Loading...
HomeMy WebLinkAboutPermit Plumbing 2000-07-11SPRINGFIELD .loU* OO-OrOZa-Ot 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: n Y spr \ 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: toN sl rlvIHSd slHl uf oNn 03zl UOHIfW 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 es yuu nnn Ut Minimum Plumbing permit Fee 07t11t2000 2521 Value/Quantity $5.00 Receipt#Fee Amount T L,,, )9 c Job# 00-01078-01 Page2 of 2 Fee Paid On Receip$ 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