HomeMy WebLinkAboutPermit Plumbing 2000-2-1
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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
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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
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BACKFLOY 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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.' 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,"',
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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
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DATE OF APPLICATION:
RECEIPT #:
TOTAL AMOUNT COLLECTED:
, JOB #:
ISSUED BY:
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