Loading...
HomeMy WebLinkAboutPermit Plumbing 2000-2-1 ".' ;-- . . . I Job# 00-00159-01 I Page 1 of2 TRANS#:01-0000429 DATE:FEB 01 2000 AMT RECD:1 $ 16.50 CHANGE: CASHIER: 059 SPRINGFIELD ~ CITY OF SPRINGFIELD~ OREGON COMMERCIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-00159-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 207 S A St Spr Assessors Map#: 17033532 Lot: Block: Addition: Tax Lot #: 07000 Subdivision: Owner: Address: Bob Hamelton 207 S A St Phone Number: 541-746-8534 City/State/Zip: Springfield, OR 97477 Alteration Value: $0 Scope Of Work: Plumbing Contractor Type General Contr Contractor Bob Hamelton 207 S A St, Springfield, OR 97477 Registration # Expiration Date Phone 541-746-8534 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Foot;:ge: 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 Plumbing I -After device is installed but before backfilling trench. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 ,Area (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# Plumbing 02/01/2000 429 02/01/2000 429 Value/Quantity Fee Amount Minimum Plumbing Permit Fee State Surcharge For Plumbing Permit $5.00 $1.05 Fee Job# 00-00159-01 Paid On Receipt# Plumbing 02/01/2000 429 02/01/2000 429 Page 2 of2 Value/Quantity Fee Amount 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 herein 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. I further state 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 reqUe~~d ~.::ess is readable from the street. ::2. _ / . Sign~ture i/ Date 1 $10.00 $.45 $16.50 $16.50 oc . . ;/ .~ . . BACKFLOY PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- .' ASSESSORS MAP #: OIlNER: Jj I? t JOB LOCATION: 1-.0 7 ':;0. /1.5 T i 1-0 ~3 '5 'S;)"- O:rOOO JIlL n1 e.-/7d Y{ TAX LOT #: ADDRESS: CITY: PHONE II: 711 $--?.s- 3' /j STATE: ZIP: BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) ~ $16.50 CONTRACTOR: (J.", e. .,. w Wz. D vr ADDRESS: S 9.5 ;: A/( ?:- P S"', CITY: /;::' Co<- q,&?d e a <: '7 A,"', . /' /' CONSTRUCTION CONTRACTORS REGISTRATION #: PHONE #: II if'.Y-.. {./<3';r STATE: n y e. yJ'//Yf ZIP: 71>?f6lS / 3/L)O JP' ,EXPIRES:d~~ BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION,. , (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT . SIGNATUR!:: " , tf2//~o DATE 7 j , , , FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: RECEIPT #: TOTAL AMOUNT COLLECTED: , JOB #: ISSUED BY: -------------------------------------------------------------------------------- '.