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HomeMy WebLinkAboutPermit Building 2000-6-6 . .! . \ ~ . I Job# 00-00880-01 I . Page 1 of2 TRANS~:01-0002033 DATE:JUN 06 2000 AMT RECD:2 $ 16.50 CHANGE: CASHIER: 061 CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-00880-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 4276 Cole Way Spr Assessors Map#: 18020524 Lot: Block: Addition: Tax Lot #: 06900 Subdivision: Redwood village Owner: Sierra Builders L1c 83188 Enterprise Road Phone Number: 541-744-8267 City/State/Zip: Creswell, OR 97426 New Value: $0 Address: Scope Of Work: Single Family Residence This is a copy with a new Application Number Contractor Type Landscape Contractor Decker landscape and irrigation . 27390 8th st, alvadore, OR 97409 Registration # Expiration Date Phone 541-688-7991 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: To request an inspection call Ihe 24 hour recording at 726-3769. All inspeci!o.".!!, ~eq\lested ~efore ,7:00IUllb" yOU ~L a.m. ~i11 be made the same working day, inspections requested after 7:00,ed~;vVfill,e~<.I1J'!9-lil~tbeJ!o.IIowihg!gon Utility working day. 'Iotilicatlol' Cente, Those rules are sat forth . . . ",",^" u,",".ill"'-'1()10 l'lrouah OAR 952-001- ReqUired Inspections bt . copl'es 01 tna rUles oy J090. You may 0 am I Plumbinll I callin9thecenter.(Note:.t~etel~~ho~a Backflow Device -After device is installed but before backfilling tr.~D.q~Jer for the Oregon Utility Notification . ('r-:""j~".l":: I ,'1r)~)~'":.'1,?~?~44). Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D' rArea (Sq. F, ,I) Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Total: Height (feet): Proposed Units: NOTICE: TMIS PERMIT SHALL EXPIRE IFTHE WORK /lIITI-l('\J:l17I=n 1II\Inl=RTHIS PERMIT IS NOT Fee Paid On Receip(#:OMM~J'JlQt~IMjlANDlFlfiPArhl6Lnt Plumbinll ~I~T I~ODAYPt::HIUU. 06/06/2000 2033 $5.00 Minimum Plumbing Permit Fee ../ .,\. . Job# 00-00880-01 . Page 2 of 2 Value/Quantity Fee Amount 1 Fee Paid On Receipt# Plumbin!l 06/06/2000 2033 06/06/2000 2033 06/06/2000 2033 1 $1.05 $10.00 $.45 $16.50 $16.50 State Surcharge For Plumbing Permit 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 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. Signature Date ..1 .'. . . SPRINGFIELD BACKFLOV PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 JOB LOCATION: L\ a.. '110 Lo \L LJ <>-..~ ASSESSORS MAP 1I: OIINER: ~ ~.p.ol' (' 0\.. ADDRESS: <61 \ ~~ CITY:~n.') \IJ\.. \\ TAX LOT 1I: \\-." "",~.s E-,^~rp{h.L R.~ STATE: OR PHONE 1I: lLfl.\-<b).,(P7 ZIP: BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CONTRACTOR: e l\iS ~, \)lLL'l.~(", ADDRESS: Q,O, \SOf-. q,l CITY: A\.J",J.o('\.. STATE: 0\t, CONSTRUCTION CONTRACTORS REGISTRATION 1I: l:)" '1 <::; '\ '\)p~( "\.LU' Lo,.,Jsc..oft Q",J. I"'f"~~,t\'n'O'" PHONE 1I: .~~~- 7'1<;\ ZIP:j]40" EXPIRES: '&- '5 \ - ).. 00 0 BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. -~ g? ~~ SIGN"ATURE - ~- b ~ :;LOOO FOR OFFICE USE -------------------------------------------------------------------------------- TOTAL AMOUNT COLLECTED: JOB 1I: CO ~ LX:>8'fiO -01 ~ -< -< C ;;0 :0:0 ;;0 -< :z mmC/J C") .. **' n t:::Ic....e.. :I> .. c:: 0 00 r-.J:Z~ -----------------------------------------------------------------------------~fJ~C)~ ", :x: 0"- 0 ;o::r>~ 0 .. :Z:O"-r-..l~ Oeil- 00 O'omt.no..... ~--oou ISSUED BY: DATE OF APPLICATION: RECEIPT 1I: