HomeMy WebLinkAboutPermit Plumbing 2003-6-9
'If' '.
/'
City of Springfield
Plumbing Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2003-00037
6/9/2003
6/9/2003
12/9/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
654 CENTENNIAL BLVD
1703264310900
replace 40 ft sanitary sewer line
and underfloor reversal
Springfield
TYPE OF WORK:
TYPE OF USE:
Repair
Residential
OWNER! APPLICANT:
FOX VIVIAN M
POBOX414
SPRINGFIELD OR 97477
PLUMBING CONTRACTOR:
NEW HORIZONS HEALTH CARE SYS~ 541-746-4224
PO BOX 636
SPRINGFIELIIDR 97477
CCB# 66681
EXPIRES 05/15/2004
Amount Paid Date1>~la~\~~\'l
\N ~e~~ O{\ v r.
1 b'50'O: (06f691200BI\ \0 .
\~.,U\e:8&~'l \~e Q91-0~/7 )Q~'2.~OO "
/ \:;.\~\ \0 a.oO\Y7().p~ose ~\}q6/.Q9)Q )o\u\eS '0,
~\ \ ~ ~\)\eSce{\\('45.00 \~~0\)~6/QJ!2'06'3 ~o{\e
\o\\~ \\o{\ ",,00 '\ ~ co~\eS e \e\e~. a.\\o{\
~o\\\\ca. S'2.~()() 0'O\a.\{\ O\e'. \~ ~o\\\\c
. _ n~~ ~ _), '({\a.'l _H>'~' ~~ .... \ \\\\\\'l_ ^a,,\.
\" 90.' '" - ~e G'O" ~e~u" ~?-~'(..v'
To Request an inspection call the0~ h~ut\?e~~rdipgft ~6S91I9~?> All inspections requested before 7:00 a.m. will be made the same
working day, inspections requested a~tJl~r00\t'ii:;\w.ifI'B'e 'made the following Working .day. \NQ~~
\\ \\ \~ ~\,)\
Reauired InsDec~ions: . ~)..~'1-.'?\~tt. t.~~\\ \~ ~
1 Sanitary Sewer Line: Prior to filling trench and includi~ts,\\i.~~~1j~~t.~ \"\~~~Q~t.\) t~
2 Rough Plumbing: Prior to cover and including required ~~~t:~\lt.\) ~~~ \~ p..~N
3 Final Plumbing: When all plumbing work is complete. p..~\~~t.~c,t.~ ~'t.~\Q\)'
By Signature, I state and agree, that I have carefully examined the c~~<<t8>~~Wcation and do hereby certify that all
information hereon is true and correct, and I further certify that an;-m'all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further
certify 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, that each address is readable from the street, and that
the approved set of plans, if applicable, will remain on the site at all times during construction.
~!~~
- /e::~~~
~er Dr Contf.acfors Signature -
Descriotion
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Fixture
Sanitary Sewer - 1st 50 Feet
1200200000000001478
1200200000000001478
1200200000000001478
1200200000000001478
& 4~ S'
Date (I ; .
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department .
Public Works Department
Official Receipt .
Receipt #: 1200200000000001478
Date: 06/09/2003
Job/Journal Number
PLM2003-00037
PLM2003-00037
PLM2003-00037
PLM2003-00037
Description
Sanitary Sewer - 1st 50 Feet
Fixture
+ 10% Administrative Fee
+ 7% State Surcharge
Item Total:
Amount Paid
45.00
70.00
11.50
8.05
$134.55
Payments:
Type of Payment
Check
Paid By
THOMPSON SEPTIC
Received By
djb
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
134.55
$134.55
6/9/2003
2:30:29PM
Page I of 1
cReceipt.rpt