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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& 0ATE;[[T 18 t0ilL-] A|'IT REIS:I $ 0. ]0T d'l/: rln' I iI,#Yut tnttuL, FA0LITtrO ' t-lr-1LrnLJl lILl\ r UUi 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= ",, " ^oJfiT#Edt*' 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 ;on *:OQ -O/S.S.E ^*A { :E> -t;E*Z. Erfd+ (fts Ic (3 L..l LNF cF. -{xlmm..rft=t3 r: F{#m (f r.J.(3 L..l 13<3Cf r'J {9 m:f)L'f J- ISSUED ax: )K TOTA: AHO3NT COLLECTED: o.tg 5,o f.J(:) C) Elats