HomeMy WebLinkAboutPermit Plumbing 2001-10-05Job# 01-01 100-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
SPRINGF!ELD
il
U
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 1140 00001st St Spr
AssessorsMap#: 17032633
Lot: Block: Addition:
Job Number: 01-01 1 00-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 00545
Subdivision:
h
clTY oF SPRTNGFTELD, OREGOTV
Owner: Nan Harrison
Address: 6897 Forsythia
Scope Of Work: Plumbing
Phone Number:
City/State/Zip:
New
541-744-1661
Springfield, OR 97478
Value: $0
100 ft of sanitary sewer replacement
Contractor Type
Plumbing Contr
Contractor
Drain Doctor
x, x, X 00000
Registration #Expiration Date
54
Phone
1-741-0981
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 24hour 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
Plumbi
Sanitary Sewer Line - Prior to filling trench.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
(Sq. Feet)
Main Accessory:
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 1010512001 6921 $.00
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Job# 01-01100-01 Page2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Sanitary Sewer Footage
Administrative Fee - Plumbing
Total Plumbing
Plumbins
1010512001
1010512001
10t05t2001
6921
6921
6921
100
$4.13
$59.00
$4.72
$67.85
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
$67.85
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requestgd at the
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proper time and that the project address is readable from the street.
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Signature Date