HomeMy WebLinkAboutPermit Plumbing 2001-11-21
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Job# 01-01287-01
Page 1 of 2
TRANS#~Ol-0007306
DA TE : NO~j 21 2001
AMT RECD~2 $ 51.75
CHANGE~
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
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Job Number: 01-01287-01
225 North Fifth Street
Springfield, OR ~7477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3406, Watermark Dr Spr
Assessors Map#: 17021943
Lot: Block: Addition:
Tax Lot #: 05900
Subdivision: Ambleside
Owner:
Chris Real
3406 Watermark Dr
Phone Number:
City/State/Zip: Springfield, OR 97478
New . Value: $0
Address:
Scope Of Work: Backflow Device
Backflow device .
Contractor Type
Plumbing Contr
Contractor
SCHELSKYS
P.O: Box 7945, Eugene, OR 97401
Registration #
l.Q3 ~O
Expiration Date
~r 1.-<"6 f 0 -z..
Phone
541-744-7135
Office Use
Lan~ Use: E~' ' # Of '~\fI'{SJ\E\NO"'\<
Zonmg Code: N01\C ~'5\-\~\..~'b~)r~~~lEP~t1Jwelling
Bedrooms: ,\-\\5 PER"" \JND~~Bur~D rOR
Range: ~1r\OR\2E~f' oR ~1J~~iAqe:
~W\t.\~oe- OD.
To request an inspection call the 24 hour recording at 726-3769. ~~i\I)~~~~ested before 7:00
a.m. will be made the same working day, inspections requested afM.\.,.:~'Ovam. will be made the following
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
1
(VN) Wood Frame
working day..
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-,Area (Sq. Feet) .
Main: Accessory:
Required Inspections
I Plumbing I
-After device is installed but before backfilling trench. , .' to
, law requires ~QU
AJTE:\l nON:oreg~nb tho Oregon Utility
folloW rules adopte Y e ;ules are set forth
Notification cen~er. Tht~~OU9h OAR 95~-001-
Garage/S~.ed)AR 952~001 ObOt1 ?I'n copies of the rules by
90 "1('\1' 1T.l?\1 0 a I hone
# Of Stories: 00 'Helglit (feeit):r (Note: thete ep .
allioQ me Ctll ~a ' \ " N t'ficatlon
Current Units: C p.rop'osed~W-nits::1n Utility 0 I
numoel IUI ""'- -. -"'"' 344)
Census Code: New SF- detached Center is 1-800-332-2 . '.
Backflow Device
Total:
Fee
Paid On Receipt#
Plumbing
11/21/2001 7306
Value/Quantity
Fee Amount
Minimum Plumbing Permit Fee
$31.00
-i.l
Fee
I
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
Job# 01-01287-011
Page 20f 2
Paid On Receipt#
Plumbing
11/21/2001 7306
11/21/2001 7306
11/21/2001 7306
Value/Quantity
Fee Amount
$3.15
$14.00
$3.60
$51.75
$51.75
By signing this permiUapplication: I agree to call for an inspection once the backflow prevention
device has been installed and is visible for inspection (726-3769). I also state that all.information on
this perm~lication is true ~ corr~ct. ._
8-^-- ~----
Signa~ure /"
!f!t/ /6/
Dat~ (
t..IIII,
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUILDING SAFETY
225 Fifth Street '
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE:, 726-3769
Job Location:
S Lfo G:. 1.-1,4 +~... -....... '- :s /-..
'Assessors Map #: '/76 Z- I 9 Lf '3.
Owner: CL~.'S ~e..1
Tax Lot#:O S 760
Address: 311- () b' ~"L ~..., u sf:
City: ~.f(/ State: 0...41.. Zip: ??~77
BACKFLOW PE~IT ~~Udes Permit Fee, State Surcharge & Administrative Fee) .
Phone#:
Contractor:
.5c.I
.f/. o. d or- . 7tC(;-
. .
Phone#: 7Lf"'~- 7135"
Address:
City:
F~,
State:
o~,
. Zip: ? 7'7'0/
Expires: 2/ ?-- aYo z
Construction. Contractors Registration#:
b '33cJ
. .
". .. .
By signing this permit/application~ I agree to call for an inspection once the backflow prevention device has ' ,
been installed and is visible for inspection (726-3769). I also ~te that all information on this permit/appl~cation
is correct.
N___
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7
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Date' ,
Signature
FOR OFFICE USE
Date of Application: I j/Z ( /0 ( Job #: eJl - 0 I Z- 87- 0 I
Checked for Delinquencies: Checked for Historical Status:
VALIDATION: .
190 ~ ;:j3IHStlj .
: 39NtJH:J
gL' 19 $ Z:a:J3t1 Hlt!"
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