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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