HomeMy WebLinkAboutPermit Plumbing 1997-04-29SPFINGFIELD
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RESTDENTTAIJ PERMIT APPLICATION
CITY OF SPRTNGFIEI.D
COMMT'NTTY SERVICES DIVISION
BUII.DING SAFETY
Page 1
Job Number: 97 0542
!
225 Nortsh Fifth Street
Springfield, OR 97477
Location of Proposed Work: 711 [fiLL ST
Assessors Ittap #: L7033522
Lot: Block:
office:
Inspection Line:
726 -37 59
726 -37 59
Tax Lot #: L47OO
Subdivision:
Owner: WESTFAIR ASSOC
Address: PO BOX 15157
Describe Work: TWO BACKFLOW DEVICES
phone #:
citylstate/zip: SEATTLE, wA 981-15
NEW
Plumbing
Contractor
VOS PLI]MBING OO418O5
PO Box 2189 Eugene OR 974O2OOOO
ConEt.
Contractor #Expiree
04/04/e8
Phone
485-0551
QUAD AREA: 1RNW
-- OFFICE USE --
LAND USE: 1134
To request an inspecEion, cal-L the 24 hour recording at 725-3769.
A11 inspections reguested before 7:00 a.m. will be made the same working day,
inspections reqluested after 7:00 a.m. will be made the fol]-owing work day.
--- REQUTRED TNSPECTTONS ---
BACKFLOW DEVICE - After device is installed but before backfilling
trench.
PI.I'}IBTNG PERMIT ---
Item
2 BACKFLOW DEVICES
Plumbing Permit
Surcharge/admin
TOTAI. CIIARGE (c)
Fee
30.00
30.00
2 .40
32.40
--- MISCELLAI'IEOUS PERMITS ---
Surcharge/eamin
BWOP PENALTY
TOTAT MISCEITIJATiIEOUS PERMITS (E)
0.00
30.00
30.00
(Excluding EIecErical)
unlees otsherwise noted
- - - TOTAL AITOUIIr DUE ...
(A, B, C, D, and E combined)62 .40
--- BUILDING VALUE, PLA.N CHECK AtiID BUILDTNG PERMIT ---
This permit is granted on the express condiEion that the said construction
shall, in aII respects, conform to the Ordinance adopEed by Ehe CiEy of
Springfield, including the Development Code, regulating the consErucEion and
use of buildings, and may be suspended or revoked at any time upon viol-ation
of any provisions of said ordinances.
SPTIINGFTELD
Job Number: 970542
o l
Page 2
Received By:
Plans Reviewed By:
Building Sit.e Reviewed By: LISA HOPPER
DaLe
... A.DDITIONAI. COMMENTS
By eignature, I Etate and agree, that I have carefully examined
the completed application and do hereby certsify that all information hereon
is true and correct, and I further certify that. any and all work performed
shall be done j-n accordance with the Ordinances of the City of Springfield,
and the Laws of t,he 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 Ehis project.
I further agree to ensure that all- required inspections are requested at the
proper time, that each address is readabfe from the street, that the permit
card is located at the front of the property, and the approved set of plans
wj-l-l remain on the site ats all times during construction.
-/-z* 77
Signature Date
--- VAI.IDATION ---
0 2 }SReceipt Number:
Date Paid:
AmounE Received:
Received By:
o