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HomeMy WebLinkAboutPermit Plumbing 2000-6-21 Job# 00.00986.01 "~, ~... - ". . ,J:~)1.. ..... .,. Page 1 of 2 TRANS#:01~0002268 DATE:JUN 21 2000 AMT RECD:2 $ 16,50 CHANGE: CASHIER: 061 '-, . -~. ~ -- II CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-00986-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 location Of Proposed Site: 708 Blackstone St Spr Assessors Map#: 17032300 lot: Block: Addition: Tax lot #: Q0907 Subdivision: Owner: Rodney Chase 708 bfackstone st Phone Number: 541-746-6973 City/State/Zip: springfield, OR 97478 New Value: $0 Address: Scope Of Work: Backflow Device install backflow device Contractor Type Plumbing Contr Contractor Hidden rivers irrigation 3487 hawthorne, eugene, OR 97402 Registration # Expiration Date Phone 541-688-1131 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 1:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. .'d i ;:.:..;:~ : :'.i':, ,.." ._'.;;".", ,a""rtiqlllreS you lL, . .. follow rulet: adopted bv the Oreqon Utility ReqUired Inspectlons\lotificatlon CemGI. ThOse rules are set tom, I Plumbing ,n1 OAR 952-001-00"1 0 through OAR 952-001- -After device is installed but before backfilliiiigHrenBh,i may obtain copies oftherules by caliing the cemer. (Note: the teiephone numberfor the Oregon Utility Notification r-~_~y..",",: -.'~ .")(".n '':'11"). f)~ "4) \ .""";',,,:,":... " " '.' ;" "'.:- '0; "~" ,..,. , .. Backflow Device Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: # Of Stories: , Current Units: Census Code: Does not apply Height (feet): Proposed Units: Accessory: Total: NOTICE: I 71-:1:':" ~~~;\i;~ I .............411 . r--A_:~~~~":" ~!:~ '!'r_I~~_ Paid On RecEJ.fBt!f-tORIZ~~y~rpl~ PFRMin~ft~wmt , Plumbing COMMI=N!r,ED OR IS ABANDONED FOR "'.' 06/21/2000 226~NY 180 DAY PERIOD. $5.00 Fee Minimum Plumbing Permit Fee Fee ,I Job# 00.00986.01 Paid On Receipt# Plumbing 06/21/2000 . 2268 06/21/2000 2268 06/21/2000 .2268 Page 2 of 2 Value/Quantity Fee Amount 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 been installed and is visible for inspection (726-3769). I also state that all information on this permit application is true and correct. ' , 1 $1.05 $10.00 $.45 $16.50 $16.50 Signature Date TRANS#:01-0002268 000 ~.50 CHANGE: CASHIER: 061 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: ~8 b~t\dL'5-r(JNE: Lf:.~ c'1-g,i';) . TAX LOT #: " ASSESSORS MAP #: \2~1\E ~I r_~ ~ '1lL'( ADDRESS: "7 a a ,8 l ~LJC0)fJ{'i'{l( c::-'/ . D~[)" I O\1NER: ~ PHONE #: D-a) tt~.C:,- 0q ~.~ " ZIP: !ilrjI);J CITY: STATE: BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 . CONTRACTOR:~;\.rr0f"'"Y\~vtQ"> ~p{Ij . . ADDRESS: 311- ~ 0 H~"'rt-~ C).'f2:yil'i . PHONE *: -.hSi5" 113' ) al Iv f IJ-erCO CITY: 'Qvn" STATE: /)2. ZIP: q~z.p2- "V - '"-' I CONSTRUCTION CONTRAC~ORS REGISTRATION #: \ ~Ul- - EXPIRES:~ oj BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I, ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. ~~~~ SIGNATURE = 11 wL/-OQ DATE FOR OFFICE USE -----------------------------------------------------------------------~-----~-- DATE OF APPLICATION: ob 2- f 00 JOB #: co -oOCYrsb -0 f , RECEIPT #: ISSUED BY: ~ ~ TOTAL AMOUNT COLLECTED: /6~ --------------------------------------------------------------------------------