HomeMy WebLinkAboutPermit Backflow Test 2000-5-30
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00832-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 554 POL TAVA St Spr
Assessors Map#: 17033423
Lot: Block: Addition:
Tax Lot #: 01700
Subdivision:
Owner:
Address:
GERALD PRUDHOMME
557 POL TAVA ST
Phone Number: 541-988-1383
City/State/Zip: SPRINGFIELD, OR 97477
New Value: $0
Scope Of Work: Backflow Device
INSTALL BACKFLOW DEVICE
Contractor Type
General Contr
Contractor
Kings Custom Concrete
91243 Coburg Road, Eugene, OR
Registration # Expiration Date
Phone
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.
Backflow Device
Required Inspections
I PlumbinQ I
-After device is installed but before backfilling trench.
Public Works
Sidewalk
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
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TRANS#:01-0001941
DATE:MAY 30 2000
AMT RECD:2 $ 79.14
CHANGE:
CASHIER:004
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Fee
Job# 00-00832-01 I
Paid On Receipt#
Plumbing
05/30/2000 0001941
05/30/2000 0001941
05/30/2000 0001941
05/30/2000 0001941
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Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
1
$5.00
$1.05
$10.00
$.45
$16.50
New Sidewalk
New Curbcut
Total Public Works
Grand Total
By signing this permiUapplication, 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 application is true and correct.
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Signature Date
Public Works
05/30/2000 0001941
05/30/2000 0001941
134
$62.64
$.00
$62.64
$79.14