HomeMy WebLinkAboutPermit Plumbing 2000-9-20
.;;.... . ',..
.
I Job# 00-01414-01 I
.
Page 1 of 2
TRANS#:01-0003261
DATE: SEP 20 2000
AMT RECD:1 $ 20.00
CHANGE:$ 3.50
CASHIER: 061
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01414-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 1058 Island St Spr
Assessors Map.#: 17033421
lot: Block: Addition:
Tax lot #: 00314
Subdivision:
Owner:
George Hanson
1058 Island St
Phone Number: 541-746-3873
City/State/Zip: Springfield, OR 97477
New Value: $0
Address:
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.
Backflow Device
Required Inspections NO"Tllit:.; THE WORK
I Plumbin!! I THI~PERM\TSHALLEXPIRE\F TISNO"
-After device is installed but before backfilling tren~ORIZEDUNDERTH\SPERM\ R
AU, OR IS ABANDONED FO
COMMENCED
ANY 180 DAY PERIOD.
Construction Types:
. Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
Main: Accessory:
Fee
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply 'res you to
I ATTENTION:Oregon la~~ed~~gon Utility
Total: follow rule:"~~~~~~h~~e rules ar.e_s.?~ ~~~:
i~.:hl(.:.:"""'d~:'.__::l ul'uu9r:.._...._h..,--
Paid On Recm~R952V'~.I.-Cl~~.lJtj\);leSof1l'lierAn\~liWt
PI b. OU~u. lUV"""Y 3,,-- INo'e.thete'l:llJllu"~
um In!!. Ithecenter.\.. tlfl atlon
09/20/2000 3261 C8111"1I f rtheoregonUtllityNO C $5.00
09/20/2000 3261 nUlOba~~ntorlS 1_800-332-2344). $1.05
09/20/2000 ;3261 1 $10.00
'0
Minimum Plumbing Permit Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
'r
..... r'.
.
Job# 00-01414-01
.
Page 2 of 2
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Plumbin!!
09/20/2000 3261
$.45
$16.50
$16.50
Plumbing Administrative Fee
Total Plumbing
Grand Total
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 permit application is true and correct.
lim., ~-
SignMure
'1/20./00
Date
-- ."....
.
.
BACKFLOY 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:
/ ().5>25 ..Is L -AN tJ
i 70 33Lf2.1
s~
(,
TAX LOT I: 00 S I tf
.' ASSESSORS MAP I:
OYNER: (;e.c,..,,,, J./MSOn.
- -. .J
ADDRESS: . }058 'Xs/...;,J.. Sf
CITY: Sfr.',,:: -t: ~ Id
STATE:
PHONE I: 7'1(, - 3tf73
(jR.. ZIP: 97'177
BACKFLOY PERMIT IS $15.00 + 1. 05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) c $16.50
CONTRACTOR:
ADDRESS:
CITY:
r-
. r~\
C 1-',
.....--- ~
PHONE I:
STATE:
ZIP:
CONSTRUCTION CONTRACTORS REGISTRATION I:
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
I . '.
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT. . .
aAT~~ Ii.-.-
CJ/2bJoo
DATE j f
FOR OFFICE USE
--------------------------------------------------------------------------------
DATE OF APPLICATION:
0'72.06 D
JOB I: DO - 0 I L( /1.( - 0 (
RECEIPT I:
32~(
ISSUED BY:
~~
~ -f
. 0;:0
DD
;:0 ......z
. . C') rTl fT1 (I)
IC""J.. '**
. . (")DOc.o..
.: .. nZ...rr1O
'_____________________________________________________-----------------------~~_o~
. . .:I:rTl I
...........""0
("T1~ 00
;:0 "" 0
..(....JOf'\)c....J
O. . 0""
O"-tJ'1ooa-.
1-1-000......
TOTAL AMOUNT COLLECTED:
/6~