HomeMy WebLinkAboutPermit Plumbing 2014-6-26 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
S - Phone: 541-726-3753
Z OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01374
www.springfieldor.gov permitcenter @springfieldor.gov
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PROJECT STATUS: Issued ISSUED: 06/26/2014 EXPIRES: 12/22/2014
STATUS DATE: . 06/26/2014- APPLIED: 06/26/2014
SITE ADDRESS: 1063 KELLY BLVD,Springfield,OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1703341103200 • TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: 82 ft of private sewer repair
OWNER: VION DANA E • Phone Number
ADDRESS: 1063 KELLY BLVD
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp " Phone
Plumbing Contractor BERNARD PETERSEN INC COB 93126 08/23/2015 541-343-9339
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INSPECTIONS REQUIRED
Inspections
3200 Sanitary Sewer • Sanitary Sewer Line: Prior to filling trench and including required testing.
3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing.
3999 Final Plumbing Final Plumbing: When all plumbing work is complete.
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.'
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Owner or Contractor Signature Date
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Springfield Building Permit . 6/26/2014 8:42:59AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
ja... iiiiii 225 Fifth$t
tit TRANSACTION RECEIPT S5FifthlSOR 97477
OREGON 541-726-3753 f
811-SPR2014-01374
www.springfeld-or.gov 1063 KELLY BLVD permitcenter @sphngheid-or.gov
RECEIPT NO: 2014001375 RECORD NO:811-SPR2014-01374 DATE:06/26/2014.
DESCRIPTION ��.,o- = r.— S-LC. .tar)_ ,._ = 3.ACCOUNT:CODE/TRANS'_CODE .;_,-7=AMOUNTiOUE .4
Continuing Education Fee 224-00000-425606 2.50
Sanitary sewer • 224-00000-425603 1005 85.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.20
Technology fee(5%of permit total) 100-00000-425605 2099 4.25
TOTAL DUE: 101.95
BAYMENTeTYPE- PAYOR CASHIER:JI-ARSOH _ COMMENTS. _ AAAOUN;f'PAIO. _
Credit Card BERNARD PETERSEN INC 101.95
00421C
TOTAL PAID: 101.95
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