HomeMy WebLinkAboutPermit Plumbing 1997-04-29OF SPilNGFIEI.O,
RESIDEITTIAI. PERMIT APPLICATION
CITY OF SPRINGFIEIJD
COMMI'NITY SERVICES DIVISION
BUII,DTNG SAFETY
Page l-
ilob Number: 97 0543
225 North Fifth Street
Springfield, OR 97477
Location of Proposed Work: 733 MILL ST
Assessors tUap #: L7033522
Lot: BLock:
office:
Inspection Line:
726 -37 s9
726 -37 69
Tax Lo
Subdivis
:05100r#
ion
Owner: WESTFATR ASSOCIATES
Address: PO BOX 15157
Describe Work: BACKFIJOW DEVICE
phone #:
City/State/zj-p: SEATTLE, WA 98115
NEW
ConUracUor
Conat.
Contractor #Expiree
04/04/ee
Phone
485-0551Plumbing:VOS PLUMBING OO418O5
PO Box 2189 Eugene OR 9"74020000
QUAD AREA: 1RNW
-- OFFICE USE --
IJAND USE: Ll.34
To requeet an inspection, calf the 24 hour recording aL 726-3769.
A1I inspections requested before 7:00 a.m. wil-l be made t,he same working day,
inspect.ions reqlu.ested after 7:00 a.m. will be made the following work day.
--- REQUTRED TNSPECTTONS ---
BACKFLOW DEVICE - After device is instal-Ied but before backfilling
trench.
--- PLUIIBING PERMIT ---
Item
BACKFLOW DEVICE
Plumbing Permit
Surcharge/eamin
TOTAL CHARGE (c)
Fee
15.00
15.00
L.20
L5.20
--- MISCELLAIVEOUS PERMITS
Surcharge/admin
BWOP PENALTY
TOTAL I{ISCELtAI{EOUS PERMITS (E)
0.00
15.00
15.00
(Excluding Electrical)
unleEs otherwise noted
--- TOTAL AUOI'NT DUE ---
(A, B, c, D, and E combined)3L.20
-.. BUII,DING VALUE, PtAIiI CIIECK ATiID BUILDING PER}TIT ---
This permit is granted on the express condition that the said construction
shaII, in all respecLs, conform to the Ordinance adopted by the CiEy of
Springfield, including the DevelopmenE Code, regulating the construction and
use of buildings, and may be suspended or revoked at any time upon violation
of any provisions of said ordinances.
!iPFINGFIELD
SPRI''.GFTELD
.fob Number : 97 0543
OF SPruNGFIEI.O,
Page 2
Received By:
Plans Reviewed By:
Building Site Reviewed By: LISA HOPPER
DaEe:
- - - ADDITIONAI. COMMENTS
By signature, I EUaUe and agree, Ehat I have carefully examined
the completed application and do hereby certify that alL information hereon
is true and correct, and I further certify that any and al-] work performed
shalI be done in accordance with the Ordinances of the City of Springfield,
and the Laws of the 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 this project.
I further agree to ensure LhaL all required inspect.ions are requested at the
proper time, that each address is readable from the street, that the permit
card is located at the front, of the property, and the approved set of plans
will remain on the site at all times during construction.
l- z-"-? 7
Signature Date
--- VAI.IDATION ---
0 2Receipt, Number:
Datse Paid:
AmounL Received:
Received By:
3 2o