HomeMy WebLinkAboutPermit Backflow Test 2001-11-16
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I Job# 01-01269-01 I
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Page 1 of2
TRANSn: 01. -0007268
DATE:NOV 16 2001
AMT RECD: 2 $ 51. 15
CHANGE:
CASHIER:061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01269-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1011 Pleasant St Spr
Assessors Map#: 17032641
Lot: Block: Addition:
Tax Lot #: 07000
Subdivision:
Owner:
Phone Number: 541-48511270
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City/State/Zip: ~,prin!!fie!2-{qg:97477
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,'Reli~tratid~#, (J'Eipiration"'Date
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^v,,\6273b~'\' 0;>'" n\-"t2/15/2001
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Office Use ~ ~-J -~ 0 c,'l;
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Quad Area: Land Use: ~" # Of Buildings:
# Of Units: Zoning Code: Occupancy Group:
Constr. Type: Bedrooms: Heat Source:
Water Heater: Range: 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 folloW~ ~'<:"
working day. ((,~' ~~ fPq;.
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eqUlre _ nspec Ions _ ~ ~-::> #.
I PlumbinR I . c#~ (("q;. ~
-After device is installed but before backfilling trencl\c,<f(;.~~ ~<;J S~
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Height (f~:
Proposed Units:
Alvord Taylor Inc
Address:
405 A Street
Scope Of Work: Backflow Device
New
Backflow device
Contractor Type
Plumbing Contr
Contractor
Omlid & Swinney Fire Sprinkler.
1265 N 35Th St, Springfield, OR
97478-5553
Phone
541-741-1775
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. F~d)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Plumbinll
11/16/2001 7268
Value/Quantity
I
Fee Amount
Minimum Plumbing Permit Fee
$31.00
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Job# 01-01269-01
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Page 2 of 2
. Fee
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
Paid On Receipt#
Plumbing
11/16/2001 7268
11/16/2001 7268
11/16/2001 7268
Value/Quantity
I
Fee Amount
1
$3.15
$14.00
$3.60
$51.75
$51.75
By signing this permiVapplication. 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
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Signature Date