HomeMy WebLinkAboutPermit Plumbing 2001-07-19SPRIiIGFIELD
Job# 01-00734-01
RESIDENTIAL PERMIT
City Of Springfield
Commun ity Services Division
Building Safety
Page 1 of 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 5939 Mt Vernon Rd Spr
AssessorsMap#: 18020300
Lot: Block: Addition:
Job Number: 01-00734-01
Office:726-3759
lnspe.ction Line: 726-3769
Tax Lot#: 00503
Subdivision:
clTY oF SPRTNGFTELD, OREGOI'
Owner: Crossroads Development
Address: 2622 SW Glacier Place, Suite 1
Scope Of Work: Plumbing
Phone Number:
City/State/Zip:
New
541-923-6607
Redmond, OR 97756
Value: $O
Sanitary and storm sewer from 59th St. to P.L. (Two lines ea. type - total 4 lines)
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 a1726-3769. 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.
Required lnspections
-Priortofillingtr"#
- Prior to filling trench.
Construction Types:
Occupancy Groups:
Sanitary Sewer Line
Storm Sewer Line
# Of Buildings:
# Of Bedrooms:
Handicap Access?
# Of Stories: Height (feet):
Current Units: Proposed Units
Gensus Code: Does not apply
Area (Sq
Main:Accessory:Total:
Fee Paid On Receipt# Vatue/Quantity Fee Amount
Plumbi
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Sanitary Sewer Footage
Storm Sewer Footage
0711912001
07119t2001
071't912001
0711912001
61 93
6193
6193
61 93
$.00
$7.70
$55.00
$55.00
170
185
Job# 01-00734-01 Page 2 ol 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Administrative Fee - Plumbing
Total Plumbing
Plumbing
07 t19t2001 6193 $3.30
$121.00
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein is true and correct, and I further certify that 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. I further state that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
at time that the project address is readable from the street.
Signature Date
$121.00