HomeMy WebLinkAboutPermit Plumbing 2001-9-6
T
I Job# 01-00965-01
--",.
Page 1 of 2
TRANS#; 01'-0006617
DATE~SEP 06 2001
AMT pc~n,0. ~ hi ry~
I ! 'I I \LLJU : L '41 :J:.J... i J
CHANGE:
CASHIER:061
CITY OF SPRINGFIELD, OREGON
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00965-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 204 00030TH St Spr
Assessors Map#: 17023100
lot: Block: Addition:
Tax lot #: 00700
Subdivision:
Owner:
Address:
Goodwill Industries
855 Seneca
Phone Number: 541-345-1801
City/State/Zip: Eugene, OR 97402
New Value: $0
Scope Of Work: Plumbing
Install new toilet
Contractor Type
Plumbing Contr
Contractor
Twin Rivers Plumbing Inc.
PO Box 40397, Eugene, OR 97404-0064
Registration #
17695
Expiration Date
3/11/2003
Phone
541-688-1444
Office Use
land Use: #. Of Buildings:
Zoning Code: I qOfccupar:lc,Y Group:
TION,O~ogon aw re lA Ire;;:, j'V'" .'
Bedrooms: ATTEN . '," Ol:leatrSolftce:
I d pted by the ''''l::I-' ~_.J, .
Range: follow ru es a 0 I-Sq'r~ootagen
",_~;~:...",tinn r.Anter. Those ru c.... . .., _~_:.. __A
. . . ;._~~~Q~~_00170010t~rougnu~:':;1;:)~-vvl.
To request an inspection call the 24 hour recording ai17'26!3769. ~IIIQSRectIOJlSillequeste<:Jll)efdfe'7:00
.. .., (\nonvnllffi;;tVI,lJ,C1"'vr-'.=' .
a.m. Will be made the same working day, Inspectlons~reqtlestedliafter 7.:00 a-.m~LwI1I1betlTha<:Je:tlile follOWing
II' t 0 celllt:\ \I\lV>V... ~ - ' .
working day. ca mg '-' hOe' gon Utility Notification
number for t e r _
R . d I - to, .'.- - j- ~ Qn'1_~~?-2344).
eqUlre nspeclons ~
Plumbing
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Rough Plumbing
Final Plumbing
- Prior to cover.
- When all plumbing work is complete.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
NOTICE: , ",' - K
PERMIT SHALL EXPIRE IF THE WOR
# Of Stories: THIS H~~Bt:~ep~~S PERMIT \S NOT
Current Units: AU~~~~I:Elproposed ~~~~NED FOR
Census Code: Doe~(j)0t~app'lyED OR IS AS
AN) 180 DAY PERIOD,
Total:
Fee
Minimum Plumbing Permit Fee
Number of Fixtures
State Surcharge - Plumbing
Administrative Fee - Plumbing
Total Plumbing
Grand Total
Job# 01-00965-01
Paid On Receipt#
Plumbing
09/06/2001 6617
09/06/2001 6617
09/06/2001 6617
09/06/2001 6617
Page 2 of 2
Value/Quantity Fee Amount
1
$31.00
$14.00
$3.15
$3,60
$51.75
$51.75
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
requested at the proper time and that the project address is readable from the street.
~~fi~
Signature
q /~ /2-00
ole /