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
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Area (Sq. Feet)
Main:
C
Accessory:Total:
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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
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