HomeMy WebLinkAboutPermit Plumbing 2003-05-21axnt*D
Gity of Springfield
Plumbing Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2003-00029
st2u2003
5t2U2003
Lu2u2003
,l\
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
1165 5THST
1703263402200
Add 5 fixtures
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Residential
OWNER/APPLICANT:
LARGE JAMES D
1318 LAWNRIDGE AVE
SPRINGFIELD OR97477
CCB#EXPIRES
Description
+ l0% Adminishative Fee
+ 7Yo State Surcharge
Fixture
ffir.,
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Date Paid
0512U2003
05/2U2003
0s12U2003
Receipt Number
l 20020000000000 r 274
r 2002000000 0000127 4
1200200000000001274
7.00
4.90
70.00
To Request an inspection call the 24 hour recording at726-3769
working day, inspections requested after 7:00 a.m. will be made
before 7:00 a.m. will be made the same
Required Insnections:
1 Rough Plumbing: Prior to cover and including required testing.
2 Final Plumbing: When all plumbing work is complete.
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 certlfy that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will 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 plans, if applicable, will remain on the site at all times during construction.
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225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
PLM2003-00029
PLM2003-00029
PLM2003-00029
Fixture
+ llYo Adminishative Fee
+ 1Yo State Surcharge
70.00
7.00
4.90
Item Total:$81.90
PryDent3:
CreditCard JAMES LARGE djb 000074 041924 81.90In Person
Payment Total:$81.90
s/21/2003 9:28:24ANl Page I of I cReceipt.rpt
Receipt #: 1200200000000001274 Date: 0s/21l2003
Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
WebAddress: rystql@
Permit #:?J)ot t9o'Zz
Address: t ILS 5+k -=I
Issued by:)4 Date:Zt o
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Statement: Information Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed with the Construction Contractors Board to sign thefollowing statement before a building
permit can be issued. This statement is requiredfor residential building, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under
ORS 701.010(7), neednot submit this statement. This statementwill befiledwith thepermit.
Fill in the appropriate blanks and initial boxes I arrd2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
3A. My general contractor is
(Name)(ccB #)
I will instuct my general contractor that all subcontractors who work on the stnrcfure must be
licensed with the Construction Contractors Board.
OR
38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the CCB and will immediately notiff the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Property Owners about Construction Responsibilities on the reverse side of this form.
2:tt*8
of applicant)(Date)
(White copy to issuing agency pennitfile, pink copy to applicant.)
Property_owner.doc 03/ I I /03