HomeMy WebLinkAboutPermit Plumbing 2001-05-15SPRINGFIELD
Job# 01-00495-01
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 160 S 00014th St Spr
AssessorsMap#: 17033632
Lot: Block: Addition
Job Number: 01-00495-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 04201
Subdivision:
crTY oF SPRTNGFIELD, OREGO^
Owner: Grocery Outlet
Address: 160 14th Street
Scope Of Work: Plumbing
water line
Phone Number:
City/State/Zip:
New
Springfield, OR97477
Value: $O
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 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
IF THEWORK
UNDER THIS PERMIT IS NOT
COMMENOE O OR IS ABANOONED FOR
ANY 1O(} DAY PERIOD.
Height (feet):
apply
Proposed Units:requires You to
rules adoPted bY the Oregon UtilitY
Required
Plum
Water Line
Construction Types:
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
- Prior to filling trench
# Of Stories:
Current Units:
Census Code: Does not
Area (Sq.
Main:Accessory
Fee
Minimum Plumbing Permit Fee
State Surcharge - Plumbing
Water Service Footage
Total
Center. Those ru les are set forth
OAR9 52-001'0010 through oAR 952-001'
Paid On Receipt#Amount
$.00
$4.90
$70.00
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05t1512001
5364
5364
5364
is 1-800-332
280
Job# 01-00495-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbi
Administrative Fee - Plumbing
Total Plumbing
05t15t2001 5364 $2.10
$77.00
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein is true and correct, and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of
the State of Oregon. I further state that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
requested at the proper time and that the project address is readable from the street.
$77.00
s-/r=/z-@lr/;--lw-f-| Jaa;
Signature o/te /