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HomeMy WebLinkAboutPermit Plumbing 2000-06-16S:IRINGFIELD Job# 00-00954-01 COMMERCIAL PERMIT City Of Springfield Community Services Division Building Safety \/<i Page 1 of 2 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 362 00042nd St Spr AssessorsMap#: 17023200 Lot: Block: Addition: Job Number: 00-00954-01 Office:726-3759 Inspection Line: 726-3769 Tax Lot#: 01100 Subdivision: ctTY oF SPRINGFIELD, OREGOTV Owner: Don McCabe Address: 38773 Old Pengra Road Scope Of Work: Commercial install backflow devices Phone Number: City/State/Zip: New 541-746-2713 Fall Creek, OR 97438 Value: $O Gontractor Type Plumbing Contr Contractor Rounds Plumbing 664 70th st, springfield, OR 97478 Registration # Expiration Date Phone 541-726-6334 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use - Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: To request an inspection call the 24 hour recording a1726-3769. All inspe^ctioqslequested before 7:00 a.m. will be made the same working day, inspections requested after TNGTrtOEltbe made the following workins dav' TFitspEBrvursHALLEXptHEtFTHEWoHK Required lnspections IMEI\CED OR IS ABANDONED FOHPlumbi Backflow Device -After device is installed but before backfillirp$ttpngb.DAY PERTOD Construction Types: Occupancy Groups # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq. Main:Accessory: # Of Stories: Gurrent Units: Census Code: Does not Total: Height (feet): Proposed Units: apply 'u i'3QUti€$|OU i" heOregon Utility 11OAH )090. \ )e! fortl 52-00r ules b\ Fee Paid On Receipt# Value/Quantity Fee Amount Minimum Plumbing Permit Fee 06fi6t2000 2192 $15.00 Job# 00-00954-01 Page2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount Plum State Surcharge For Plumbing Permit Backfl ow Prevention Device Plumbing Administrative Fee Total Plumbing 06/16/2000 06/16/2000 06/16/2000 2192 2192 2192 3 $3.15 $30.00 $1.35 $49.50 Grand Total By signature, I state and agree, that ihave carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employess who are in acompliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the stret, that the permit card is lcoated at the front of the property, and the approved set of plans will remain on the site at all times during construction. Signature Date $49.50 CITY OF OFEGO'U SPI|INGFTELD BACKFLOV PREVEMION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 192 En [HAl-i6E: IASHIER:061 225 FIFTH STREBT SPRINGFIELD OR 97477 JOB LOCATION: OFFICE: INSPECTION LINE: 726-3759 726-37 69 342 trZLJ -f ,/ ASSESSoRS MAP *, IAOZ3TDO OI.INER: i ,+A IYKCUbZ TAX LOr *: C> llOO AJ PHOM *:ADDRESS: 362 12 s4 crrY: g,anV2to 1/STATE: C4 ZIP z *"*-g BACKFLOIi PBRMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CONTRACTOR:L ADDRESS:c6r >o/\ S{PH0NE *: 22 €-/ff f CITY:a STATE:M ZTP:9?r:e / // Z < ( nxvmnst Yz4 /o2-CONSTRUCTION CONTRACTORS REGISTRATION *: BY SIGNING THIS PERMIT/APPLICATION, I AGREB TO CALL FOR AN INSPECTION ONCE THE BACKFLO1I PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. FOR OFFICE USE DATE OF APPLICATION: RECEIPT #: oC/6oo ISSUED BY: TOTAL AHOUNT COLLECTED:q? :o bZ JoB * z oooo 7Sq'O t /