HomeMy WebLinkAboutPermit Plumbing 2001-09-12SPR!NGFIELD
Job# 01-00988-01
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 1 159 Mohawk Blvd Spr
AssessorsMap#: 17032533
Lot: Block: Addition
Job Number: 01-00988-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 16800
Subdivision:
ctrY oF SPRTNGFIELD, OREGOTV
Owner: Villy Chanthavong
Address: 1 159 Mohawk Blvd
Scope Of Work: Backflow Device
Master Donuts
Backflow device
Phone Number:
City/State/Zip:
New
541-741-8033
Springfield, OR97477
Value: $0
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 callthe 24
a.m. will be made the same working
working day.
hour recording at726-3769. All inspections requested before 7:00
day, inspections requested after 7:00 a.m. will be made the following
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
Required lnspections
Plumbin
-After device is installed but before backfilling trench
# Of Stories:
Current Units:
Census Code: Does
Accessory:Total:
)
S\g
Fee Paid On Receipt#Value/Quantity Fee Amount
Plum
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Backflow Prevention Device
0911212001
0911212001
09t12t2001
6679
6679
6679
$31.00
$3.15
$14.001
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Job# 01-00988-01 Page 2 ot 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Administrative Fee - Plumbing
Total Plumbing
09t12t2001 6679 $3.60
$51.75
Grand Total
By signing this permiVapplication, I agree to callfor 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 true and correct.
Signature
$s1.75
crql12-lo I
Date
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
C OMMI]NTIY SERVICES DTVIS ION . BI]ILDING SAFETY
225 Fiffn Street
Springfield, Oregon 97 477
SPFINGFIELO
Office: 726-3759
INSPECION LINE: 726-37 69
Job Location:
Assessors Map #:lzo i 1 L"#: /(60O
t 0 E
Tax
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Or<g?.{ -1-?
BACKFLOW PERMT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
Contractor:lz
DruYAddress:
State:
Construction Contractors Registration#: E>rpires:-
By sigaing this permit/applicatiorq I agree to call for an inspection once the backflow preve,lrtion device has
been installed
is correct.
and is for inspection (726-3769). I also state that all information on this permit/application
e
Date
FOR OFFICE USE
Date ofApplication:o7
Checked for
Job #:c/-o o 78tr-ol
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VALIDATION:
Checked for Historical Status:
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Address: \\ 91, )Ao hc^,"s \< B Lvg Phone#: 5z/ /- 1'/r- gos t