HomeMy WebLinkAboutPermit Plumbing 2002-07-23225Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2075 Otto St Spr
AssessorsMap#: 17032443
Lot: BIock:
Job# 02-00877-01
RESIDENTIAL PERMIT
City Of Springfield
Gommunity Services Division
Building Safety
Addition:
Page 1 of2
Job Numbe r: 02-00877 -01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 02311
Subdivision:
SPR!NGF!ELD
crTY oF SPRINGFTELD, OREGOTV
Owner: Frank Mascall
Address: 2075 Otto Street
Scope Of Work: Backflow Device
I nstall backflow device *.Ns*1
Phone Number:
City/State/Zip:
New
541-746-6318
Springfield, OR97477
Value: $0
\\r \r-
Date
# Of Buildings:
Occupancy Group:
Phone
541-6B8-7991
Gontractor Type
Plumbing Contr
Contractor
Decker landscape and irrigation
PO Box 87, Alvadore, OR 97409
67
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
Land
Zoning
Bedrooms:
Range:
To request an inspection call the 24 hour recording at 726-3769. All
a.m. will be made the same working day, inspections requested
working day.g$'
Required I
Backflow Device -After device is installed but
Construction Types:
Occupancy Groups:
g\w
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main: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 07t23t2002 10011 $31.00
Heat
iq
Job# 02-00877-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
07t23t2002
07t23t2002
07t23t2002
10011
10011
10011
$3.15
$14.00
$3.60
$51.75
Grand Total
By signing this permiUapplication, I agree to call for 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
is true and correct.
nature Date
$51.75
7>j-o>-
1
225 FIITH STREET . SPRINGFIELD, OR 97477 o PH:(541)726-3753 o FAX: (541)726-3689
City Job N oZ-oo877 -C-l
Job Location Zct f cTc) 5T
Assessors I To3zqqs Tax 6z=t
Owner (,r ^*\(\ P^t Antc^t\&n
Address \01< 0++o Et {
zip 4tq7"City 5rr",.,^*f;,iJ 01,0 S:/-
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State ve Fee)
\t \5
Contractor U<r It.
Phone 1 'r I
City A lv^/u,\
Construction Contractors Registration #
By signing this permit/application, I agree to call for an
devise has been installed and is visible for
this permit/application is correct.
zip 9 l,t,r 1
uqd eO\
the
? -io- oA
on
>-Oa\
,1
o
\e
.{OU
For Office Use
Date of Application C7Z)oZ
checked for Delinquencies t---' checked for Historical Status -/-
Shared Drive (T:)/Building Forms/Backfl ow preventionl -02.doc
af
CITY OF SPRINGFIELD, OREGON
I
Co ntractor I n formation
an