HomeMy WebLinkAboutPermit Plumbing 2002-12-3
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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
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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.
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22~ FIfTH STREET. SPRINGFIELD, OR 97477 . PH:(~41)72G-37~g . FAX: (541)72G<~G89
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CITY OF SPRINGFIELD, OREGON
City Job Numb.. PL/M Z.OOz. - 00 II ~
Job Locatior '1'6 b 7 :I (/ Y
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Tax Lot
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Zip '11 0/ 1 7
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BACKFLOW PERMIT IS $51.75 (includes Permit Fee4sIIrCharge & Administrative Fee)
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Contractor Information
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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><"
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For Office Use
Date of Applicatiop
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Checked for Delinquenr-;p<
Checked for Historical Status
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Shared Drive (f:YBuilding Fonns/Backflow Preventionl-02.doc