HomeMy WebLinkAboutPermit Plumbing 2001-5-9 (2)
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I Job# 01-00484-01 I
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Page 1 of 2
TRANS#:01-0005253
OATE:MAY 09 2001
AMT RECO:2 $ 77.00
CHANGE:
CASHIER: 061
CITY OF SPRINGFIELD, OREGON
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00484-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4215 Franklin Blvd Spr
Assessors Map#: 17033444
Lot: Block: Addition:
Tax Lot #: 03100
Subdivision:
Owner:
Address:
Darimart Corp
668 Greenwood Street
Phone Number: 541-998-2388
City/State/Zip: Junction City, OR 97448
New Value: $0
Scope Of Work: Plumbing
replacing existing piping
Contractor Type
Plumbing Contr
Contractor
John Riley Plumbing
25900 Hwy 36, CHESHIRE, OR 97419
Registration #
55173
Expiration Date
12/1/2002
Phone
541-998-2812
A"T"Tl':::I\ITII"\I\I.I"\..................I........,..""',.l......joo"...ii.'"
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use :.:::.:';. :Jles adopted by tho Oronon Uiility
Land Use: Notification Center. T"tfOt B'I.~ii{'r" "flt fO'ih
in OAR 952-001-001 0 'Onrolla~L"-~gG~::i2-0r;1-
Zoning Code: 0090. You may obtain "esp!?,a.l1,~y, , rQ,u~:
Bedrooms: calling the center. (,H3i!.t, ~o!lrce: " .
Range: numberforthe OreQ~.q:_Foo,tage: ..-w
Lemer IS l-t:SUU- ,J'::'~i1
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.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
[Ar~a (Sq. Feet)
_ Main: Accessory:
I
-Prior to cover. rJar'c~:
-After device is installed but before backfilli~91}rrPEP;:lrr BHALL EXPIRE IF THE WORK
- When all plumbing work IS complete. 8 PERMIT IS NOT
AVmOnlZED UNDER THI
COMM!:NCED OR 18 ABANDONED FOR
#!Y 180 DAY PERIOD.
Required Inspections
Plumbinq
Rough Plumbing
Backflow Device
Final Plumbing
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
-'0
Fee
Minimum Plumbing Permit Fee
Number of Fixtures
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Total Plumbing
Grand Total
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Job# 01-00484-01
Paid On Receipt#
Plumbing
05/09/2001 5253
05/09/2001 5253
05/09/2001 5253
05/09/2001 5253
05/09/2001 5253
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Page 2 of 2
Value/Quantity Fee Amount
$.00
5 $50.00
$4.90
2 $20.00
$2.10
$77.00
$77.00
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 used on this project. I further agree to ensure that all required inspections are
requested at the proper time and that the project address is readable from the street.
~~~
s&ture ~
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Date
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SPRINGFIELD
BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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JOB LOCATION: '-i Z / S-
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ASSESSORS MAP 1I: I 70 ~ sL/t./t/
OIlNER: """:nfl e.( 1/V/.4t2.1
ADDRESS:k,(.;)( Gy~", ''/0<:> J
CITY: J", ~ LJ, 0---.
TAX LOT 1I: C>31() 0
CI~
s 1-- PHONE 1I:
STATE: ~
5T.f( - 79 f - z3%g
ZIP: q. 7<f"'t' rr'
. 0
FEE) = $16.50 (<2:: SS'-
BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN.
CONTRACTOR: Tel '" '-
2- <:;9 era
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s~ PHONE 1I:
CITY:
STATE:
C5L
S-<)( 7 '3
99f- 2'612...
ZIP: 97C1/ c;
EXPIRES: /2c{ 02-
ADDRESS:
CONSTRUCTION CONTRACTORS REGISTRATION 1I:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
L1l~~
0)090 (
DATE
FOR OFFICE USE
--------------------------------------------------------------------------------
DATE OF APPLICATION: OS-O '7 0 I
JOB 1I: 0(- 0-0 '-18'(-0 (
RECEIPT 1I:
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ISSUED BY:
'1-.&
TOTAL AMOUNT COLLECTED:
3.3~