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HomeMy WebLinkAboutPermit Plumbing 2002-12-3 r ,/ .... - Wiitr~:~~" " , ,,", -, " , , " . ,. 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: PLM2002-00118 12/3/2002 12/3/2002 6/3/2003 SITE ADDRESS: 4667 IVY ST Springfield ASSESSOR'S PARCE~h<<((r.E' 1802051305400 TYPE OF WORK: PROJECT DESCRI1t'm9~tR~lltte\,,q,asIUlil",ae~iHlE WORK TYPE OF USE: . _, I__.~~n I "1"CO TUI<: P~RMIT IS NOT MU II VII""lI..."" Co. 1:._ OWNERlAPPLICAN['jMMENCED OR IS ABANDONED FIlI\,UMBING CONTRACTOR: CLEO MCCUTCHEON ANY 180 DAY 5'W~P8362 GRANTS LANDSCAPE SERVICE 4667 IVY ST PO BOX 221 SPRINGF]ELD OR 97477 SPRINGFIELD OR 97477 Phone: 541-746-8482 New Residential + 7% State Surcharge + 8% Administrative Fee Backflow Device Minimum! Adjustment Plumbing 3,15 3,60 14,00 31.00 CCB#: 10250 EXPIRES: tI09/30/2004 rOQ....Ub,;. v,_, 'h.I __^' "alJ': - __n \ ,\I\i" -. .:\If)\''.'-'''-'' ..,'..,f:\..,.;.....:-. \iO'~~ rDatelPaid. cO?,edtReceil'.t Number 0" _ Cashier \o\1~/O}/~9.9~~nte(. Ji~Q~9.~~~~Ooo[O.9H?~s ~'i dib \,-\oI12!QJI?.297.)01-UO I ~().o.?pO,~..QQOOOOOom,ne dib in (]2/03~2_()97(1a'1 o'o'120()2QO.()0()()QOOOO~.2.8 tiOn dib OC]]i:0312002 cent'!'200200PO,QRooo00328> dib calling tile the o;eQC:" :~2~2344), nul11pe!lOf. . < '\ _bOG-;),) Cenle' \. Desc riotion Amount Paid To Request an inspection call the 24 hour recording at 726-3769, All inspections requested before 7:00 am, will be made the same working day. inspections requested after 7 :00 a.m. will be made the following working day, Reouired Insoections: 1 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 he done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work descrihed herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 will he 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 applicahle, will remain on the site at all times during construction. /5-/s /n~ Date I 22~ FIfTH STREET. SPRINGFIELD, OR 97477 . PH:(~41)72G-37~g . FAX: (541)72G<~G89 ~~ ~ ..~ ~ ~ Assessors Ma:, ..~ ~ CI c. - J ~ Owner ~O If/;::; c..VJc:",,^ €.Il A) ~ . 4/t --\) <(; . Addres< it:::> 7 ~ (/ . City SP?-l~M.lj , .-/. f~ '~ ~ ~ ~ ~ ..~ > ~ Q, ~ ..~ I~ i t ~ ~ ~ ~ M . . , CITY OF SPRINGFIELD, OREGON City Job Numb.. PL/M Z.OOz. - 00 II ~ Job Locatior '1'6 b 7 :I (/ Y . I i 2'ocoS"n ST Tax Lot 6 '5' Lf 0 <;,J Phonp 7'1 / -~3(' "2- Zip '11 0/ 1 7 State--<!)..,L BACKFLOW PERMIT IS $51.75 (includes Permit Fee4sIIrCharge & Administrative Fee) '\~<<., f.o ~ ~~ #~\)~ ~~ ~<<.,~ &,\) '--~~S r::,~ . ContractorG P-A I'-"Ts- tA~J.~~~G//Ce.<' A /)/j;15/~1U 01' t=-ek1vS /) CL. ~'\~~~"!-~\) 'V,\)~~\)\). Addrers r. ("). rc;oX ~.,'f_ r~ r'-<"Y o~ , '''\::::\{..~~''''-\)~. City .:S of/fL)t--&ple IJr-_\J~\ ,<o\J ~ Construction Contractors Registration # S 3 I d... Contractor Information Phonp State i') ,-t:.- Zip,) en '17 ~ ,0',)',,,, r:;..... .\~~\.~.>~ _ / _,\-!,.0 ~.Exrl1res "II')/~ ~ ,'C."'-:. .Iov.~ _ c;oiJ"_ (\\J' _ ( '\l).... v 'l;-'- b'" v' , 0\' >\S'o0 \0'" ;q8J ~0'i> .:f,<;f o'Q~ e~~' 0'<' e~~ ~0 By signing this permit/application, I agree to call for ,ail' i~~ftiOR~~ni:f tJ.1~'~c~%~fP~evention devise has been installed and is visible for insp'e~tion'(~7i'6~3~62)";l'1 ~1s6\tal~,thai\'all information on this permit/application is correct. ,?--\~\O~ \~o~ ~<;)<;)\,IJ ~\?;>~ ~0\~)~~:~bJ><" \0 ~\c,~~ ~~7; ~'l>~ 0 ~'9\)Q;O<>-(P:" f ~~OOl'-r--l.O\) ec,0 O~ c.!\", /} ~.d .."\ i;) ,,~~e ^,u..... / h Signature ~ '"dil :\\\"'''_\0\ '",.\', DatI' /0-/ '?/'O~ /1 / v- ~'Qu Ce' ' V "'',)\ For Office Use Date of Applicatiop /;10> looz- Checked for Delinquenr-;p< Checked for Historical Status ~ ----- ......- Shared Drive (f:YBuilding Fonns/Backflow Preventionl-02.doc