HomeMy WebLinkAboutPermit Plumbing 2002-8-7
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TRANS#:01-0010206
DATE:AUG 07 2002
AMT RECD:2 $ 51,75
CHANGE:
CASHIER:061
I Job# 02-00948-01 I
.
225 Fifth Street
Springfield, OR 97477
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00948-01
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4969 Forsythia St Spr
Assessors Map#: 18020422
Lot: Block: Addition:
Owner:
Tax Lot#: 03100
Subdivision:
Connie Secrist
Phone Number: 541-747-2678
City/State/Zip: Springfield, OR 97478
New Value: $0
Address: 4969 Forsythia Street
Scope Of Work: Backflow Device
Contractor Type
Landscape
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Install backflow device
C t t R. . # E' -.... r<'(IUlleD's yoU \,U
on rac or eglstratlon~(lol xplratlon ateJtillty Phone
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Grants Landscape Service " 10250,sadopte 9/30/20023 are set '541-746-8482
Po Box 221, Springfield, OR 97 477 to\'\tO;a~i~~ Centel. ih~soe ~9uhv OAR 952-00b~-
"'nt" _..... nn10tllf ..' _ ...,\ee:=. V
Office USE'-' (lARy"''';;;;;y obtain COPI~~~\~i~phO~e
Land Use: OO~~ili;9 the cente:~ t'tr~pj\~!!jlllifl~i;.atlon
Zoning Code: numberlOl tM? 1_i&,c;s!!pa-ric~,1Group:
Bedrooms: Center IS Heat Source:
Range: 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.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. Feet)
I Main: Accessory:
Backflow Device
Fcc
Required Inspections
I PluliiDUfd;t: I
-After device is installed but QE1IO'fJlftiaali.fillfngltlllbl:hEXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Paid On Receipt#
r--- Plumbin!!
08/07/2002 10206
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$31,00
.~ .
. /
Job# 02-'10948-'11
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Page 2 of 2
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Plumbinn
08/07/2002 10206
08/07/2002 10206
08/07/2002 10206
1
$3,15
$14,00
$3,60
$51.75
$51.75
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
Grand Total
By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has been inst led and is visible for inspection (726-3769). I also state that all information on this
per~t aif,pr at' n.:rue and correct.
~ J/ ___ f-7-oL
Signatu~ Date
225 F1ITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726,3753 . FAX: (541)726-3689
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p,.., Owner Lb/u/Il/e-- S(J'Cf-(S'-,-
~ Add=, 41(,1 !ifj477!"+-
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~ Contractor Information
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CITY OF SPRINGFIELD, OREGON
TRANS#:01-0010206
DATE:AUG 07 2002
AMT RECD:2 $ 51.75
CHANGE:
CASHIER:061
City Job Numb.. 02- -00 9Lf r -01
Job LocatioI' tf1!Ptf f61-5r11lfr1f- Sflf/Uj). ()f!- 77tJl!'
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Tax Lot
03/00
Phnrp
7C(7-Z& 7f
Statp
D;L-
Zir 97Y7Y
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
Contractor
GjUl1VI~ Wt>S <-Me- S'e1e-v\ US
Address
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Phonp 7)C,-J'OJ.Y
Statp 6(L 7ip '17Y7!
Cit:' 5rFGIJ. of-
Construction Contractors Registration #
/02 s-O
0'930 02..
Expires
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible for inspection (726-3769). I also state that all information on
this permit/apPliczatiozn's. c:Jle .
0-]-0 z..,
Signaturp DatI' 0
For Office Use
Date of Application
o 8'0 7 0 -z...
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Checked for Historical Stall'.
...---
Checked for Delinquencip<
Shared Drive rr:)/Building FormslBackflow Preventionl.o2.doc