HomeMy WebLinkAboutPermit Plumbing 1997-4-29
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SPRINGFIELD
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Page 1
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
Job Number: 970544
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 855 A ST
Assessors Map #: 17033542
Lot: Block:
Tax Lot #: 04200
Subdivision:
Owner: KATHRYN BRYSON TRUST Phone #: 0
Address: 31476 SW OLD FARM ROAD City/State/Zip: WILSONVILLE, OREGON 97070
Describe Work: BACKFLOW DEVICE
NEW
Contractor
Const.
Contractor #
Expires
Phone
Plumbing:
VOS PLUMBING 0041805
PO Box 2189 Eugene OR 974020000
04/04/98
485-0551
QUAD AREA: 2RNW
OFFICE USE
LAND USE: 1134
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 work day.
REQUIRED INSPECTIONS ---
BACKFLOW DEVICE - After device is installed but before backfilling
trench.
--- PLUMBING PERMIT ---
Item
BACKFLOW DEVICE
Fee
15.00
Plumbing Permit
Surcharge/Admin
15.00
1.20
TOTAL CHARGE
(C)
16.20
--- MISCELLANEOUS PERMITS ---
Surcharge/Admin
BWOP PENALTY
0.00
15.00
TOTAL MISCELLANEOUS PERMITS
(E)
15.00
(Excluding Electrical)
unless otherwise noted
TOTAL AMOUNT DUE
(A, B, C, D, and E combined)
31.20
--- BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT ---
This permit is granted on the express condition that the said construction
shall, in all respects, conform to the Ordinance adopted by the City of
Springfield, including the Development Code, regulating the construction and
use of buildings, and may be suspended or revoked at any time upon violation
of any provisions of said ordinances.
SPRINGFIELD
Job Number: 970544
Page 2
Received By:
Plans Reviewed By: Date:
Building Site Reviewed By: LISA HOPPER
--- ADDITIONAL COMMENTS ---
By signature, X 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 OCCUPANCY 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.
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Signature
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Date
-- - VALIDATION
Date Paid:
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Receipt Number:
Amount Received:
Received By: