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
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52-00r
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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
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