HomeMy WebLinkAboutPermit Plumbing 2000-3-22
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TRANS#:01-0001003
DATE:MAR 22 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 059
Job# 00-00441-01
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225 North Fifth Street
Springfield, OR 97477
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-00441-01
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3522 Main St Spr
Assessors Map#: 17023131
Lot: Block: Addition:
Tax Lot #: 02000
Subdivision:
*
Owner:
Address:
Jeff Olson
3522 Main Street
Phone Number: 541-744-8170
City/State/Zip: Springfield, OR 97478
Alteration Value: $0
Scope Of Work: Plumbing
Contractor Type
Plumbing Contr
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Contractor 'ao/8~cF~~'8dtoJ~\t
Vos Plumbing Inc 80~a3NOaN\t8\tSI8dd~~3V1JVlJOO
Po Box 2189, ItG)feDH!!)fflH!ttI.9,fr.\!~ONn 037
. .. . _ Il-lnl-ll n"
.f,,,v/VI ::IN.l.:lIOWicl;>(u~\tu:, 1:~;:';3d SIHl
Land Use: :30/10N
Zoning Code:
Bedrooms:
Range:
Expiration Date Phone
4/4/2000 541-485-0551
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same w6i1<ing:day"iO~p"e9tloQ~,[l'!Cluested after 7:00 a.m. will be made the following
working day. 'JOIII1:)II!ION f,1!l!ln u06eJO E,ljl Joj';eqUJfib
. eUOljdSISl 8ljl :SIO~1l 'J"ll)"'''''''' ;l"",,,~ .
.. ~"I"J dllllO seloo:) I JleRe!l U1reil Inspections
00 r~lllO.'t1eUJ.l1o'\-06b:- -I
l -CS6 !:l\tO ullnOJllm Ion. "P,I\!lJ1bin~_ .
Backflow Device IOII~'l>.fte:r aeiiice1iS;installedlb.,Y!.JlJl!9rnj01!ykfilling trench.
III'1n ,U?5a.J?,8UIAQ ~aldOPI1 saln~ MOI;~
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Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
Fee
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Paid On Receipt#
~ Plumbinll
03/22/2000 1003
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$5.00
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Job# 00-00441-01
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Fee
Paid On Receipt#
Plumbinll
03/22/2000 1003
03/22/2000 1003
03/22/2000 1003
Value/Quantity
Fee Amount
State Surcharge For Plumbing Permit
Backftow Prevention Device
Plumbing Administrative Fee
Total Plumbing
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein 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. I further state that only contractors and employees who are in compliance 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 and that the project address is readable from the street.
~~~~/~? 5'-22~C77J
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$1.05
$10.00
$.45
$16.50
$16.50
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SPRINGFIELD
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225. FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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JOB LOCATION: 7' S- 22- /ncu;, )'-1-
.' ASSESSORS MAP II:
OVNER: :Tf'~ Ols ~#1
ADDRESS: 5<) 22 MCllh r-r
CITY: ~/!//-i1p..r:/~/d
TAX LOT II:
PHONE II: 7o/"~~5-I'7tf
STATE: /Jr ZIP:f 7Y7~
BACKFLOV PERMIT IS $15.00 + 1. 05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16. 50
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CONTRACTOR: I/o ~ //U'I'>'/Ot'/1&'
,
ADDRESS: jJ(J If OK 2/$1'
CITY: 0'7--'14 1: STATE:d.......
CONSTRUCTION CONTRACTORS REGISTRATION I: 7"1 ?tJS
PHONE I: 7"R"'5"-OSS-/
ZIP: f7YtflZ
, EXPIRES: 7'"-tnJ
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION.
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT .
"1P;~u~. ,,' ..~~
SIGNa'. RE " .
,
3 -:-2 2-~~
I5ATE
. FOR OFFICE USE
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.DATE OF APPLICATION:
RECEIPT I:
TOTAL AKOUNT COLLECTED:
. JOB 1:.00- OOL(L((--q
ISSUED BY:
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