ ~,?{)..? (JCJ ~\\'(\<b \ \\\e '\ _9-('.0~' c'3' e~ \0 ~ ,'" Accessor;y\.St}1ctgre",\0 # Of Stories: Height (feet): Current Units: Proposed Units:1 Census Code: New SF - detached Phone Quad Area: # Of Units: Constr. Type: Water Heater: 1 (VN) Wood Frame Backflow Device Accessory: Total: Fee Paid On Receipt# Plumbing 07/15/2002 9923 Value/Quantity Fee Amount Minimum Plumbing Permit Fee $31.00 Fee State Surcharge - Plumbing Backflow Prevention Device 8% Administrative Fee - Plumbing Total Plumbing Grand Total Job# 02-00832-01 Paid On Receipt# Plumbing 07/15/2002 9923 07/15/2002 9923 07/15/2002 9923 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 permit ,pliC tion is true~ corr~c~ ~~~,. Signature - ----,,}/ --, II ") 10 2- 'I' I Date ,~ eoT'r'"":14 ~= ~~ ~,/ ~ ~ tJ4 ~ r~,~~ ~ o r~~~ .~ "'~.;," ~ M .. , TRANS# . 01-,0(;09923 , ,D1Wr.<<t.: 1;:; 'f(1rJ-r) . nj~s ~~ L~'_ {W-j. '. ,RI!:.A7I ,l;.j.' ,':;"k '7 r " ;m;'.~h.;'wM.-.:j:L~" ",~rnl.t ~-...I, Lu i.:" '4J .,J.L ft t...J CHPlf,Ji:3i: ; CASHIE:~~: 061 City Job Number 02 -00 g.:> z. 33. 9 7 AVV\ bl (-s'": dc:- 170 Z-19Lfs. be Tax Lot 083<JO s I- "" c-:((,\;;... )" 33f7 A__ j, ~r ,,",, Phone '5,o..p tJ. , of!. Zip <('7Ff7(? State ~ '~ BACKFLOW PERMIT ~0JiDcludes Permit Fee, State Surcharge & Administrative Fee) Phone 7L;t(-- 7/3 ~ E",-~-t o.e ZipJf. ,"'WtJ I , , '" :-j~ l , ..~'" '~,. ~Vl'" rrt..;""" J .: . ,".;' , ~,\(;cGP",,:( :\"j / '~3 D .,''\\,:'i:\'.6..... :E~pi~s.;;21"z,..~ 0 3 ..' '-' ~ ""l(;.i::" . P. ~\- u\-:'J"'" ~ c~'I"..' .,...:... . ,..,~ '..: _.....c. _ I\--,....~ ..;;"'- _ ~;"'\\.; , , ,..\__"c.- . 'I\~- ,,:,\v" 1\';''''''''- .". ,:' ';v,w ,_ ."c!\C\' 'O\\\~olJ~J' ~ \\"\8. .,,~ '" '".". ",.'....-;....;.J, rl'\'\ ' ~i"'S O. \r'jC\~w ",',' "ct.,v. . "'\" .",V 'CC\.J'" 'ra1eQ. ,~ ',' ,."''' -j v I ,f, -. n'=' ,,," ,..'~Ol By signing this permit/application, I agree to c~~(f.Qr~a~:r~~p.~cti9~ ~nc'e').mt:(,\>fl"CK,flB'~ prevention devise has been installed and is visible for inspeqtj,6n"fl,f~~~"l6'9):.~!~~lsd)ta?e;th~t all information on this permit/application is correct. v~~~~~.~:;~;:-_~~> _>1", I \\ .~!_ 1.' "... ,.,,- State Signature 0__ ~ Date of Application 07/ S-o z... D.4~/(J2- A~~~~~~~~~ " ~l"~~~ ~ ~ For Office ~ !lot t::J~~~~~ ~~'P~ ~~~ ~~~~ \$," ~' ~~~ ~~1.~~ ()~~~~~. ~ (\\", ~<..~ .....~ y;..... ~~~(- ~ V- i ___ ~~ ~,\Cij V'" Che~l1 for Historical Status Checked for Delinquencies ".,-- Shared Drive (T:)/Building Fonns/BackJlow Preventionl.02,doc