HomeMy WebLinkAboutPermit Plumbing 2000-6-21
Job# 00.00986.01
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Page 1 of 2
TRANS#:01~0002268
DATE:JUN 21 2000
AMT RECD:2 $ 16,50
CHANGE:
CASHIER: 061
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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
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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
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JOB LOCATION:
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. TAX LOT #:
" ASSESSORS MAP #:
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ADDRESS: "7 a a ,8 l ~LJC0)fJ{'i'{l(
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O\1NER:
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PHONE #:
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" 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-
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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~
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