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HomeMy WebLinkAboutPermit Plumbing 2002-8-9 r Job# 02-00963-01 Page 1 of 2 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety TRANS#;Ol-OOl0243 DATE=AUG 09 2002 AMI RECD:l $ 51.75 CHANGE: CASHIER~061 Job Number: 02-00963-01 225 Fifth Street Springfield, OR 9.7477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 5196 Forsythia St Spr Assessors Map#: 18020421 Lot: Block: Addition: Tax Lot #: 02000 Subdivision: Owner: Hollis Oldfield Phone Number: 541-726-5662 City/State/Zip: Springfield, OR 97478 t"I~\O n,.,.V.aiu~~,,:-"~ $..0, 'f...1d~ . \)",. ~\ ,\0~V.'" ~O(\e\ \0 ~' \'3-~ 0,\0 '3-,\0 S a:()() 'O~ ...n(\ ....'(\.e ,,,e;:, ...."Ot~ \o^e;:, , O,\'<::J':J 0.'0'1 ,\\)'- o?-,' ,\\)'- e C T C t t ~\R' "-~tr.>, t" ~c.0.# (\Y"r.= ..'\rPt~', ~ t ... ontractor ype on rac or ~,,\\o\ ''3-tg)~ r""c:m ~o\).~~;8!r:a~W\"A~~t,g., Plumbing Contr Hol~is Oldfield ::\,,'? '(..y.eS Ge{\\~~~\~~~o~\0.~e\~o~\\V 541-726-5662 5196 Forsythia Street, Springfiel~o\(j).R\ ~O(\ ~()\' :o\'lY(\ ~o\e~\~~~ ~~f>.,. 97478 :o\~\~~ q,~~ ~'3-~ _~(\\e'\ :n('},O{\ n..~?;?) . Oir - ....u~ e..... u'- C\'J Off" . i( "," ~~ ",e ,CO'" Ice (~jJv . i\~ - 'f... ~, . s '\ ()",,-, ~\" \0 (~ Quad Area: Land Use: c'O- ~'Oe'( CF)(\\0 # Of Buil~~ngs: # Of Units: Zoning Code: (\'1> Occupan<:y Group: Constr. Type: Bedrooms: Heat so~.U~~~ Water Heater: Range: S,..{{\~,~\ ~"t 'r. ~\ \ ~ ~ To request an inspection call the 24 hour recording at 726-3769. All inspe~~~~~~'lW<f&).\' 7:00 a.m. will be made the same working day, inspections request~fterl~~~\\WI1P~eJe the f<?/Iowing working day. \\~~~ ~~,,~~\) \)~~ ,S ~~ Requirecn.n"S\~~lh~tiV ~'(\(:;., I Plum~w,:~~t.~~ ~~ \> .-After device is installed but befo~~e.c'kYil~ng trench. Address: 5196 Forsythia Street Scope Of Work: Backflow Device New Install backflow device Phone Backflow Device Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# Plumbing 08/09/2002 10243 Value/Quantity Fee Amount Minimum Plumbing Permit Fee $31.00 Fee State Surcharge - Plumbing Backflow Prevention Device 8% Administrative Fee - Plumbing Total Plumbing Grand Total Job# 02-00963-01 I Paid On Receipt# Plumbing 08/09/2002 10243 08/09/2002 10243 08/09/2002 10243 Page 2 of 2 Value/Quantity Fee Amount 1 $3.15 $14.00 $3.60 $51.75 $51.75 By signing this permiUapplication, I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). I also state that all information on this permit application is true and correct. Signature //~ IY-~~d/ / ,"'l;.....~ _. ~ .....,.,~ " q.- 7- t:J 2 Date \ , , t) Checked for Delinquencif3<;: aj C} iF"": -oJ ~-"i 8,,, ''F',.Ji !~="lf ~?, ,""I) ~ 8" . ?,,~J4 . '* .........Ii ~ 0", ,y=~!q _,J ~nl) ~, "'" ~.. . ~'J 0", "f",.Jq >? 00 ~~'1 .~ ~....".' ~.j, ~ > ~ ~~""ji TRANS# :Ol-00102Lf3 DATE:AUG 09 2002 Ri'H REeD:1 $ 51.75 CHANGE: CASHIER:061 ZZ5 FIITH STREET 0 SPRINGFIELD, OR 97477 . PH:(541)7Z6-3753 0 FAX: (541)726-3689 City Job Number6Z- 009 b J ~6 f S-I 9 b ~o<LS,-/J l i~ ) '6'OZ 6lfZI Job Location s .}- Tax Lot o zo-oo Assessors Map CJld J;eld brlv...u Owner +1 Dill '5 p, Address 51 q to Forsy+A /l; City :5prl nq-h'e I d Phonf3 7 2 t. -.,5/; t z:. State (){;JEbON Zip t11cfl% ~ 7h7 BACKFLOW PERMIT~5L~IUdes Permit Fee, State Surcharge & Administrative Fee) Contractor Information ~ ~\)~~\ ~\~A'\~~ /~ w IV! [:fL- --'"~..~\~~~<(,~*~ ~~~ L/' ~\ \.. ~f>-n~~ ~'(-.r'P ~ ~\)Y \~~. ~:~ ~~~ ~~~ ..>>,~ ~~.<'(\ ~ -~ \'0 1"'- Zip ~\~S \\<J~(.R,~\) \)~~~\)v' ~~'\..,,~~~ (\~ EXRit:~}~,,-.1 ('~\~-- 1>0. Y:JV - ~o~ 'i ,\\\"-:"&" - ~, " o..>v" 0" 1\,..... fl.' ~ ~ ,,0 O'l<,e~ '1<,0 ~0 O/\J\J '0'\ \?i- 0 ?i- 9J(.j ~ B . . h' . I l' . I 11.(.'." ...o{\ '~1.. ~'U~ '1st. ,~~0..... . Y ~lgnIng t IS ~enmt app lc~tIO~,. agree ~o ca ~or an Insp,eIS\l;9Fr 8.Q:e~ ~~e ",~~~l~QJV Rb~~~~tI?n devIse has been Installed and IS vlSlble for InSpectIOn (7260'.Sl'o2d~\er.als6 sJJte ~ha'fa.~~:Qf~atIOn on this permit/application is correct. ::~,'\ eC;)'(). ~\.0'" ~\J~'t. O~\0.~0\.0~p~\\.J (" \":'~ ,,~:~ G~\J\,(;j(::) ~iY~ ~o\.e' ~~~ ~f).~' (' ,o~~,\\c.# brz:\S 'O-~ 0'0 ~0"'~ o~..s fJ>rz:1; Signature /;1. / cY~~ ~0\.~\>-~:lp~~~.c.0~~O"~~a<f; 8~ 7"- t:JZ- tf/ \~. 9\J',:\\~ t 10:\ ~ . \':; \)\) ~" :\ " ~e'- , c. ~'O0 (Jc<" -^,\, Contractor Address ...--' City Construction Contractors Registration # For Office Use Date of Application o 8'0962.. L---" .~ I,..r Checked for Historical Status Shared Drive (T:)/Building Forms/Backflow PreventionI-02.doc