HomeMy WebLinkAboutPermit Plumbing 2000-6-9
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Job# 00-00915-01
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Page 1 of 2
TRANS#:01-0002099
DATE:JUN 09 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
RESIDENTIAL PERMIT
. City Of Springfield
Community Services Division
Building Safety .
Job Number: 00-00915-01
225 North Fifth Street .
Springfield,OR97477
. Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 786 Blackstone St Spr
Assessors Map#: 17032343
lot: Block: Addition: 3
Tax lot #: 02102
Subdivision: River Glen
Owner:
Address:
Future B Homes
P.O. Box 7425
Phone Number: 541-744-2660
City/State/Zip: Eugene, OR 97401
New Value: $0.
Scope Of Work: Single Family Residence
backflow device install
Contractor Type
Plumbing Contr
Contractor
Hunter Irrigation and Landscape
25226 Strawberry Lanej Veneta, OR
97487
Registration, # Expiration Date
Phone
Quad Area:
# Of Units:
Constr. Type:
Water Heater: .
1 .
(VN) Wood Frame
. Office Use
land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
Dwelling
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made t~e same working day, inspections requested after 7:0NOifI@(8)e made the following
working day. . . THISPERMITSHALLEXPIREIFTHEWORK
. R'. d I t" --I"~~UflDr-nTulcoP::lM'TI~NOT
equlre nspec Ions AU I nvr, L-L-V . - I ... - .
I Plumbing I COMMENCEDORISABANDONEDFOR
Backflow Device -After device is installed but before backfilling ~m~80 DAY PERIOD.
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
-Area (Sq. Feet)
Main: ' Accessory:
Fee
Store
# Of Stories: Height (feet): . ,
. .l....k.,...;.., ;iI;'" n\....,:\.,.j,C\1t.'icquttd..:yuu.
Current Umts: . ~~:~~~~~~:~~pf~a1bYtheOregon Utilii.
Census Code: New SF - detclC:;n~a. ct. Thoso (u!e~ are set fOl',
..Iotiflcatlon ,en e!. ... . ..... r ";
" OAR 952-001 -00'\ 0 thro~gh OAR 95~-OO
Total: . J090. You may obtai~.?O'ple,:~~:~:,:~~~~ 0.,
_ -11;....,p;;: 'i/'rn.n r'Q{II$.-o11 . ~ \1\ H.':";'. 1,.'._ "-'-1-
Paid On Rec~r~#~~.j~~Y.alueJGl:P-ai1H~it~i~I'~~ftEfA~~unt'
Plumbing "~I"~:"~' :,' . ."'" '. ". .... .. ..... .
06/09/2000 2099 $5.00
. Minimum Plumbing Permit Fee
Fee
Job# 00-00915-01
Paid On Receipt#
Plumbing
06/09/2000 2099
06/09/2000 2099
06/09/2000 2099
Page 2 of 2
, Value/Quantity Fee Amount
, State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
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 hereon 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 pertaining to the work described herein, and that NO OCCl!PANCY will be made.
of any structure without permission of the Community Services Division, Building Safety. I further
certify 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 requested at the proper time, that each
address is readable from the street, that the permit card is located at the front of the property; and the
approved set of plans will remain on the site at all times during construction. '
1
$1.05
$10.00
$.45 .
$16.50
$16.50
Signature'
Date
.
.
BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION 00 --0 D 9 / S - 0 (
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
JOB LOCATION:
'7~6
aG.k-s./ #IF:"'---
ASSESSORS MAP #:
OT,INER:, 14,('.A'v ~.4/ ..s
ADDRESS: 7 fr6' #41~k'8/~";~--
CITY: ~~r.-f'_~;:::::J , STATE:
TAX LOT #:
PHONE #: 7y~- 6' Sy@
6)~ ZIP: :77~:;?
\
BACKFLOW PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: )/u,..,-rzA Tff>At7~'7/~.y ..I
r
r /
ADDRESS: ;;'J~^6 ~6-t/~.r1y ,~.../
CITY: !A/\,.........7/1 STATE:
Lr?-,-./b7s e ~'"<..
-:--,
~"y ~
PHONE #: '3 JJ:- 3:~ -2/5-
~~ ZIP:}?7Vn
CONSTRUCTION CONTRACTORS REGISTRATION #: J /7f'? ~
EXPIRES: y~Y&-t9/
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/ApPLICATION IS
CORRECT.
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DATE
FOR OFFICE USE
DATE OF APPLICATION:
JOB #:
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RECEIPT #: ISSUED BY: ~o::::o
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TOTAL AMOUNT COLLECTED: ~ '7: ~
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