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HomeMy WebLinkAboutPermit Plumbing 2001-7-19 1- ~. . I Job# 01-00743-01 I . Page 1 of 2 TRANS#:01-0006193 DATE:JUL 19 2001 AMT RECD:2 $ 726.00 1 $ 30.00 CHANGE:$ 2.50 CASHIER: 003 SPRINGFIELD ~ CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00743-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 5975 Obsidian Ave Spr Assessors Map#: 18020300 Lot: Block: Addition: Tax Lot #: 00502 Subdivision: Owner: Address: Crossroads Development 2622 SW Glacier Place, Suite 1 Phone Number: 541-923-6607 City/State/Zip: Redmond, OR 97756 New Value: $0 Scope Of Work: Plumbing Sanitary sewer line from street to P.L. 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 at 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. Sanitary Sewer Line Required Inspections I Plumbing I - Prior to filling trench. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 rArea (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# Value/Quantity Plumbing 1 07/19/2001 6193 07/19/2001 6193 07/19/2001 6193 34 Fee Amount Minimum Plumbing Permit Fee State Surcharge - Plumbing Sanitary Sewer Footage $.00 $1.75 $25.00 .-~ :'"'. . Job# 01-00743-01 Paid On Receipt# r Plumbing 07/19/2001 6193 . Page 2 of 2 Value/Quantity Fee Amount I Fee Administrative Fee - Plumbing 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 wil be used on this project. I further agree to ensure that all required inspections are ted at '. ~~<-.' ~t the project address is readable from the street. ~ JIP;,I Date r- $.75 $27.50 $27.50