HomeMy WebLinkAboutPermit Plumbing 2013-5-9 SPRINGFIELD 225 Fifth St
'` — = CITY OF SPRINGFIELD Springfield,OR 97477
{ +.,d' `r ' I Phone: 541-726-3753
loaecoN Building / Permit Inspection Phone: 541-726-3769
• Fax 541-726-3676
PERMIT NO:
'm wspringfield-or.gov gl Cr j fl j , a -073,3 permitcenter@spnngfield-or.gov
PROJECT STATUS: ,1550er ISSUED: 5/1 13 EXPIRES: \t/ /2013
STATUS DATE: /�^^ APPLIED: 1S--/ /2012
SITE ADDRESS: 930 & S-cc2 E 7 SCOPE: `PLU MC'JZ-du L,-
ASSESOR'S PARCEL NO: TYPE OF STRUCTURE: S F'fl
PROJECT DESCRIPTION:
OWNER: PROCK LIVING TRUST Phone Number:
•
ADDRESS: PO BOX 114
SPRINGFIELD OR 97477
OWNER: PROCK LYNDA L TE Phone Number:
ADDRESS: PO BOX 114
SPRINGFIELD OR 97477
OWNER: PROCK ORVILLE DALE TE Phone Number:
ADDRESS: PO BOX 114
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
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 or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.005 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, that the
permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during
construction. •
2 '-zni 3 •
Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility JTICE: •
Notification Center. Those rules are set forth HIS PERMIT SHALL EXPIRE IF THE WORK
• In OAR 952-001-0010 through OAR 952-001- !)THORIZED UNDER THIS PERMIT IS NOT •
0090. You may obtain copies of the rules by OMNIENCED OR IS ABANDONED FOR ;
calling the center. (Note: the telephone
. number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Springfield Building Permit Center is 1-800-332-2344). 5/9/2013 1:53:19PM Page 1 of 1
•
SPRINGFIELD — CITY OF SPRINGFIELD
4 f • :� 225 Fifth St
t . TRANSACTION RECEIPT Spnngfielef OR 97477
`.OREGON 541-726-3753
811-SPR2012-02393
www.spnngfield-or.gov 930 Q ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2013000919 RECORD NO:811-SPR2012-02393 DATE:05/09/2013
Lam. 8x".:1ar•§P te iS =_ i_ACCOUNT o o ; • , COOS I=' .e:_AMOUNT!DUE .
Sanitary sewer 224-00000-425603 1005 76.00
Sewer cap/septic tank demolition 224-00000-425603 1005 58.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 16.08
Technology fee(5%of permit total) 100-00000-425605 2099 - 6.70
TOTAL DUE: 156.78
KS AYMENTnTYPE PAY Alare ieie:;C nRPERiER- . ,COMMENTS "MU ANQU MAIS
Check PROCK LYNDA L TE 156.78
140000946693
TOTAL PAID: 156.78
SPRINGFIELD'__. CITY OF SPRINGFIELD
225 Fifth St
`OREGON TRANSACTION RECEIPT SpnngfeltOR 97477
541-726-3753
811-SPR2012-02393
www.springfield-orgov 930 Q ST permitcenter @springfield-or.gov
RECEIPT NO: 2013000919 RECORD NO:811-SPR2012-02393 DATE:05/09/2013
lggeie7 T13id1o11 ai „;' rr ..z: iipiar S t _-ACGOUNT.CODHLRANS CODEe :„12 i:, AMOUNTI TTIt..J
Sanitary sewer 224-00000-425603 1005 76.00
Sewer cap/septic tank demolition 224-00000-425603 1005 58.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 16.08
Technology fee(5%of permit total) 100-00000-425605 2099 6.70
TOTAL DUE: 156.78
PAYMENTRTYlle . . rPAYOR arilEa cairgiu COMMENTS AMOUNTLPdID
Check PROCK LYNDA L TE 156.78
140000946693
TOTAL PAID: 156.78