HomeMy WebLinkAboutPermit Plumbing 2000-07-11SPRINGFIELD
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RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Addition:
Page 1 of 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 4059 Virginia Ave
AssessorsMap#: 11023144
Lot: Block:
Job Number: 00-01 078-01
Office:726-3759
!nspection Line: 726-3769
Tax Lot#: 05600
Subdivision:
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ctrY oF SPRTNGFIELD, OREGOI'
Owner: Frank Farnsworth
Address: 4058 Virginia Av
Scope Of Work: Backflow Device
Contractor Type
Landscape
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Phone Number:
City/State/Zip:
New
541-
Springfield, OR9t4T7
Value: $O
backflow device
Contractor
Harris lrrigation
po box 1297, Springfield, OR g74t|
Registration # Expiration Date
office use _
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
d
Phone
541-746-6444
SNStNtNOC
To request an inspection call the 24 hour recording at 7 26-3769. Ail inspections requesteda.m. willbe made the same working day,inspection s requested after 7:00 aworking day
Required lnspections
PlumbinqBackflow Device -After device is installed but before backfilling trench
Construction Types:
Occupancy Groups:
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SIHI
:3ClroN
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
Fee
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units
Accessory:Total:
Paid On
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Minimum Plumbing permit Fee 07t11t2000 2521
Value/Quantity
$5.00
Receipt#Fee Amount
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Job# 00-01078-01 Page2 of 2
Fee Paid On Receip$ Value/Quantity Fee Amount
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
07t11t2000
07t11t2000
07t11t2000
2s21
2521
2521
1
$1.05
$10.00
$.45
$16.50
Grand Total
By signing this permiUapplication, I agree to callfor an inspection
device installed and is visible for inspection (726-3769).
this true
Signature
once the backflow prevention
I also state that all information on
$16.50
Date
CITY OF SPB OREGO'U
SPFIIYGFIELO
BACKFLOU PREVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
TRANS$:01-0002511
000
Lt l
IHANEE:
IASHIER:06].
225 FITTH STRBET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-37s9
726-3769
JOB LOCATION:{zJ-z-r+
ASSESSORS MAP *:2
OTINER: FReUp- Oe-7?J
TAX LOT *:05@oo
ADDRESS: - 1"'PHONE #:
cIrY: Sf RriliQt-etfl STATE: OR zrPz lt9-(
BACKFL0I.I PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50
COMRACToR: i4A*Rz-< ZR"Rz-6*rszD
ADDRESS: P "O , tsA, /&9 )PHoNE *z )4b 4 q4y
CITY: *< PrLfr)€,tr STATE: D/4-zrPz f;)1117
CONSTRUCTION CONTRACTORS REGISTRATION *: ; '-:EXPIRES:3 dI-O
BY SIGNING THIS PERHIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE THAT ALL TNFoRMATIoN 0N THrS PERHTT/APPLrCATroN IS
CORRECT
-2 -oo
DATE 0F APPLICATION: D7 / / O O
RECEIPT *: Z; Z- (ISSUED BY: >G
TOTAL AI{OI'NT COLLECTED:/6f?
JoB *rN-Oto7 F-O|
FOR OFFTCE USE