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HomeMy WebLinkAboutPermit Plumbing 2001-7-19 '. . I Job# 01-00741-01 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 I CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00741-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 5991 Obsidian Ave Spr Assessors Map#: 18020300 Lot: Block: Addition: Tax Lot #: 00502 Subdivision: Owner: Crossroads Development Phone Number: 541-923-6607 City/StatelZip: Redmond, OR 97756 New Value: $0 Address: 2622 SW Glacier Place, Suite 1 Scope Of Work: Plumbing Quad Area: # Of Units: Constr. Type: Water Heater: Sanitary and storm sewer lines from street to P.L. NotA: ~torm ~AWAr linA '*0 ~ArvA~ S!l7S. S!lR:l Oh~ic1i'm ,mc11R!l!l ~ ROth ~,. 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 Storm Sewer Line Required Inspections I Plumbin~ I -Prior to filling trench. -Prior to filling trench. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 ,Area (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# Plumbin~ 07/19/2001 6193 07/19/2001 6193 07/19/2001 6193 07/19/2001 6193 Value/Quantity Minimum Plumbing Permit Fee State Surcharge - Plumbing Sanitary Sewer Footage Storm Sewer Footage 123 185 ~ Fee Amount $.00 $6.65 $40.00 $55,00 . - . " --.. I '-/ Job# 01-00741-01 . Page 2 of 2 Fee Paid On Receipt# Plumbin~ 07/19/2001 6193 Value/Quantity Fee Amount 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 will be sed on this project. I further agree to ensure that all required inspections are req at the pro ime and thaytJ project address is readable from the street. 0# _ , 1~~~ ~/ Signature r Oat $2.85 $104.50 $104.50