HomeMy WebLinkAboutPermit Plumbing 2002-09-11Job# 02-01094-01
RESIDENTIAL PERMIT
Caty Of Springfield
Community Services Division
Building Safety
Page 1 of2
Job Number: 02-01 094-01
Office:726-3759
lnspection Line: 726-3769
SPRINGFIELD
225 Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2431 00017th St Spr
AssessorsMap#: 17032434
Lot: Block: Addition:
ctTY oF SPRTNGFIELD, OREGO^
Owner: Mike Hulti
Address: 2431 17th Street
Scope Of Work: Backflow Device
Backflow device
Phone Number:
City/State/Zip:
New
541-736-0173
Springfield, OR97477
Value: $0
Contractor Type
Plumbing Contr
Contractor
Mike Hulti
2431 17lh Street, Springfield, OR97477
Registration # Expiration Date Phone
541-736-0173
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
To request an inspection call the 24 hour recording at726-3769.
a.m. will be made the same working day, inspections requested
working day.
Required lnspections
Plumbinq
-After device is installed but before backfi
# Of Stories:
Current Units:
Gensus Code: Does not apply
Accessory Total:
Sq
All inspections req
after 7:00 a.m. will be
ht (feet):
Proposed Units:
Backflow Device
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 09t11t2002 10576 $31.00
,r/
Tax Lot#: 00330
Subdivision:
a\
I.d
Job# 02-01094-01 PageZ ol2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
09t11t2002
09t1112002
09t11t2002
1 0576
10576
10576
1
$3.1 5
$14.00
$3.60
$51.75
Grand Total
By signing this permiVapplication, I
has been installed and is visible for
permit
agree to call for an inspection once the backflow prevention device
(726-3769). I also state that all information on this
$51.75
9-tt-o<
Date
225 FIilH STREET . SPRINGIIELD,OR 97477 r PH:(541)726-3753 r fAX: (541)726-3689
City Job Nrnber,oZ'oto7 -ol
Job Location ZLt3 I t7+L sJ-
Assessors 170 3zv =Tax Lot oo 33C-
Owner
-)q cll *)-o/)
City lPRJil GTl f tD S to,.()F a 7zipL
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
C o n tr u ct o r I nfo rm atio n
Contractor OoJ ttL(L
OBK
tlr
\S
City
IS hBOB
Construction Contractors Registration #Expires
By signing this permit/application, I agree to call for an inspection once prevention
devise has been installed and is visible for (726-3769). I also information on
this permiVapplication is
01 TCE:
S
For Office Use
Date of Application
Checked for Historical StatusChecked for Delinq
o9 (r OL
Sharcd Drive (I:/Building Forms/Baclflow Preventionl{2.doc
a,
CITY OF SPRINGFIELD, OREGON
a
a.
rrQIfllv
r\f
\6\
g\
w
q
ff\
l.J-{l