HomeMy WebLinkAboutPermit Plumbing 2002-12-20
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Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
3520 GA TEW A Y ST
1703153301400
Install backflow device
OWNER! APPLI CANT:
TOSCO MARKETING CO INC
% PHILLIPS PETROLEUM CO. TAX DI
BORGER TX 79008
Descrintion
Amount Paid
+ 7% State Surcharge
+ 8% Administrative Fee
Backflow Device
Minimum/Adjustment Plumbing
3.15
3.60
14.00
31.00
.
City of Springfield
Plumbing Permit
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2002-00123
12/20/2002
12/20/2002
6/20/2003
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Commercial
PLUMBING CONTRACTOR:
HARVEY & PRICE CO
PO BOX 1910
EUGENE OR
Phone: 541.746.1621
541.746.1621
97440
CCB#: 77
EXPIRES: 10/31/2004
Date Paid....o Receint Number
12/20/20Q2 ,,~ ~.:;~c: ~ 1. 200200000000000444
12120/2002 .".:' r.> !)1200200000000000444
121.2012i>02~.'.,~t- (~~,A200200000000000444
,1,2/20/2002 ". -;?J~,\~"1200200000000000444
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To Request an inspection call the 24 hour recording at 726,,3.769.;1\,11 !ns~.iionsr;;q'ueSteA]?efore 7:00 am. will be made the same working day,
inspections requested after 7 :00 a.m. will be made the)oll~~Jng,~,or~i,~( ~:'}~. ,(. r.r"'"' .,~<::>~~'\
Reouired Insoections: . '>/':,.rj>"J~(~ ."" " ,<- '\~~ f.>:-
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1 Backflow Device: Prior to covering and pr'ri~ide\~'c6'~y:of'the test report on site at the~'~IlSI'~\Tion.
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By Signature, I state and agree, that I have carefully e~amined the completed appli ~aIt~~Sl~rebY certify that all
information hereon is true and correct, and I further certify tbat any andAll,II,w f9 ~ball be done in accordance
with the Ordinances ofthe City of Springfield and the laws of the Stat~~m'<l!l, ~~.!b't!l.the work described hereilL I
further certify that only contractors and employees wbo are in coml\~~%~'U ~will be used on this project I
further agree to ensure that all required inspections are requested at t1t~~~!&..qGie~ t each address is readable from the
street, and that the approved set of plans, if applicable, will remain on t~~~~\Il>,!~es during construction.
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ZZ5 F1ITH STREET. SPRINCFH:W, OR 97477 . PH:(541)726.3753 . FAX: (541)726.%89
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CITY OF SPRINGFIELD, OREGON
CityJobNumbpr PLll1ZC>O[. - 00123
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Job Location ' ro .4./e. u/~f
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Tax Lot
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BACKFLOW PERMIT IS $51.75 (includes Permit Fee, State Surcharge & Administrative Fee)
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By signing this permit/application, I agree to cal\ for an inspection once the baCkf1S~:"%~~tion
devise has been instal\ed and is visible for inspection (726-3769). I also stat~Wt1l.~R ~ ation on
this permit/application is correct. \. 'i;.'f..v\~ v'i;.'(I~\ 'i'\j'(l
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Signa, a......., ( ./ 1'-7~ '\~\\f,~~t't.~~()'(I\~~'\DatP /02-.;1.0-(/2-
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For Office Use
Contractor Information
Contractor
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Expires
Date of Application
IZ-ZO-Oz.
Checked for Delinquencil"<
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Checked for Historical Stan'<
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Shared Drive (f:)!Building FonnslBackflow ~ _. .....:_.J~2.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
PLM2002.00123
PLM2002.00123
PLM2002.00123
PLM2002.00123
Payments:
Type .fPayment
Check
Paid By
Description
Backflow Device
Receipt #: 1200200000000000444
Date: 12/20/2002
Minimum/Adjustment Plumbing
+ 8% Administrative Fee
+ 7% State Surcharge
HARVEY & PRlCE
Received By
Cbeck Number Confirm No
djb
Page I of I
12/20/2002
12:00:23PM
,
10'
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
14.00
31.00
3.60
3.15
Line Item Total:
$51.75
How Received
Amount Paid
In Person
.
Pavment Total:
51.75
$51.75
cReceiptrpt