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HomeMy WebLinkAboutPermit Plumbing 2001-02-21SPR!NGFIELD Job# 01-00146-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page 1 of 2 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 1219 00012th St Spr Assessors Map#: 17032644 Lot: Block: Addition: Job Number: 01 -00146-01 Office: 726-3759 lnspection Line: 726-3769 Tax Lot#: 11100 Subdivision: ctrY oF SPRiNGFiELD, OREGOTV Owner: Cliff Ellis Address: 1219 12th St Scope Of Work: Plumbing 40'sewer line Phone Number: City/State/Zip: New Springfield, OR97477 Value: $O Contractor Type Plumbing Contr Contractor Hoffman Northwest lnc 23311Madero St, Mission Viejo, CA 92691 Registration # 71162 Expiration Date 1t16t2001 Phone 541-689-1711 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use - Land Use: Zoning Gode: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: Torequestaninspectioncallthe24hourrecordingat726.3769.Atlinspectionsrequestedbefore7:00, a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following i,' working daY' ll' ' -"''" Required lnspections PlumUlng I Sanitary Sewer Line -Prior to filling trench. Construction Types: Occupancy Groups: 14l NOTICE: # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq Main:Accessory: # Of Stories: Current Units: Census Code: Does not Total Height (feet): Proposed Units: apply Fee Paid On Receipt# Value/Quantity Fee Amount Plum Minimum Plumbing Permit Fee 02121t2001 4499 $.00 Job# 01-00146-01 Page 2 oI 2 Fee Paid On Receipt# Value/Quantity Fee Amount Plumbing State Surcharge - Plumbing Sanitary Sewer Footage Administrative Fee - Plumbing Total Plumbing 0212112001 0212112001 02t2112001 4499 4499 4499 40 $1.75 $2s.00 $.75 $27.50 Grand Tota! 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 the proper time the project address is readable from the street. re Date $27.50 Z-zt -ol