HomeMy WebLinkAboutPermit Building 2000-6-6
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I Job# 00-00881-01 I
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Page 1 of2
TRANS#:01-0002036
DATE:JUN 06 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER:032
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00881-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4288 Cole Way Spr
Assessors Map#: 18020524
Lot: Block: Addition:
Tax Lot #: 06900
Subdivision: Redwood
Owner:
Sierra Builders L1c
Phone Number: 541-744-8267
City/State/Zip: Creswell, OR 97426
New Value: $0
Address: 83188 Enterprise Road
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 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. .: '_I, .'-':\o.....;I.,l::;),...;Ic.:,~.,.:::yuub~iuUl
Tallow rules adopted by the Oregon Utilil\
. ..... - -. .,
Required Inspections ................~'.....; "".....,l\Jl. III\J';;:J;;' tl.lU::;;~Ctloo:ttlIUIUI
I Plumbinll 1'1 OAR 9b2-001-001~ (:'ro~gil OAo-1952.001.
-After device is installed but before backfilling tre~~~?' You may obtain copIes of the rules b)
"ailing the center. (Not:::: the tel::phone
number tor the Oregon Utility Notification
rr.'!....to~;(" 04 -"1f1~)~"''}_?~?'M4).
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Fee
NOTICE:
Total: THIS PERMIT SHALL F)(PII=li= Ii=TI.Jt= '^'''ov
Paid On Receipti~: ~~v!i1l!~C!l)I~lrtttYHIS PWMKrWo~fitr
PI b' - -.. "b'.;\\vcuvn '''f\Of\I~UUNI::DFOR
um mil ....
06/06/2000 2036 "'''' I u DAY PERIOD. $5.00
Minimum Plumbing Permit Fee
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Job# 00-00881-01
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Page 2 of 2
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Plumbinll
06/06/2000 2036
06/06/2000 2036
06/06/2000 2036
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
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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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JOB LOCATION:
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ASSESSORS MAP #:
OIINER: L, \ 0((' r~
ADDRESS: ~ ~ \ cg ~
CITY: r'('C <, Wt,\\
TAX LOT #:
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STATE: 0 i.(.
PHONE #: /4 ~ ~ <g ';). Co 1
ZIP:
BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: [1\ I: s 'P D<<....\lU'
ADDRESS: ~_O. \3o'j.... ~I
CITY: A hl/l\(JoI"l. €fi\ STATE: <9\(.
CONSTRUCTION CONTRACTORS REGISTRATION #: \d.~ '< ~
\)~c....w L-^,.J V c.~ o,.J. rt(\;O'\~;O '"
PHONE #: C, % ~-l~~\
ZIP: '1140~
EXPIRES: ~-~\ -';)....000
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.
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h~6-d-0c90
DATE
FOR OFFICE USE
DATE OF APPLICATION:
JOB #:D:::>.....CO ~CZI-O (
TOTAL AMOUNT COLLECTED:
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ISSUED BY:
RECEIPT #: