HomeMy WebLinkAboutPermit Mechanical 2002-9-30
\
-I-
I Job# 02-01169-01 I
Page 1 of 2
TRANS#:Ol-0010755
DATE:SEF 30 2002
AMT RECD:2 $ 51.75
CHANGE:
CASHIER:061
, "
",
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-01169-01
225 Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4321 Mt Vernon Rd Spr
Assessors Map#: 18020521
Lot: Block: Addition:
Tax Lot #: 08803
Subdivision:
Owner:
Address:
Doris Korte
4321 Mt Vernon'Rd
Phone Number:
City/State/Zip: Springfield, OR 97478
New Value: $0
Scope Of Work: Backflow Device
Backflow device
Contractor Type
Landscape
Contractor
Registration #
10250
Expiration Date
9/30/2004
Phone
541-746-8482
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main:
_\\\0 .
~- '~\")
Office Use ~\~eC;, ~ '0\'\ ,o~'\
, {ees. ~o 0\ ~\'
Quad Area: Land Use: \'3-~ O~e?}e <5 ~~#jOf~uildings:
# Of Units: Zoning Code: ~e~O~ 'O,\~e~.s.eC;,Of(-.<(-.~ {~c~~pancy Group:
Constr. Type: Bedrooms:O~9 o~\eO '(\oC;,e ~~ o\~ee~e~t\~ource:
Water Heater: Range.:<~'\~ ~'3-(j ~e~:'\ t'\,~'<..o .r.\ec;' e,\e~ k~\cf;lFootage:
A~ .\0 _~(\ ,..!\V _l"l..... .Y\: "'l"l'-
1'>.\' \V v.... ~v .~.... e.- ,\,-
" r- .\l"~ . _(\,t'\,\' ~1\~ ,~~o'\! .,..:\\~..., .... ~i>t"\"
To request an inspection call the 24 hour recor\Q.lngeJW26t3y.6g.0~III1'1s,pectls>ns J~<i1uested before 7:00
a.m. will be made the same working day, inspec!!ons~~qVUe~t&l' ~fit~\{~0Sl)~.m:)~ill be made the following
working day. ~ ^ O~ -..l. o'V ..'(\13 CI ",13 0 ... }o()\)
\" ~(). . ~" ~ ~, . ~ ' ' ,
Rrc?uire~le$~~~~~i()~~
I P,IU'inbing- I
-After device is installed but before backfilling trench. f0~'t..
~~ ~ ~~\
~'\ ~ ,S
~~~~~~~~ ~~~
. 't-.~\"\" \~S ~~~
# Of Stories:~\~~' ~~ S~~\il~~~1eet):
Current Un.!&: S ~"<-~ ~"<-\) \)\P}~ed Units:
Census COdQYB~~~~~~ ~"<-~
~ \~~\ ~ \)~
Total: C).. ~"'.
Grants Landscape Service
Po Box 221, Springfield, OR 97477
Backflow Device
Accessory:
Fee
Paid On Receipt#
Plumbing
09/30/2002 10755
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
j $31.00
Fee
State Surcharge - Plumbing
Backflow Prevention Device
8% Administrative Fee - Plumbing
Total Plumbing
Grand Total
"
Job# 02-01169-01 I
Paid On Receipt#
Plumbing
09/30/2002 10155
09/30/2002 10755
09/30/2002 10755
Page 2 of 2
Value/Quantity Fee Amount
. $3.15
1 $14.00
$3,60
$51.75
$51.75
By signing this permit/application, I agree to call for an inspection once the backflow prevention device
has bee install d is visible for inspection (726-3769). I also state that all information on this
permit plidci. n i rue and correct
Signature
;r-So~aL
Date
04'~J
t;",~
~
~
,,*~;j
~Li
'. '<:
~;'w~;g
0& ,~"-(i
,.il
0& 'r-1i
~
~
~f,\ );,
~
0& <r-1.j
t;,..,!j
~4
~t
TRANSlt;Ol~00107.55
DATE:SEP 30 2002
AMT RECD:2 $ 51.75
CHANGE:
CASHlm:061
ZZ5 FrITH STREET. SPRINGFIELD, OR 97477 . PH:(541)7Z6-3753 . FAX: (541)726-3689
City Job Number DZ-o ) I b 9-01
Job Location f!eJl3 Z- J iVr(rr(Ve'f-A}();U
, ,
/eOZ-OSZf
12d
Tax Lot
o 8g-0 ~
Assessors M~r
Owner '(:be I S Jc-O~ , t
Address if 3? l VV\ 't. ve?ND rJ
\
City SPt11J~rl~
Phone"
State" 6 f- Zip '17 if 7 ?
BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
Contractor Information
Contractor
~ f2.4N ''\ (S lA1vf) S lA{?<<, S VG I
Address 'PI 0 \ Bo"- 25ZA
Phone"
?).Co ,-f63 V
State Of-- Zip.G"~o 7?f(7 f'
~ {e~U\{es ~ ~\\\\'1
/0 Z ~~eC\O'{\ \~ "hP. o{eE~!:f@S'O'{\~ 9- .:300 Y
_,,\"'(\U\"'-_~od '0')'" .. ~\ClS a: _...I").()IJ \ - .
~\ \ t:-' -u\eS a.ou\"~ \nos~' ~~ O~\"\ '::I"'~\es '0'1
\O\\~\j\J ~\O'{\ cef\\e O,\O\n~Ou~s 0\ \ne {~o'{\e
B . . h" .t/ l' 'I . ~1'~1\~a; ".~f\'\.O.. ('(')'0\ h u.~\~9f1c ..,,0 .
y slgmng t IS penm app lcatlOn, agree to~ca ,- rs.:;orSa1l',mspe8&li.~t1'onc~.t~.e3uaC1\.'n@~,wprevenhon
devise has been ,installed and is visible for insp-~tj~r.lI{)'l>'2;(/?~16W:'S.i~~~o;'sfafe~\R~t all information on
9v:'\ c"""~ '(\U"" bi'!')'
this permit/application is correct. 00 ca\\\r.Q; \ne \'{\e O{e~o O.?;?J'2.-2'3
'i.J "edot ,'5 ,\_so
9 (\\,}'{'{\o (~, ,A'<.C:;\ \ oJ
, , -" \)~"
Signature., Dat~ ~ ~~~~C-
'\:.i-'?\\"I.~ i~~\ \ ry~
~ S\\~\.\. \\\\S '? ~~'\:.~ ~
\),\\~ ~,t\\\ \\Q\-~ ~t~\)
For Office U\~\S ~\::Q,\1..'\:.~ \) (\~ ,S ~.
. ~\t\1J ~\Jt~ '?'\:.~\S.
~\J\)~~~~ \)~
~~"
City
S9PW .
Construction Contractors Registration #
Date of Application
C:>7S00Z
,
L///
~h Checked for Delinquencies
~
'" J)
, -----
~
Checked for Historical Status
Shared Drive (T:)lBuilding FormslBackflow Preventionl-Ol,doc
..
City of Springfield
Plumbing Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.: PLM2002-00100
ISSUED: 10/4/2002
APPLIED: 10/4/2002
EXPIRES: 4/4/2003
SITE ADDRESS: 4321 MT VERNON RD
ASSESSOR'S PARCEL NO.: 1802052108803
Springfield
PROJECT DESCRIPTION:
Install Backflow Device
TYPE OF WORK:
TYPE OF USE:
New
Residential
OWNER/APPLICANT:
KORTE DORIS ELAINE
4321 MT VERNON RD
SPRINGFIELD OR 97478
PLUMBING CONTRACTOR:
GRANTS LANDSCAPE SERVICE
PO BOX 221
SPRINGFIELD OR 97477
CCB # 10250 Expiration Date: 20/4/9/30
Descrintion
Amount Paid
Date Paid
Receint Number
Cashier
Backflow Device
Minimum/Adjustment Plum
+ 8% Administrative Fee
+ 7% State Surcharge
$14.00
$31.00
$3.60
$3.15
10/04/2002
10/04/2002
10/04/2002
10/04/2002
10755
10755
10755
10755
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.
Reauired Insoections:
1 Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
By Signature, I state and agree, that I have 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. I further certify 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, that each address is readable from the street, and that the approved set of plans, if applicable, will
remain on the site at all times during construction.
Owner or Contractors Signature
Date