HomeMy WebLinkAboutPermit Plumbing 1997-04-29SPF!rrGFIELE,
RESIDE}flTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMI'NITY SERVICES DIVISION
BUII.DING SAFETY
a a
Office:
Inspection Line:
Page 1
ilob Number: 97O54L
726 -37 59
726 -37 59
225 NorEh Fifth StreeL
Springfield, OR 97477
Locatsion of Proposed Work: 844 MILL ST
Assessors tutap #; L7033522
Lot: Block:
Tax Lot #: 09800
Subdivision:
Owner: KYIING S GREGOR
Address:. 4l6L FAIROAKS ROAD
Describe Work: 5 BACKFLOW DEVICES
phone #:
city/srare/zip: EUGENE, OREGON 97401,
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 regueet an inspecEion, call the 24 hour recording aL 726-3769.
A11 inspecEions requested before 7:00 a.m. will be made Ehe same working day,
inspections requested after 7:00 a.m. will be made the following work day.
BACKFLOW DEVICE
trench.
--- REQUTRED TNSPECTTONS ---
- After device is instal-Ied but before backfilling
PLI'}TBING PERUIT ---
IUem
5 BACKFLOW DEVICES
Plumbing PermiE
Surcharge/eamin
TOTAL CII.A,RGE (c)
Fee
75.00
75.00
5.00
81. 00
--- }IISCELI,AIiIEOUS PERDTITS ---
Surcharge/edmin
BWOP PENALTY
TOTAL MISCEI.I.ANEOUS PERITTTS (E)
0.00
75.00
75 .00
(Excluding Electrical )
unless otherwiae noted
--- TOTAI. AMOI'}flT DUE ---
(A, B, C, D, and E combined)155.00
--- BUII.DING VAI.I'E, PLA.I{ CHECK A}ID BUIIJDING PER}IIT ---
This permit is granted on Lhe express condition that the said construction
shaIl, in all respects, conform to the Ordinance adopted by the City of
Springfield, including the Development Code, regulating the construction and
use of buildings, and may be suspended or revoked aE any t,ime upon violation
of any provisions of said ordinances.
--\
SPFIi|GFIELD
Job Number: 97054L
SPruNGFIEI.O,
Page 2
Received By:
Pfans Reviewed By:
Building Site Reviewed By: LISA HOPPER
DaLe:
--- ADDITIONAI. COMMENTS ---
By Eignature, I Etate and agree, thats I have carefully examined
the completed application and do hereby certify that all information hereon
is true and correct, and I further certify thaL any and aLl work performed
shall 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 OCCUPAIICY will- be made of any structure without permission of the
Community Services Division, Building Safety. I further certify that only
contracLors and employees who are in compliance with ORS 701.055 wilL be
used on this project.
f furEher agree to ensure that all reguired inspections are reguested aE Lhe
proper time, thaL 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.
,/-zf -? z
Signature Date
--- VALIDATION ---
Receipt Number
DaLe Paid
Amount Received
Received By
07
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