HomeMy WebLinkAboutPermit Plumbing 2001-5-29
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I Job# 01-00541-01 I
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Page 1 af 2
TRANS#:01-0005553
DATE:MAY 29 2001
AMT REeD:1 $ 16,50
CHANGE:
CASHIEF~; 061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00541-01
225 Narth Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 4260 Daisy St Spr
Assessors Map#: 17023233
lot: Block: Addition:
Tax lot #: 00601
Subdivision:
Owner:
Paul Wilsan
Phone Number: 541-741-0930
City/State/Zip: Springfield, OR 97478
New Value: $0
Address: 4260 Daisy St
Scope Of Work: Plumbing
underflaar plumbing repair
Contractor Type
Plumbing Cantr
Contractor
Paul Wilsan
4260 Daisy St, Springfield, OR 97478
Registration # Expiration Date
Phone
541-741-0930
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
land Use:
Zoning Code:
Bedrooms:
Range:
,
# Of Buildings:
Occupancy Group: '
Heat Source:
Sq. Footage:,
'I
To. request an inspectian call the 24 haur recarding at 726-3769. All inspectians requested before 7:00
a,m. will be made the same warking day, inspectians requested after 7:00 a,m. will be ,made the fallowing
warking day. . . , ',- ,
Required Inspections
Plumbing
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." _ ,I. _,,: .
Rough Plumbing
Final Plumbing
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
-Area (Sq. Feet)
Main:
- Priar to. caver.
-When all plumbing wark is camplete:,\'~~,_";~:
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# Of Stories:
Current Units:
Census Code: Daes nat apply
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f 'V 18l' 'Heigh't'{feet}:
Proposed Units:
Accessory:
Total:
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Job# 01-00541-01
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Page 2 of 2
Value/Quantity Fee Amount
I
, '
Fee
Paid On Receipt#
Plumbing
OS/29/2001 5553
OS/29/2001 5553
OS/29/2001 5553
OS/29/2001 5553
1
$5.00
$10.00
$1.05
$.45
$16.50
$16.50
Minimum Plumbing Permit Fee
Number of Fixtures
State Surcharge - Plumbing
Administrative Fee - Plumbing
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
requeste~ ;; proPrf tim1 and {hat .\9'l project add ress is readable from the street.
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Signature Date
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,
P 447 891 .966
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDEO
NOT FOR INTERNATIONAL MAil
(See Reverse)
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~lsenttoM t
~ argare L Batchelor
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; I Street a19 ~5. Box 611
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Q; P.O.. State and ZIP Code
~ Sorinafield.
~ Postage
O~ 97477
s
.25
Certified Fee
.85
Special Delivery Fee
Restricted Delivery Fee
Return Receipt showing
to whom and Date Delivered
III
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.90
s 2.00
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