HomeMy WebLinkAboutPermit Plumbing 2003-02-05SPBI}J' TIELO
City of Springfield
Plumbing Permit
Status: issued
225 Fifttr Street
Springfieltl, Oregon 97 477
541-726-?-: o Phone
54t-126-: , " Fax
541-:25 | Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2003-00008
2t5t2003
2tst2003
8t5t2003
. r lE ADDRESS:
ASSESS'' I PARCELNO.:
PI] OJF.'' NESCRIPTION:
345 14THST
1703362310400
Backflow Device
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Residential
C'
Bt'sl
3-+-i l
SPR]'
!r
: l:'
1-ICANT:
) & DOROTHY
'\97477
'ive Fee
le
,,'nt Plumbine
Amount Paid
4.50
3.15
14.00
3l.00
Date Paid
02105/2003
0210512003
0210512003
0210512003
PLT]MBING CONTRACTOR:
t\ lluN:ureg on taw requlres you
CCB#: {ollo E)OIRES:theOregon UtititY
er.Those rules are set for
in OAR9
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thetelePhone
ility Notification
2-2344\.
To t' '!1
ir'
','ction call the 24 hour recording at726-37 69. All inspections
I after 7:00 a.m. will be made the following working day." * -
i'9ffifi-i-' li illt$',,ia f H il$"H ffit
L 'ctions:
\evice: Prior to covering and provide a copy ofthe test
By Si',..:rtu
illftr r': " "t1n '
wil" I ')
fur'' '('r'
fur
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te and agree, that I have carefully examined the completed application and do hereby certify that all
rr is true and correct, and I further certiS that any and all work performed shall be done in accordance
,'r's of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein I
't only contractors and employees who are in compliance with ORS 701.055 will be used on this project I
; ure that all required inspections are requested at the proper time, that each address is readable from the
'rpproved set of plans, if applicable, will remain on the site at all times during construction.
(-c; S
Or, r'\ . rs Signature Date
tu L
Phone:
(
2ls/2003
2:42:291'M
Cify of Springfield
I .. ,. .!.,r,r- T\Onot-t t
- .,-r.c tr u.,..r ..,,,,....^^.- .t
Official Receipt
,'.' l-..'ar: f .-,:Ct
, . ...,o.',...1, .),'l'gi;,, trl-i7
541-726-3759 Phone
Receipt #: 2200200000000000448
Date: 0210512003
7
Items:
Job/Journal Number Description Amount Paid
PLM2003-00008
PLM2003-00008
PLM2003-00008
PLM2003-00008
Backflow Device
Minimum/Adj ustment Plumbing
+ lUYo Administrative Fee
+ 7%o State Surcharge
Payments:
14.00
3 r.00
4.50
3.15
Line ltem Total:$52.65
Type of Payment Paid By Received By Check Number Confirm No How Received Amount Paid
Check EUGENE LANDSCAPE dlm 2038 In Person 52.65
Total:
Page I of I cReceipt.rpt
lBF$lttgFllts
)
225 FIilH STREET . SPRINGFIELD, OR 97477 r PH:(541)726-3753 r FAX: (541)726-3689
:..jD < -0&06City Job N'mber
iU lql!ltl
Job
Assessors Tax
Oor t,5COwner
Address l14 1)
t,\f"',lS /' -\
State-Ud-- Zip 9'.7 1)7
BACKFLOW PERMIT IS $52.65 (includes Permit Fee, State Surcharge & Administrative Fee)
C ontr actor I nfo rm atio n
Y
City
il k)o(|,,k'bUd5 €tl<l*Jr.f),,q(o"r,)a
Contractor
)cl Cl*f7u"
City S tate O,r-.zip ciTYoL
Construction Contractors Registration #!.64 6 tz7 Expires e6
By signing this permit/application, I agree to call for an inspection once the backflow prevention
devise has been installed and is visible for inspection (725-3769). I also state that all information on
this permiVapplication is correct.
S ,*" )-i'o",
For Office Use
tt u-.
!,+
Date of Application
Checked for Historical StatusChecked for
Shared Drive (t:/Building Forms/Bacldlow Preventionl-03.doc
ffiflg'=,,O;s ;
Phone
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22sIilth Sheet, SprmglieH, OR9?4??
541:tZ6-3759 phone
541,-726-3676 Fax
July 18,2003
BUSCHFRANKD&DOROTHY
345 N 14TH ST
SPRINGFIELD OR 97477
Job Number:
Location:
Dear PermitHolder:
Sincerely,
Lisa Hopper
PLM2003-00008
345 I4TH ST
Backflow DeviceProject:
The Springfield Building safety code Admi,istrative code provides that in order for a pennit to remain varid,,'H,:,TIJffl iLffi lHjTTf*# ,5;,j$ffi fl'ilr, r s0 a ;i, ;ia. a. n or i s uance, an a an
Accordingtoourrecordgyouobtainedapennitforaproject
at3.4.5.14THsTwhichissettoexpire ongl5l2003.our records indicate that vlu h;;;;;;;;i.rt.o * i,rJp.'.tio, wrthin the pasr nr. ijl^rontls. This retter is
written to norigz vou that vou.r.*;G;;11b.;-p*t-ffiri ,rrou J;;;;,rqu.u an inspecrion forvour project, please phoni the i,"r;;, i* .at s4ttzZ-376;:r#;;;;r,A.lJil r**tion prior to the
exptrafion date' vour permit(s) *iir opii. Ld additionJ;#; f..s wil b;;E;i;'ii orderto complete yourpro;ecl
Ifyou have any questions, prease feer free to phone me at 541-7263790.
Buildin g Safe ty Sup ervisor