HomeMy WebLinkAboutPermit Plumbing 2000-6-23
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I Job# 00-00997-01 I
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Page 1 of2
TRANS#:01-0002294
DATE:JUN 23 2000
ANT RECD:2 $ 16.50
CHANGE:
CASHIER:061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00997-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4691 Hailey Ct Spr
Assessors Map#: 18020512
Lot: Block: Addition:
Tax Lot #: 10500
Subdivision:
Owner:
Address:
Mark Allen
4691 Hailey Ct
Phone Number: 541-747-7310
City/State/Zip: Springfield, OR 97478
New Value: $0
Scope Of Work: Backflow Device
backflow device
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
- Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[Ar~a (Sq. Feet)
_ Main: Accessory:
Required Inspections
I Plumbing I
-After device is installed but before backfilling trench. .,' _" '~"".....,.".". ...a.' r<Jq,lITesyout{
lOHow rules adopted by the Oregon Utility
'ntiflcc:tlo, Cent\.;1 These rules are set forth
. 0/-,1-, tl:.<:-uv 1-l.lJhj 1;"uUgdOA,'1S52-00i-
J09lJ YOLi ,Tlay obtain copies ollhe rules by
<':1.lIlr:', .n" ';'3I1ter. (Not:: the t::l;.pl1one
Height,I!,~~n:; lor ttllJ Oregon Utility Notification
Proposed Unlts:.~.,. '. . ..""r\.."^,:'!)'l.14).
# Of Stories:
Current Units:
Census Code: Does not apply
Backflow Device
Total:
Fee
Paid On Receipt#
Plumbinll
06/23/2000 2294
06/23/2000 2294
06/23/2000 2294
Value/Quantity Fee Amount
"lOTICE:
THIS PERMIT SHALL EXPIRE IF1~r~&~ORK
AUTHORIZED UN!jlER THIS PEI$'1ofdo' NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Minimum Plumbing Permit Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
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Job# 00-00997-01
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Page 2 of2
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Plumbinll
06/23/2000 2294
$.45
$16.50
$16.50
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signing this permit/application, 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 true and correct.
Signature
Date
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TRANS#:01-0002294
- 00
50
CHANGE:
CASHIER: 061
SPRINGFIELD
BACKFLOY PREVENTIO~ DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
:::-::::~:::~--~~;----~~l:~----~-J~------------------------------------------
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ASSESSORS MAP ll: 1 'bO Z OS 1 Z-
OllNER: M(>;.s-l J..i\~,^
ADDRESS: t.//h9/ ~(I~ ci-
CITY: "lX\vVooJ.old
TAX LOT ll: 10500
PHONE ll: 7<{7 - -, '310
STATE: cR ZIP: Q)ct7/3
BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: O'A1i1d: J Se.JF
ADDRESS:
PHONE ll:
CITY:
STATE:
ZIP:
CONSTRUCTION CONTRACTORS REGISTRATION ll:
EXPIRES:
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 .
IttJJ J/
&-Z3-oo
DATE
FOR OFFICE USE
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JOB 11: OO-oo'797-0{
DATE OF APPLICATION: 06 Z'3 00
RECEIPT ll: ISSUED BY: ~E
TOTAL AMOUNT COLLECTED: Ib~
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