HomeMy WebLinkAboutPermit Backflow Test 2000-11-21
..
.
I Job# 00-01700.01 I
.
CITY OF SPRINGFIELD, OREGON
Page 1 of2
TRANS#:01-0003841
DATE:NOV 21 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER:061
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01700-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 735 Old Orchard Ln Spr
Assessors Map#: 17032343
Lot: Block: Addition: 3rd
Tax Lot #: 02102
Subdivision: River Glen
Owner:
Future B Inc,
Po Box 7425
Phone Number: 541-744-2660
Address:
Scope Of Work: Backflow Device
City/State/Zip:
New
Eugene, OR 97401-0017
Value: $0
backflow device
Contractor Type
Landscape
Contractor
Hunter Irrigation and Landscape
25226 Strawberry Lane, Veneta, OR
97487
Registration # Expiration Date
Phone
- Office Use
Land Use: # Of Buildings:
Zoning Code: Occupancy Group: Dwelling
Bedrooms: Heat Source:
Range: '.'" "''';. Sq. Footage:
;. ..
-- co >,cp 'IT SHf\I L f;XPI1::: 1;- II-it: '!VV'''''
To request an inspection call the 24 hour recording at 726-3769. All inspections'requested before,7.:00'\TISNOT
a,m. will be made the same working day, inspections requested after ,7;:OOa.m,:WTI'j;be'lTjad~ tii'e::-fbll()i!Ji~g. '"
working day, ,.. . ,=,~c:::; OF:S ABANDONED 1-0.,
L. ",d......_ .....-
Required Inspections" .::: :.'." a'=':Lnn
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
Backflow Device
I Plumbing )
-After device is installed but before backfilling trench.
Construction Types:(VN) Wood Frame
Occupancy Groups:Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[Ar~a (Sq. Feet)
_ Mam: Accessory:
, . .....,..,.;..#. "r"~' I
TTE"-"'O~I."..."~-:,,, .'.' - .
1\1 I 1'\31 .- -,: .. .,~. """ .., on' "+;;:1\
AccessoryStructure,I""~,dc"", ""1 "r,u I
11..1111..'" ,.. ....' " .' I . "'I~
# Of Stories: NotifiLHeighf(feet):.IIIUSc ,1''-'' .' , .' ,
. . ,. qr," 'rl~- I ,'j1lC1HUfl\)"\;' ).,....'h.,
Current Umts: In OAPrOpOsed"Umts:1., n; 'C. ~: i:'" ""I~s b
r.\r.t"w V )1)'11":.'1" ')ht'-'111 " . .
CensusCode:NewSF-detach~d" ':. "" 1 '~I.:.)'r.lJI13
calhlflJ .' '" _.,m ",' - ..' .'
b 1 . 1-' l ,.,. I" i.t~:'t\ \b~'~IC.3.uor
nu.11 tJr VI. . ...! ,.,,",
Total: G-- ," \.
Fee
Paid On , Receipt#
Plumbing
11/21/2000 3841
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
I,
.
Job# 00-01700.01 I
Paid On Receipt#
Plumbing
11/21/2000 3841
11/21/2000 3841
11/21/2000 3841
.
Page 2 of 2
Value/Quantity Fee Amount
Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signing this permit/application. I agree to call for an inspection once the backflow prevention
device has b en installed and is visible for inspection (726-3769). I also state that all information on
this per~ plica' n is true a d correct.
1
$1,05
$10,00
$.45
$16.50
$16.50
)/-2,/-d> &/
Date
"
.
.
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
--------------------------------------------------------------------------------
,
JOB LOCATION: 'l31.r CJ t. & (!)/fc"f),;-9/f;Gl
ASSESSORS HAP II: 17o~ 2. 3L(:) TAX LOT II: 02 /6 Z-
OVNER: F<-<-IU -< <- ./f H 6 _~ ~<,
ADDRESS: f?tfJ. g~ 7<'t';J.. r PHONE II: 7V'-;l-~ b.6'O
CITY:
STATE:
ZIP:
BACKFLOII PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16. 50
CONTRACTOR: II U-A/7<.A. l)f>;f1,<pT;#_ ..; /i4-~ ,,cJ s e. i9/-l-\...
,
ADDRESS: ~,f""J..:z ~ S'7?f'~U/~.-f'A"/ 1..../ PHONE II: '9J"u-o..S..2../ J-
-
.,-.,
?. ^I ~
CITY: 'J/c~._ 'T'A- STATE: (!7~
. ..
ZIP: 9?Y' Y?
EXPIRES: "1-3" - t9 /
CONSTRUCTION CONTRACTORS REGISTRATION II: / J"'5 ? ?-
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOII PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
""JL /~
I h;;. /- t9.!7
DATE
FOR OFFICE USE
::::-::-:::~:::::::~-----~~~~~-j7v:::----------------------:::-:~-~:;~::~-~~ - ()/
1 I "-
RECEIPT II: -:s g'i( ~ ISSUED BY: vf:. ~ -I
-I "" ::0
TOTAL AMOUNT COLLECTED: If, <,~ fg~~
C"J.. **
C"J l::::l:Z:..
-----------------------~----------------------------------------------------~-- ~~:=;
:I: I
1--f(""J(04NO
fTlI ........0
;0:0....... C)
.. zcr-.r-..Jt.N
ocn. aeo
l:1""-rrlU'10~
.......... 00........