HomeMy WebLinkAboutPermit Plumbing 2001-12-19Job# 01-01402-01
RES!DENTIAL PERMIT
Gity Of Springfield
Community Services Division
Building Safety
Page 1 of2
SPRINGFIELD
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2680 Viewmont Ave Spr
AssessorsMap#: 17032441
Lot: Block: Addition:
Job Number: 01 -01402-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 00113
Subdivision:
ctTY oF SPRfiNGFIELq OREGON
Owner: Don Gray
Address: 2680 Viewmont Ave
Scope Of Work: Backflow Device
Phone Number:
City/State/Zip:
New
541-741-2988
Springfield, OR97477
Value: $0
Contractor Type
Landscape
Backflow device
Contractor
SCHELSKY'S
P.O. BOX 7945, EUGENE, OR 97401
iration Date Phone
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq.
To request an inspection call the 24 hour recording at726-3769. All inspections
a.m. will be made the same working day, inspections requested after 7:00 a.m
working day.
Required lnspections
Plumbin
Backflow Device -After device is installed but before
Construction Types:
Occupancy Groups:
7:00
following
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
# Of Stories:
Current Units:
Gensus Code: Does not apply
Total:
its:
Accessory:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 1211912001 7570 $31.00
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Land
Range:
(feet):
Job# 01-01402-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backfl ow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
1211912001
12t19t2001
12t19t2001
7570
7570
7570
1
$3.15
$14.00
$3.60
$51.75
Grand Total
By signing this
device has
this
Signature
correct.
once the backflow prevention
I also state that all information on
$51.75
ol
is
/
Date
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BACKFL OW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
C OMMI.INITY S ERVICES DTVIS ION . BIJILDING SAFETY
225 Fifth Street
Springfield, Oregon 97 477
Office: 726-3759
INSPECTION LINE: 726-37 69
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Assessors Map *: | 7 03 Zx ct ( ,,,r Lo#:71 Ot t 3
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BACKFLOW PERMIT(!.-U]".]J Gu"tirdes Permit Fee, State Surcharge & Administrative Fee)
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Ciry: Ewor.-r starc: C"1 zip: f ?+o t'
Construction Contadors Registration# :433 o
By signing this permit/application, I agree to call for an inspeclion once the backflow prevention device has
been installed and is visible for inspection (726-3769). I also state that all information on ttris permit/application
is correct.
iz
Signature Date
FOR OFFICE USE
Conaacbr:
Address:
Z /?2CJO t Job a.,+.o/-o)t(oz*olDate of
Checked for Delinquencies
VALIDATION:
Checked for Historical Status:
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Address: ZGYO v'-'-**trnf Pnone*: 77-6-7/77