HomeMy WebLinkAboutPermit Plumbing 2002-03-15Job# 02-00284-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
Job Number: 02-00284-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 00100
Subdivision:
SPRINGFIELD
225 Fitlh Street
Springfield, OR97477
Location Of Proposed Site: 2580 00023rd St Spr
AssessorsMap#: 17032442
Lot: Block: Addition
crTY oF SPRINGFIELD, OREGOTV
Owner: Martelle Derrickson
Address: 2580 23rd Street
Scope Of Work: Backflow Device
Backflow device
New
Phone Number:
City/State/Zip:
541-747-2218
ld, oR 97477
e: $0
Date
# Of Buildings:
Occupancy Group:
Heat Source:
Contractor Type
Plumbing Contr
Contractor
Schelskys - SLI
P.O. Box 7945, Eugen
Phone
541-744-7135\n
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Land Use:
Zoning Code:
Bedrooms:
Range:
To request an inspection call the 24 hour recording at 72
a.m. will be made the same working day, inspections
working day.
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Sq .F
OR\S
# Of Stories: Height (feet):
Current Units: Proposed Units
Census Code: Does not apply
Total:
Required
Plumbing6$Y tq
Backflow Device -After device is installed but before backfilling trench
Construction Types:
Occupancy Groups:
Area (Sq. Feet)
Main:Accessory:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbinq
Minimum Plumbing Permit Fee 03t15t2002 8307 $31.00
Job# 02-00284-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
State Surcharge - Plumbing
Backflow Prevention Device
B% Administrative Fee - Plumbing
Total Plumbing
03t1512002
03t1512002
0311512002
8307
8307
8307
1
$3.1 5
$14.00
$3.60
$51.75
Grand Total
By signing this permiVapplication, I agree to callfor an inspection once the backflow prevention
device has been installed and is visible for inspection (726-3769). I also state that all information on
this is true and
$51.75
-)
Signature Date
N
a
11
h
225 HFIH STRXET . SPRINGTIELD, OR 97477 o PH:(541)726-3753 o FAX: (541)726-3689
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Assessors ?o3Z ,12 Tax Lot OO'O O
Owner /r(.Jtt. 0o.-:u(1.! n^
1.75
Address z5?o zsd rl-
City
BACKFLOW
Contractor SJ.('
Ao, 4,7
City y'oro-.State
Construction Contractors Registration #6 7 o
By signing this permit/application, I agree to call
devise has been installed and is visible for
this permit/application is correct.
pton" ?lvrur
.
Zip v7477
urcharge & Administrative Fee)
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Phone '7117/ 3J
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I also
the backflow prevention
state that all information on
3 ,o L
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For Office Use
Date of Application o3 /t62-
Checked for Delinqu "n"i", ? Checked for Historical Status
Shred Drive (T:)/Building Forms/Bacldlow Prcventionl -02.dm
CITY OF SPRINGFIELD, OREGON
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C ofltractor I nformatio n