HomeMy WebLinkAboutPermit Plumbing 2002-07-18SPRINGFIELD
Job# 02-008s2-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
Job Number: 02-00852-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 00800
Subdivision:
225 Fifth Street
Springfield, OR97477
Location Of Proposed Site: 1430 Vera Dr Spr
AssessorsMap#: 17032432
Lot: Block: Addition
crTY oF SPRINGFTELD, OREGON
Owner: B.J. Brandt
Address: 37952 Camp Creek Rd
Scope Of Work: Backflow Device
PhoneNumber: 541-746-8866
City/State{ipTE fV$pdng@dgQfir97ia7& .. i, r i: r (r J, I :
New follow rules qdfl&Fd Sthe OreUr;ri Uir'
Notification Center. Those rules are set fori
in OAR 952-001-0010 throtiqh OAR $52"{}0 ,
Contractor Type
Landscape
lnstall Sprinkler System
Contractor
Meadow Landscape Services
1755 Cleanivater Lane, Springfield, OR
97478
Reg Phone
In
6695 541-726-9903
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 call the 24
a.m. will be made the same working
working day.
hour recording at726-3769. All inspections requested before 7:00
day, inspections requested aftff @fE€T will be made the following
THIS PEBMIT SHALL EXPIR E IF THE WORequired
MENCED OR IS
trench.
ABANDONED F
D.
IS NOI
OR
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? !
Area (Sq
Main:
-After device is installed but before
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Accessory:Total:
Plum
Fee Paid On Receipt# Value/Quantity Fee Amount
Minimum Plumbing Permit Fee 0711812002 9975 $31.00
\
Job# 02-00852-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backfl ow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
07t1812002
07t18t2002
07t1812002
9975
9975
9975
1
$3.1 5
$14.00
$3.60
$51.75
Grand Total
By signing this permiVapplication, I agree to callfor 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
perm it application is true and correct.
Signature Date
$s1.7s
OFEGO'UC'TY OF
SPFT]{GF!ELE'
BACKFLOII PREVBNTION DEVICE PERI.IIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
JOB LOCATION:
ASSESSORS MAP *:t1 2+ VL TAX LOT *:
OIINER:BT f\f<,+Nb*r-
aopnsss : 57?5J Cnnn :nc= L ?or+b p noue * JL/(.,'XRA!( rl) 7L/ 6aSz / 3(o)
CITY:\STATB: CJIL ZTPz 9>.179
BACKFLOW PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADl'tIN. rEE) =$16.50
g)I>7
COMRACIOR:m -)A-/+ \+ar'--- \
ADDRESS:c
CITY:SPtz Tr,r 6FrPt t>
DATE OF APPLICATION:/t ')o oL
PHoNE *r 7)a \
ZIP:>vSTATE: OT<
CONSTRUCTION CONTRAC1TORS REGISTRATION *:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVEMION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
Tiio-llogl. r ALSo srATE THAT ALL rNFoRMArroN 0N THrs PERl.trr/APPLrcATrON rs
conngcT.
POR OTFICE USE
r Ffil.3
7"
RECEIPT *:qqls ISSUED BY: T7
JOB *:
TOTAL AI{OUTT COLLECTED:&5|'.
lWt r,4z
(lL-85L ol