HomeMy WebLinkAboutPermit Plumbing 2002-01-23SPRII'GFIELD
Job# 02-00084-01
RESIDENTIAL PERMIT
Caty Of Springfield
Community Services Division
Building Safety
Page 1 of 2
Job Number: 02-00084-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 02719
Subdivision:
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2620 00023rd St Spr
Assessors Map#: 17032442
Lot: Block: Addition:
ctTY oF sPRtNcFtELD, OREGON
Owner: Ron Jenkins
Address: 2620 23rd Street
Scope Of Work: Backflow Device
lnstall backflow device
Phone Number:
City/State/Zip:
New
Springfield, OR97477
Value: $O
Contractor Type
Landscape
Contractor
Schelskys - SLI
P.O. Box 7945, Eugene, OR 97401
Registration #
6330
Expiration Date
2128t2002
Phone
541-744-7135
Office Use
Land Use:
rrl I
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Zoning Code:p:
Bedrooms:
Range:
$tttica
AR 0c1.0t)
fnay obt ain cs52
ou
1e
To request an inspection call the 24 hour recording at
a.m. will be made the same working day, inspections
working day.
- Required lnspections
Plumbin
Backflow Device -After device is installed but before backfilling trench
Construction Types:
Occupancy Groups:
t.t,
7:00
made the following
# Of Stories:
Gurrent Units: ANy 180 its:
Census Code: Does not apply
Area (Sq.
Main:Accessory:Total:
Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee 01t23t2002 7858 $31.00
law
Fee
Job# 02-00084-01 Page 2 of 2
Fee Paid On Receipt# Value/euantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
01123t2002
01t23t2002
01123t2002
7858
7858
7858
1
$3.15
$14.00
$3.60
$51.75
Grand Total
By signing this permiUapplication, I agree to call for an inspection once the backflow prevention
device has been installed and is visible for inspection (726-3769). I also state that atl information on
this is true and correct.
Signature
$s1.7s
23 o 7-
Date
I
225 FIFIH STREET;SPRINGFIELD, OR 97477 . PH:(54D 6-3753 o tAX:(s4t)726-s68i
City Job N 'mber n:y -C>AO E 7-o/
Job Location 26 Zo --1-/. ?_3 d s,/.
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BACKFLOW PERMIT IS $51
Contractor I nfonn otion
Contractor LT -S-4r'
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'75 (includes permit Fee, state surcharge & Administrative Fee)
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Construction Contractors Registration # ( SS O
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Expires
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By signing this permit/application, I agree to call for an inspection once the backflow preventiondevise has been installed and is visible for inspection llza-\las1. I also state that all information onthis permit/application is correct.
S
For Office Use
Date of Application
Checked for Historical StatusChecked for Delinquencies
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Sharcd Drive (T:)/Building Fom/Backflow Preventionl-02'doc
SPRTNGFIELD,CIryOF OREGON
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