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HomeMy WebLinkAboutPermit Plumbing 2001-11-07SPRII\IGFIELD Job# 01-01234-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page 1 ot 2 Job Number: 01 -01 234-01 Office:726-3759 !nspection Line: 726-3769 Tax Lot#: 00500 Subdivision: 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 4082 North St Spr AssessorsMap#: 18020611 Lot: Block: Addition: ctTY oF SPRTNGFTELD, OREGON Owner: Leolyn McKinley Address: 4082 North Street Scope Of Work: Plumbing Phone Number: City/State/Zip: New 541-520- Springfield, OR 97478 Value: $O Sanitary connection and septic abandon Quad Area: # Of Units: Constr. Type: Water Heater: Office Use - Land Use: Zoning Code: Bedrooms: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: To request an inspection callthe 24 hour recording at726-3769. 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 Please provide the Plumbing I - Prior to filling trench. -After septic tank has been pumped and filled.inspector with receipt and ver Sanitary Sewer Line Septic Tank Pumped Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq. Feet) Main: ,Q Accessory # Of Stories: Height (feet): Current Units: Proposed Units Census Code: Does not apply Total: Fee Paid On Receipt# Value/Quantity Fee Amount Minimum Plumbing Permit Fee Septic Tank Removal or Fill State Surcharge - Plumbing Sanitary Sewer Footage 11t0712001 1110712001 11t0712001 11t0712001 1 $.00 $14.00 $5.11 $s9.00 71 98 7198 7198 71 98 BO Job# 01-01234-01 Page 2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount Administrative Fee - Plumbing Total Plumbing Plumbing 11t07t2001 7198 $5.84 $83.s5 Grand Total By signature, I state and agree that I have carefully examined the completed application and do h6reby 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 requested at the proper time and that the roject address is readable from the street. )/t1(Y l<; sig Date $83.e5 //- 1_ JaD /