HomeMy WebLinkAboutPermit Plumbing 2001-11-13
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225 North Fifth Street
Springfield, OR 97477
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I Job# 01-01251-01 I
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Page 1 of2
TRANS#:Ol-0007239
DATE:NDV 13 2001.
AMT RECD:1 $ 51.75
CHANGE:
CASHIER:061
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01251-01
Office: 726-3759
Inspection Line: 726-3769
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Location Of Proposed Site: 6944 Jessica Dr Spr
Assessors Map#: 18020223
Lot: Block: Addition:
Owner:
Address:
Sara Kiner
6944 Jessica Dr
New
Scope Of Work: Backfiow Device
Backflow device
Contractor Type
Plumbing Contr
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Contractor
Grants Landscape Service
Po Box 221, Springfield. OR 97477
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
Tax Lot #: 03200
Subdivision:
Phone Number: 541-747-8809
City/State/Zip: Springfield. OR 97477
Value: $0 _'
...~
_)~~~~C.~
Q\'"'''' 9.~' \. ~
Regist~n # ~~1rilt~~tli\~Q~ Phone
~~;'Q~~cr 541-746-8482
~ . 'rQl _",0 -'"
l'\}" ~~'v"'" /y:""?-,,r
O~~ Q~\'
CJ ~'>{ \~ # Of Buildings:
f" 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.
Backflow Device
'0
Required Inspections "6'" ;--'~'\\\':l
eo.u\' \),\ :n
I Plumbin!! I 0\\ \'il-'i'i I Ola~O\\ sa\ \0(1: .
-After device is installed but before backfilling,(fiEfn~h. 'O'l \\\a u\es e~ 9s'Z-!::l:J~"
._~\,J' 60QWv osa I Op..'p ~as v,
p.."\ ~ lU\aS ee\\\el"~\\\IOU~\\ 0\ \\\a lU o\\a
\O\~~ce\\O\\ C()()\"'()()'\~n cOQ\~~\;'.e \0\a?~ce\\O\\
\,\0\\ a 9S'Z-- "o'O\e .\,\o,e.. .", \,\0\\
.\\Op..'P"ou \l\e, \\\e'. ~ \\ \)\\\\" ~AA).
\ g().' :nece nle\lO ~'Z-.Z
# Of Stories: 00 ce\X\\\9 \\,!eig~t (fltet):'3
C t U .t 1,)e1 n ''odS . d U 'ts
urren m s: \\u\l\ C!;ropose m:
Census Code: Does not apply
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
iArea (Sq. Feet)
I Main: Accessory:
Fee
Paid On Receipt#
Plumbin!!
11/13/2001 7239
Total:
Minimum Plumbing Permit Fee
Value/Quantity
Fee Amount
$31.00
By signing this permiVapplication, I agree to call for an inspection once the backflow prevention
device has been installed and is visible for inspection (726-3769), I also state that all information on
this~caw~
Si~'ature (
.~
~.,.'/ Fee
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
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Job# 01-01251-01
Paid On Receipt#
Plumbing
11/13/2001 7239
11/13/2001 7239
11/13/2001 7239
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Page 2 of2
Value/Quantity Fee Amount
I
1
$3.15
$14.00
$3,60
$51.75
$51.75
1//;3/0 I
I
Date
I
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SPAINQFIELD
".'
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
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Job Location: . b 9 (,/ L/ se S'51LfJ
Assessors Map #: . I 8d Z 0 2. 'Z.::.
Owner: ~/) fZ-.1J <t::, /V~
Address: 7r..i-:#(f..7': {,~CfC( JeS516A.
City: 5 Pr<-'I t--&--t0.e IJ State: 0 f-.
tlL
TaxLot#: 03 zoo
Phone#:~/7 ~<7, q () 9
Zip:c;7 '17 7
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
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Contractor: 6 tf2-;.d. o---.J)S- ~ ~ 5C::AR-e' ~f2-t/ J~
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Address: PO f:kx -:;.~i
City: 5" f?f2-J !'fG..;::ti (::/
Phone#:
Zip: 97 If ~ 7
. Expires: /0/0.").-
(
By signing this pennitlapplication, I agree to call for an inspection once the backflow prevention device has
been installed and is visible for inspection (726-3769), I also state that all information on this permit/application
is correct.
State: 0 t.-
Construction Contractors Registration#:
s-,;; 1::2-'
t~~ f:e/~~
S~ture / r en
1//9 /0/
Dare { .
FOR OFFICE USE
Date of Application: . I (If 541
, I
. Checked for Delinquencies:
Job #: 0 I - 0 It ~ I ~O I
7Z3 i
Checked for Historical Status:
VALIDATION: .
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