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HomeMy WebLinkAboutPermit Plumbing 2003-01-22City of Springfield Plumbing Permit Status: Issued 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone 541-726-3676Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: PLM2003-00006 u22t2003 u22t2003 7t22t2003 SITE ADDRESS: 1377 MOHAWK BLVD ASSESSOR'S PARCELNO.: 1703253403901 PROJECT DESCRIPTION: Install backflow device 10 Springfield TYPE OF WORK: TYPE OF USE: New Commercial 503CORPUMPQUA HOLDING 2OO SW MARKET ST PORTLAND OR 9720 o\ 900 c STE I OWNERYAPPLICANT: Descrintion + l0% Administrative Fee + 7o/o State Surcharge Backflow Device Minimum/Adiustment Plumbine IRzuGATION CORP RD PMB 305 oR 97401 r-686-9493 6049 E)0IRES: 02/2812003 Receint Number l 200200000000000587 1200200000000000s87 I 200200000000000s87 l 200200000000000587 \$ C 0U2212003 0U2212003 0v22/2003 0t/2212003 3.15 14.00 31.00 To Request an inryection call the 24 hour recording at726-3'169. All inspections I be made the same working day, inpections requested after 7:00 a.rn will be made the following Required Inspections:$ss 1 Backflow Device: Prior to covering and on site at the time of inspection. By Signature, I state and agree, that I have carefully completed application and do hereby certify that all information hereon is true and correct, and I further that any and all work performed shall be done in accordance with the Ordinances of the City of Springfietd and the laws of the State of Oregon pertaining to the work described herein. I further certiff that only contractors and employees who are in compliance with ORS 701.055 witl 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 if applicable, will remain on the site at all times during construction. \ Owner or Contractors Signafure o3 -r t/22/2003 l:43:00PM City of Springfield ' Development Services Department Public Works I)epartment Official Receipt 225Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Receipt #: 1200200000000000587 Date: 0112212003 Line ltems: JoUJournal Number Description Amount Paid PLM2003-00006 PLM2003-00006 PLM2003-00006 PLM2003-00006 Backflow Device Minimum/Adj ustment P lumbing + l0% Administrative Fee + 7Yo State Surcharge Payments: 14.00 31.00 4.50 3. l5 Line ltem Total:$52.6s Tlpe of Payment Paid By Received By Check Number Confirm No How Received Amount Paid Check LANDMARK IRzuGATION djb In Person 52.65 Total:$s2.6s Page I of 1 cReceipt.rpt rsFl*lr{SFtsLo 225 IIFII{ STREET . SPRINGFIELD, OR 97477 r PH:(541)726-3753 o FAX: (541)726-3689 e'1H"l-\. \JOJ arr!t {!tt,*!-V:, CitV Job flrrmber ?ta'teco) -oeaL Job Assessors t31 Lv,,'-rlc Bl ,l ao"ZS3 A Tax 7t e..r.,,.Et:d,.!\tF#{ ,rF\t*{d +*/ '*llt*tr+ CNi.rt $-*,(t lef..+|& 6t Q}=qtpCu h.etn,hril r{:irt' r--r\\J;t'lffi -lirlkt4i++r GT h- G}g'a, G+Ii{lc; kAr\JJ r*G\ri#lji \l+; -; 'e); qt r,Y],L-r;;;f{ Owner C,L Address I 3-l -l v\AoLta *lc B I v cl City SnvNqG.k( Ototr^ '18 -t"t0z zip ?-lYll & Administrative Fee) C" eG-1 Ye 3 7)uo1 Expires 3/ o: rI BACKFLOW PERMIT IS $52.65 (includes Permit C o ntractor Information Contractor llvaO"rf l5l LoL" City 8., Construction Contractors Registration #ov1 By signing this permit/application, I agree to call for devise has been installed and is visible for inspection this permiVapplication is correct. D r$ Use Date ofApplication ZZ o7 Checked for Historical Status the backflow prevention state that all information on 27-o Checked for Delinquenci es Sbared Drive (T:/Building Forms/BacKlow Preventionl{3.doc ctrr..y'or,, EG0)d I\rf qn S.-Qfofa zip I