HomeMy WebLinkAboutPermit Plumbing 2002-07-18Job# 02-00853-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
Job Number: 02-00853-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 00102
Subdivision:
SPFINGFIELD
€n
225 Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2465 00014th Pl Spr
AssessorsMap#: 17032433
Lot: BIock: Addition:
ctTY oF SPRTNGFIELD, OREGON
Owner: Alfred Brandt
Address: 2465 14th Place
Scope Of Work: Backflow Device
Sprinkler System
Phone Number:
City/State/Zip:
New
541-746-8866
Springfield, OR97477
Value: $0
taw leq ulres you iu
uGontractor Type
Landscape
Contractor Reg
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t4ot
NMeadow Landscape Services
in OAR91755 Clearwater Lane, Springfield, OR 0090. You
97478
0
ote: the telePhone
Nntiticat!c)r1
Office U"" )
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Land Use:
Zoning Gode:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
Required lnspections
Backflow Device
Gonstruction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
-After device is installed but
t[$FJ[ili,',1'RBf
ABANDONED FOR
0.
AUT HORIZE D UNDER
c0M MENCED OR IS
ANY 180 DAY PERIO
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Plumb
(Sq. Feet)
Main:Accessory:Total
Fee Paid On Receipf# Value/Quantity Fee Amount
Plumbi
Minimum Plumbing Permit Fee 07t1812002 9975 $31.00
Job# 02-00853-01 Page2 ot 2
Fee Paid On Receipt#Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
07t18t2002
07118t2002
07118t2002
9975
9975
9975
1
$3.15
$14.00
$3.60
$51.75
Grand Total $s1.75
By signing this permiVapplication, I agree to call for an inspection once the backflow prevention devicehas been installed and is visible for inspection (726-37691. t also state that all information on thispermit application is true and correct.
Signature Date
SPRINGFIELD
BACKFLOI PRBVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SATETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LIM:
726-3759
726-3769
JOB LOCATION:
ASSESSORS MAP *:
tt\
/(J} TAX LOT *:
9),'/77
OIJNER: A I_?TRANT):f
CITY OF SPRINGFIELD, OREGO'V
ADDRESS: )4b {A/crRfiJ H^Pt +
CITY:
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ADDRESS:l-{5 ( LttrZt -. fz;r< (Ortr-- pndr.rp'*
CITY:srArE: 5f<
(€-PEONE *I f qb" Sxbb (on'a Hfar()
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CONSTRUCf,ION CONTRACTORS REGISTRATION *:EXPIRES:
BY SIGNING THIS PERHIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TIIE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AI.ID IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE THAT ALL INFoRMATToN 0N THIS PERMIT/APPLTCATIoN IS
ionnscr.
FOR OFTICE USE
DATE OF App,,rcArr onz 1= /V -a 0 o >-.JOB *,()).
RECEIPT *:?9tr ISSUED sYrfl
t?/o=
TOTAL AI{OMIT COLLECTED:5l .7t
6LdO
o/
THIS PER Mtl T
PERIOD.
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