HomeMy WebLinkAboutPermit Plumbing 2014-7-9 SPRINGFIELD-- 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
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• •' Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01475
www.springfieldor.gov permitcenter @springfield-or.gov
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PROJECT STATUS: Issued ISSUED: 07/09/2014 EXPIRES: 01/04/2015
STATUS DATE: 07/09/2014 APPLIED: 07/09/2014
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SITE ADDRESS: 1125 58TH ST,SPC#79,Springfield,OR 97478 SCOPE: Backflow Device
ASSESOR'S PARCEL NO: 1702342200100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Backflow device
OWNER: GOLDEN OAKS MOBILE HOME PARK LLC Phone Number:
ADDRESS: 6009 SHANE DR
EDINA MN 55439
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
FOUR SEASONS YARD MAINTENANCE LLC Landscape Contra 9178 05/31/2014 541-895-5242
INSPECTIONS REQUIRED
Inspections
3620 Backflow Device . Backflow Device: Prior to covering and provide a copy of the test report on site at the
time of inspection. .
• 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 oft e property, and the approved set of plans will remain on the site at all times during
construction.
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Own- o•Contracto Sign. . e Date
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK Not ii at oln Centel Those Oregon
set forth .
in OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD, calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332.2344).
Springfield Building Permit 7/9/2014 11:33:49AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
i . 225 Fifth St
at
TRANSACTION RECEIPT Spdngfield,OR 97477
" 'OREGON 541-726-3753
811-SPR2014-01475
wren springfeld-or.gcv _ 1125 58TH ST. SPC 79 permitcenter @springfield-or.gov.
RECEIPT NO: 2014001482 RECORD NO:811-SPR2014.01475 DATE:07/09/2014
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jo7d.4o3.il�d(ol: " �`�,,�;� ,*�.�R':.t��: °�'.�w°��;ia�`.�ACCOUNT+CODE/�TRANS.CODE '-'` .�`<`"AMOUNT DO '"
Backflow preventer 224-00000-425603 1005 21.00
Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 61.00
Continuing Education Fee 224-00000-425606 2.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
.BAYMENTaTYPE" PAYOR cnwEe ZEZTPNER�-L7,. CO ,,...MMENTS �"AMOUq
Credit
Card FOUR SEASONS YARD MAINTENANI 98.44
06016g LLC
TOTAL PAID: 98.44
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Plumbing Permit Application DEPARTMENT'USE ONLY ':
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: ///'/ /7
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits
expire if work is not started within 180 days of issuance or if work is suspended for 180 days.
. r LOCAL"-`GOVERNMENT.',;AP..PROVALr < r 3 ;; - ,'__3 4e1.::FEE ZSCHEDULE ft„ Y 5 1 ?:.- ,:;- ,?•
Zoning approval verified? ❑Yes ❑No *Descnptlori r.;