HomeMy WebLinkAboutPermit Plumbing 2000-07-18SPFThrGFTELD
225 North Fifth Street
Springfield, OR97477
Page 1 of 2
Location Of Proposed Site: 712N 00004th St
AssessorsMap#: 17033521
Lot: Block:
Job Number: 00-01 117-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 11404
Subdivision:
RESIDENTIAL PERMIT
GitY Of SPringfield
GommunitY Services Division
Building SafetY
k*
v
spr
Addition:
-017100-01
Owner: Jonas KungY
Address: Po box 50565
Scope Of Work: Backflow Device
backflow
Phone Number:
Gity/State/Zip:
New
541-687-2323
Eugene, OR 97405
Value: $O
Contractor Type
Landscape
Contractor
Grants Landscape Service
Po Box 221, Springfield, OR 97477
Registration # Expiration Date Phone
541-746-8482
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq, Footage:
To request an inspection call the 24 hour 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
Plumbi nl
^]ir:'Backflow Device
# Of Stories:
Current Units:
Gensus Code: Does not
-After device is installed but before backfilling trench
(feet)
N IFTHEWORK
Area (Sq.
Main:
Fee
Accessory Total:
Paid On Receipt# Value/Quantity Fee Amount
Plumbi
Minimum Plumbing Permit Fee 07118t2000 2605 $5.00
OREGONOFCITY
1n(tio
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? [
Fee
00-01117-01
Paid On ReceiPt#
Page 2 of 2
ValuelQuantitY Fee Amount
State Surcharge For Plumbing Permit
Backflow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signing th
device has been installed and is
07t18t2000
07/1 8/2000
07/1 8/2000
2605
2605
2605
1
$1.05
$10.00
$.+s
$16.50
$16.50
this it application is
is permiUapplication, I agree to call for an inspection once the backflow preventionvisible for i nspection (726-3769). I atso state that a ll information onand
SPFII{GFTELt,
0n
BACKFLOV PREVBNTToN DEVTCE PEII',lIT APPLICATIoN
CITY OF SPRINGFIELD
BUILDING SAFBTY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
73e - 7/2 /D,vvn,JOB LOCATTON:
ASSESSORS UAP *:r-7O3> 5 ZI TAX LOT *: I I tloL{
OVNER:O NA'
PHONE *: b ?4-{V-{aa
ADDRESS:
CITY:Z,uat{STATE:oE-zrP; ?7 / e,5''
BACKFLOy pERMIT rs $15.00 + 1.05 (STATE SURCHARGE) * $.45 (ADMIN. FEE) =$16.50
CONTRACTOR: G ,U Lp G-<
,/2 . /-)
ADDRESS: f 0 /6c'x +'>i PHoNB *: 74L'trYn,
CITY:5 4Q k SrArE: J f -ZTPz ?;{- 7
CONSTRUCTION CONTRACTORS REGISTRATION *:{st>t0/ o>*-._-EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOI{ PREVBNTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). r ALSo STATE THAT ALL TNFoRMATT0N ON THrS PERUTT/APPLTCATToN rS
CORRECT.
FOR OFFICE USE
DATE 0F APPLICATI0N: ')-O -
RECEIPT *: 26A 5-ISSUBD BY:
TOTAT AMOTJNT COLLECTBD:
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