HomeMy WebLinkAboutPermit Plumbing 2000-05-09SPRINGFIELD
Job# 00-00679-01
RESIDENTIAL PERMIT
City Of Springfield
Gommunity Services Division
Building Safety
Page 1 of2
Nf;Y 09 ?000/3:40 Pl'l/$ 0.45
AIEIS : 100-00000-4?{i605
-OOO162?/HCKENZIE LAND$IAFE
J0ES:00-006??-01
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 865 S 00037th Pl Spr
AssessorsMap#: 18020612
Lot: Block: Addition:
Job Number: 00-00679-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 02500
Subdivision:
ctTY oF SPRfiNGFfiELq OREGON
Owner: Steve Unruh
Address: 965 s 37th Place
Scope Of Work: Backflow Device
Phone Number:
City/State/Zip:
New
541-746-1343
Springfield, OR 97478
Value: $O
Contractor Type
Plumbing Contr
Contractor
McKenzie Landscapes
42000 Holden Creek road, Springfield,
oR 97478
Registration # Expiration Date Phone
541-896-9000
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
3RSE
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection callthe 24hour recording at726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
Required lnspections
Plum
Backflow Device -After device is installed but before backfilling trench.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq
Main:Accessory:
# Of Stories: Height (feet):
Current Units: Proposed Units
Census Code: Does not apply
Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 05/09/2000 1627 $s.00
Job# 00-00679-01 Page2 ot 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbins
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
05/09/2000
05/09/2000
05/09/2000
1627
1627
1627
1
$1.05
$10.00
$.45
$16.50
Grand Total
By signing this permiVapplication, I agree to callfor 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
SPTIlllGFIELf,
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTII STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-37s9
726-3769
JOB LOCATION:
ASSESSORS MAP *:
OITNBR
ADDRESS:
CITY
BACKFLOW PERMIT IS $15.00 + 1.05 (STATE
CONTRACTOR:
ADDRESS:
TAX LOT *:
PHONE #:
ZTPz
) + $.45 (ADMIN. FEE) =$16.50
HONE *:
STATE:
ooz?-. 7rCITY:STATE:ZIPz
CON REGISTRATION EXPIRES:ga, d7)
BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE THE
BACKFLOI*I PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE THAT ALL TNFoRHATI0N 0N THIS PERMIT/APPLICATIoN IS
CORRECT.
r--c2
FOR OFFICE USE
CITY OF SPR OFEGO'U
DATE OF APPLICATION:
RECEIPT *:
TOTAL AMOI'NT COLLECTED:
ISSUED BY:
JOB *:
€76