HomeMy WebLinkAboutPermit Plumbing 2001-09-20SPBINGFIELD
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 973 S 00037th Pl
Assessors MaP#: 18020613
Lot: Block:
Owner: Walter Vanderhorst
Address: 973 S 37th Pl
Scope Of Work: Backflow Device
Page 1 of2
Job Number: 01-01 032-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 12500
Subdivision:
541-
Springfield, OR 97478
Vatue: $O
RESIDENTIAL PERMTT
CitY Of SPringfield
CommunitY Services Division
Building SafetY
spr
Addition:
Phone Number:
City/State/ZiP:
New
Backflow device
aIIlll=
Contractor Type
Landscape
Contractor
Decker landscape and irrigation
PO Box 87, Alvadore, OR 97409
Registration #
6746
Expiration Date
9t30t2002
Phone
541-688-7991
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
Backflow Device
To request an inspection callthe 24hour recording a1726-3769. 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 !nspections
-Afterdevice i. inffi trench
Construction Types
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq
Main:Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbi
Minimum Plumbing Permit Fee 0912012001 67s6 $31.00
CITY OF
Job# 01-01032-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
09t20t2001
09120t2001
09t20t2001
6756
6756
6756
I
$3.15
$14.00
$3.60
$51.7s
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 lication true and correct.
$51.7s
)o-df
Signature Date
15PFTrlGFIELE,
iJu
I* i0'rli
'1 $ TI.TT
IH{II{IIr
[*-Hliliti:ffii
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD ---]
COM}/ftNITY SgNfrrES DIVISION - BTM'DING SAFETY
225Flfrh Strest
Springfield, Oregon 97 477
Office: 726'3759
ntirncuoN LINE: 726-3769
1 ,3 1Vu ? \ .
Job
Assessors MaP #:t8 oL eGr>Tat L ts-
*Io,c \n o aslOwler:(,.)
tr:5,j-t Yrr.. P \ .Phone#
Address:
tr^/ltu\
C trn II OR
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
Contractor:<_(-f-,^.[5 c + T t,t-,r\,
o'.\ttc V*
{1tr
Address Qp.( {'l 68s'tq
Jov^t-1
"t(O\
C onstruction Contrac0ors -30- oI
By signing this permit/application, I agreeto call for an inspection once ttre backflow prevention device has
U"* i*t tt.d and is visible for inspection (726-3769). I aiso state that atl information onthis permit/application
is correct.
L(
,fu-4'Z-Z'^-?- )o- ot
Signature Date
FOR OFFICE USE
Date of C)ZAC>
Checked for Delinquencies:---
VALIDATION:
Job #:ct-c laSz-6 (
Checked for Historical Status:
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