HomeMy WebLinkAboutPermit Plumbing 2002-08-07d/
Job# 02-00949-01
RESIDENTIAL PERMIT
Caty Of Springfield
Community Services Division
Building Safety
Page 1 of2
€n
225Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2414 0001sth St Spr
AssessorsMap#: 17032433
Lot: Block: Addition:
Job Number: 02-00949-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot #: 00400
Subdivision:
crrY oF SPRINGFIELD, OREGOI'
Owner: Jerry Bentien
Address: 241415th Street
Scope Of Work: Backflow Device
lnstall backflow device
Phone Number:
City/State/Zip:
New
541-746-5486
Springfield, OR97477
Value: $0
Contractor Type
Landscape
Contractor
Terry Thorn
969 lrving Ct, Eugene, OR 97404
Registration #
144160
Expiration Date
6t1512004
Phone
541-689-5736
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
Land
Bed
Office Use
-
ICE:
RM T SHA
ORIZED UND
MMENCED OR I
# Of Buildings:
LL EXPIRE lF Tmpwolnxcy Group:
ER THIS PEfiMtflgtttlgryirce:
lS ABAND0N ED Ssfootage:
To request an inspection callthe 24hour 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
Plumbing
Backflow Device -After device is installed but before backfilling trench.es yo
lon u
in OAR 0:
0090. YoL
callino
# Of Stories: numuei
Current Units: (
ler. Those rules are set fort
001 0 through OAR 952-001
>btain copies of the rules bConstruction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
(sq.
Main:
r-00'
may
Height (feet):
Proposed Units:
:elephone
,lotification
44\.
Accessory:
Census Code: Does not apply
Total
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 08t0712002 10207 $31.00
SPRINGFIELD
Job# 02-00949-01 Page2 ot 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
08107t2002
08t07t2002
08t07t2002
10207
10207
10207
1
$3.1 5
$14.00
$3.60
$51.75
Grand Total
By this permiVapplication, I agree to call for an inspection once the backflow prevention device
has been is visible for inspection (726-3769). I also state that all information on this
true and correct.
Date
permit
$s1.7s
f- 7-o?--
22S|LY|HSTREET. SPRINGFIELD,OR97477 r PH:(541)726-3753 oFAX:(541)726-3689
ciryJob vr*o", CZ- bo ?'(7-o I
Job 2,1 lq
Assessors t10>Z 3)
S+L 3T 5? FLO b(7q 77
Tax Lot GOqoo
<
Owner BEN
z4 trl ttb Sr,Address - 573b
City S?FLID - o (-o{L zip ?7t'^7
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
C ontract or I nfo rm atio n
-16sp., Tl+r"J \?4rG, +Cq&sr.,Contractor
L F'-S 7 3b
City EudeluB- t o s-S lqte 6{L-zip
Construction Contractors Registration #tu%1 ///b0 Expires
By signing this permit/application, I agree to call for an
devise has been installed and is visible for inspection
this permit/application is correct.
7 ot,
\S
information on
3o -oz
N01
,R
I ?* ) -'^. ,Date J '- -
For OIIice Use
o7o7OzDate of Application
Checked for Delinquencies u' Checked for Historical Status
Shred Drive (T:/Building Foms,tsrcldlow Prcventionl42.doc
CITY OF SPRINGFIELD, OREGON
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