HomeMy WebLinkAboutPermit Plumbing 2000-06-27SPRIf,GFIELD
Job# 00-01008-01
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
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: 00-01 008-01
Office: 726-3759
Inspection Line: 726-3769
Tax Lot#: 01100
Subdivision:
clTY oF SPR1NGFfiEL4 OREGON
Owner: Don McCabe
Address: 38773 Old Pengra Road
Scope Of Work: Commercial
backfl ow device installation
Phone Number:
Gity/State/Zip:
New
541-746-2713
Fall Creek, OR 97438
Value: $0
Gontractor Type
Landscape
Registration # Expiration Date Phone
541-744-1885
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 callthe 24 hour recording a|726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day .ut
Backflow Device
Construction Typest
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Required lnspections
Plum
-After device is installed but before backfilling trench
# Of Stories:
Current Units:
Census Code:Does
Height (feet):
NOTlCffieposed Units:
nofr4BPrnr\4rr sHALL EXptRE tF THE woRKArea (Sq.
Main:Accessory:Total:UNDER THIS PERIVIIT IS NOT
Minimum Plumbing Permit Fee 0612712000 2329
FOR
$5.00
Fee Paid on ARcCfitiSY PEtHUeror'*titv Fee Amount
Contractor
H & K Landscape Contractors
po box 97, Walterville, OR 97489
]sb
ificatior
tl
Job# 00-01008-01 Page 2 ot 2
Fee Paid On Receipt#Value/Quantity Fee Amount
PIumbi
rte Surcharge For Plumbing permit
rckflow Prevention Device
rlumbing Administrative Fee
Total Plumbing
06t27t2000
06t27t2000
06127t2000
2329
2329
2329
1
$1.0s
$10.00
$.45
$16.50
Grand Total
$16.s0
By signature, I state and agree, that I have carefully examined the completed application and dohereby certify that all information hereon is true and correct, and I further ."rtiry n--.1 ,ny anO all workperformed shall be done in accordance with the Ordinances of the City of spiingfiJd and the Laws ofthe state of oregon pertaining to the work described herein, and that No occupANcy will be madeof any structure without permission of the Community Services Division, Buildin! Safely. I furthercertlfY that only contractors and employess who are in acompliance with ORS ZO1.05S will be usedon this project.
Signature Date
I further agree to ensure that
address is readable from the
all required inspections are
stret, that the permit card is
requested at the proper time, that each
lcoated at the front of the
of plans on the site at alltimes during construction.