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HomeMy WebLinkAboutPermit Plumbing 2001-11-13Job# 01-01255-01 RESIDENTIAL PERMIT Gity Of Springfield Community Services Division Building Safety Page 1 of 2 Job Number: 01-01 255-01 Office: 726-3759 Inspection Line: 726-3769 Tax Lot #: 04900 Subdivision: SPRINGFIELD 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 868 00021st St Spr AssessorsMap#: 17033612 Lot: Block: Addition crTY oF SPRINGFTELD, OREGOTV Owner: Evelyn Daniels Address: 868 21st Street Scope Of Work: Plumbing Phone Number: City/State/Zip: Addition Springfield, OR97477 Value: $O Contractor Type Plumbing Contr Contractor Roto Rooter Service Registration #-l l\rr2 Expiration Date l-\\e-c,3 Phone 84448*+74 4,q-W.+tbt 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. AII 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 I E:Plumbin Sanitary Sewer Line FinalPlumbing Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? # Of Stories: Current Units: Census Gode: Does not apply Height (feet): Proposed Units - Prior to filling trench.PERMISHALI-EXPIBEIFTHE WORK-When allplumbing work is complete.AUTHORZEDU NDERTHISPERMIT ISNOTCOt\4MENCED ORISABANDONED FORANY 180 DAY PERIOD f( Area (Sq. Feet) Main: C Accessory:Total: ]i {he Oregon t ]S€ IUIES ?fts ,:' nrough OAR vl eletr'!One vqa Job# 01-01255-01 Page 2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount Plum Minimum Plumbing Permit Fee State Surcharge - Plumbing Sanitary Sewer Footage Administrative Fee - Plumbing Total Plumbing 1111312001 1111312001 11t1312001 1111312001 7243 7243 7243 7243 30 $.00 $3.1s $45.00 $3.60 $s1.75 Grand Total By signature, I state and agree that I have carefully examined the completed application and do n6redy 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 ine 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 requ ested at the proper time and that the project address is readable from the street. nature $51.7s (( * (3^o(