HomeMy WebLinkAboutPermit Plumbing 2000-8-28
oJ.. ~.
Job# 00-01309-01
Page 1 of 2
TRANS#:Ol-0003045
DATE:AUG 28 2000
AMT RECD:2 $ 16.50
CHANGE:
CASHIER: 061
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01309-01
225 North Fifth Street
Springfield, OR 97477
. Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 141 Hayden Bridge.Way Spr
Assessors Map#: 17032333
Lot: Block: Addition:
Tax Lot #: 07400
Subdivision:
Owner:
Ralph Carson
141 Hayden Bridge Way
Phone Number: 541-746-1380
City/State/Zip: Springfield, OR 97477
New Value: $0:
Address:
Scope Of Work: Backflow Device
backflow device
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
'# Of Buildings:
Occupancy Group:
, Heat Source:
Sq. Footage:
Backflow Device
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. ~ill be made the same working day, inspections requested after 7:00 a.~~cm1Jr~WI~i'e<quires you to
workmg day. follow rules adopted by the Oregon Utility
Required Inspections NetiflsatieR CeRts", These n.11?,:, ':lr? 'i'J~~
. . in OAR 952-001:'001 o through OAR 952-001
I Plumbmg I 0090. You may obtain copies of the rules by
-After device is installed but before backfilling trensalling the center. (Note: the telephone
numberforthe Oregon Utility Notification
. Center!~ ~'e~O-332-2344).
.,
~!A
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D .
-Area (Sq. Feet)
Main: Accessory:
,1,____.... \
# Of Stories: Height (feet):
Current Units:, Proposed Units:
Census Code: Does not apply
Fee
NOTICE:
Total: THIS PERMIT SHALL EXPIRE IFTHEWORK
Paid On ReceiPt~~IIOR~-~~' ~~n~Rli-ii6 r:;~~:Y'}[ri,~I~Wl
PI b. "1 .1\ ~r- r I I I "C,;~ JDO~ ~[D ;:-0;:;
urn mg ANY"8
08/28/2000 3045 I 0 DAY PERIOD. $5.00
08/28/2000 3045 $1.05
08/28/2000 .3045 1 $10.00
Minimum Plumbing Permit Fee
State Surcharge For Plumbing Permit
Backflow Prevention Device
.;,.,
:,.
Fee
Plumbing Administrative Fee
Total Plumbing
Grand Total
Job# 00-01309-01
Paid On Receipt#
Plumbing
08/28/2000 3045
Page 2 of 2
Value/Quantity Fee Amount
$.45
$16.50
$16.50
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 state that all information on
thiS(;:lilS~7}~ i?/~ ?/HJ
SignatUrE! ( . ----- D~te I
, ,
BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
-----------------------------------------------------~--------------------------
JOB LOCATION: / L/ / /IiI v1 J p rJ 13 R I'd C{ co kJ A- If
III ';"_1 ~ (
.' ASSESSORS MAP #: 1705233.3:. TAX LOT #:
OYNE~: Rli-Lf/l. l, .J- (?;/2 rIv % (} /if<. (n,Ai
ADDRESS::/1( II It vir! p Ai (J~ R L- Jq e fA) 11-0/ PHONE #:
. . (0- 'J ( WJ/J
CITY: .::;:fi)rl II.! eJ / ,f7. / STATE: ((/K,
\J -1' '=-,
b7L(OO
7cjb'- (~2 0
ZIP:9.7cf77
BACKFLOY PERMIT IS $15.00 + 1. 05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) ::: $16.50
CONTRACTOR:
6 w /116{Z.-
CITY:
PHONE-1t~'
ADDRESS:
ZIP:
CONSTRUCTION CONTRACTORS REGISTRATION/#: EXPIRES:
'. .~.
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR I~SPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATIONIS
CORRECT.
~ ;;to ~
'''~..;;? C. . . .
"._.~. _ Ud (
SIGNlfrURE r
"2'iz%/~
DATE( I
FOR OFFICE USE
, .
-------------------------------~-------~---------------------------------~------
.DATE OF APPLICATION: (:) '6 Z ~ 0;::'>
JOB #: 00 ~ 0/3:,0 7' ~O (
TOTAL AMOUNT COLLECTED:
::p
:3: -i
-i C :;0
::p ::p
:::u -i ::z
FT1 IT1 c.o
('"').. #
. . . ' C"J CD..
-----------..:.----------------------.:..--------:....--------...;-'..:.-.:..:...-.-~-..:.--:...-----..:.----_65_- ;~ ~ ~ .
. =c I
1-tC"J~NO
. m=c COO
:::0 ::p ,....,. 0
.. ::z 0-. f".,) c...J
0Ci). 00
0-. m 01 0 ~
,....,...0001
.50'-(.~
ISSUED BY:
~~
RECEIPT #:
,/6~