HomeMy WebLinkAboutPermit Plumbing 2003-08-07City of Springfield
Plumbing Permit
Status: Issued
225 Fifrh Street
Springfield, Oregon 97471
541-726-3759 Phone
541-726-3616Fax
541-7 26-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2003-00041
8t7t2003
8t6t2003
2t7t2004
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
936 SUMMIT BLVD
1703341106304
Install backllow device
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Residential
OWNER/APPLICANT:
STARRJEREMYA&DEBRA
936 SUMMIT BLVD
SPRINGFIELD OP.97477
PLUMBING CONTRACTOR:
LANDMARK IRzuGATION CORP
1574 COBURG RD PMB 305
oR 97401
EXPTRES 02/28/200:
Description
+ l0% Administrative Fee
+ 1Yo State Surcharge
Backflow Device /2003
Minimum/Adiustment 8/07t2003
19
To Request an inspection call the 24 recording at726-3769. All inspections requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will be made the following working day
Receint Number
I 20020000000000 I 909
I 20020000000000 I 909
l 20020000000000 l 909
I 20020000000000 1 909
Required Inspections:
1 Backflow Device: Prior to covering and provide a copy of the report on site at the time of inspection.
By Signature, I state and agree, that I have carefully,
information hereon is true and correct, and I further
application and do hereby certify that all
the Ordinances of the City of Springfield and the
all work performed shall be done in accordance with
certify that only contractors and employees
pertaining to the work described herein. I further
to ensure that all required
the approved set ofplans, if
ORS 701.055 will be used on this project. I further agree
that each address is readable from the street, and that
at all times during construction.
time,
Owner or Contractors Signafure Date
aDrrflcilat&
225 FIFTH STREET . SPNNGIIELD, OR 97477 r PH:(541)726-3753 o FA)t [541)726-3689
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BACKFLOW PERMTT IS $52.65 (includes Permit Fee, Stafe Surcharge & Administrative Fee)
C ontroctor Informatio n
Contractor (
*Jo{GUb YqI
City
Construction Contractors Registration #o
q .)10)
Expires 4 q-/ol
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zip
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By signing this permit/application, I asree
devise has been installed and is uirlLi.'fo,
this permit/apphcation is correct.
Date of Application o 8C^6c3
backflow prevention
state that all information on
to
$
's\
Checked for Delinquencies t/
Shared Drive (I:/Building Forms/Baclflow preventionl{3.doc
CITY OF SPRI}{GFMLD, O&EGON
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Receipt #z 120020000000000 1 909 Date: 0810712003 8:27:08AM
PLM2003-00041
PLM2003-00041
PLM2003-00041
PLM2003-00041
+ l0%o Administrative Fee
+ 7Yo State Surcharge
Backllow Device
Minimum/Adj ustment Plumbing
4.s0
3.15
14.00
31.00
Item Total:$s2.6s
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Check LANDMARK IRRIGATION DJB In Person
Payment Total:$52.65
s52.65