HomeMy WebLinkAboutPermit Plumbing 2000-10-18SPRINGFIELD
Job# 00-01 558-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
TFiANES:01*000351&
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A|'IT REIS:I $ 0. ]0T d'l/: rln' I iI,#Yut tnttuL,
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 3496 Water Mark Dr Spr
AssessorsMap#: 17021943
Lot: Block: Addition:
Job Number: 00-01 558-01
Office:726-3759
Inspection Line: 726-3769
Tax Lot #: 05000
Subdivision: Ambleside
ctTY oF SPRilNGF1ELq OREGON
Owner: Bailey Jacobs Homes lnc
Address: Po Box 41407
Scope Of Work: Backflow Device
backflow device
Phone Number:
Gity/State/Zip:
New
541-431-0550
Eugene, OR 97404
Value: $0
Gontractor Type
Landscape
Contractor Registration # Expiration Date
Star Landscape
93066 River Rd, Junction City, OR 97448
Phone
541-998-2039
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(V) Wood Frame
Office Use
-
Land Use: # Of Buildings:
Zoning Code: Occupancy Group: Dwelling
Bedrooms: Heat Source:
Range: Sq. Footage:
To request an inspection ca
a.m. will be made the same
working day
Backflow Device
Construction Types(V) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory
# Of Stories:
Current Units:
Census Code: New SF - d
Total
rlqiq$rffry0=
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s+^LL ExP I tlE l F rH E woRK
AI}THORIZT-D UNDfff THIS PERIV1IT IS NOT
CCil/itVlEl'ICED OF i3 'trBAf'lDONED FOR
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 10t1812000 3516 $5.00
-After device is installed but before backfilling trench.
Job# 00-01 558-01 Page 2 ol 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Plumbins
1011812000
1011812000
10/18/2000
351 6
351 6
351 6
1
$1.05
$10.00
$.4s
$16.s0
Grand Total
By signing this permiUapplication, I agree to call for 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 permit application is true and correct.
Signature
$16.50
Date
SPN$IOFIELI,
BACKFLOS PREIJENTION DEVICE PEB}IIT AP9IJCATIOH
CITY OT SPRI}IGFIELD
BUILDII'IG SAffry DIVISION l,
p&
225 P:FTII STREEt
SPRINGFIELf OR 97477
OFFICE:
nISPECrfOll ul{Er
726-3759
726-3769
ry|qJOB L,ICATI,]N:
ASSESSORS ;'IAP *:1 oL l7L/
OIINER:
ADDRESS:4o+
CTTY:
TAX IOt *: C)-S3GO
PHONE *:4tt - or:il
ZIP:0
Da2
STATE:h(4
BACKFL0H P3RI{IT Is $15.00 + $.75 (STATE SURCHARGE) + g,45 (Ar}r{IN, FEE) = S16.20
CONTRACTOF.:
ADDRESS:PHoNE *: 1'79 - hoe 7
CTTY:STATE: 0e ZIP:
CONSIRU9IION CONTRACf,ORS BEGISTRATION *:bl?r,EXPIBES:Ces/ir
Br srGNrNG Tllrs PER!,IrT/APPLTCATT0N, r ABEE T0 CAIJ FOR N{ rNSpECf,roN oNCE TUE
BACKFLOS PREVEHTION DE1rICE EAS SEEN INSTALLED A}ID IS VISIBLE FOR INSPE TION{726-3769). I ALSO STATE TBAT ALL INTORHATION ON THIS PERHTT/APPTICATIO}I IS
CORRECT.
/2
FOR OFTICE USE
,ATE 0f'AIPIJCATION: /
RECE-PT *: 351
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TOTA: AHO3NT COLLECTED:
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