HomeMy WebLinkAboutPermit Backflow Test 2001-6-19
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I Job# 01-00625-01 I
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Page 1 of2
TRANS#:01-0005870
DATE: JUN 19 2001
AMT RECD:1 $ 20.00
CHANGE:$ 3.50
CASHIER:003
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00625-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 804 Royaldel Ln Spr
Assessors Map#: 17032343
Lot: Block: Addition:
Tax Lot #: 02102
Subdivision:
Owner:
Mark Reifschneider
804 Royaldel Lane
Phone Number: 541- -
Address:
Scope Of Work: Plumbing
City/State/Zip:
New
Springfield, OR 97477
Value: $0
Back flow device
Contractor Type
Plumbing Contr
Contractor
SCHELSKYS
P.O. Box 7945, Eugene, OR 97401
Registration # Expiration Date
Phone
541-744-7135
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
BackfJow Device
Required Inspections
I Plumbing I
-After device is installed but before backfilling trench.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. F~, l)~n..
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Plumbing
06/19/2001 5870
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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Job# 01-00625-01
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Page 2 of 2
Value/Quantity Fee Amount
I
Fee
Paid On Receipt#
Plumbinn
06/19/2001 5870
06/19/2001 5870
06/19/2001 5870
1
$1.05
$10.00
$.45
$16.50
$16.50
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
By signature. I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein 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. I further state 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
requee al re proper time ~ that t~e.lroject address is readable from the street. b Ii f /0 (
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Signature-/" Date