HomeMy WebLinkAboutPermit Plumbing 2002-10-14City of Springfield
Plumbing Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMITNO.:
ISSUED:
APPLIED:
EXPIRES:
PLM2002-00106
10n412002
10n4t2002
4n4t2003
SITE ADDRESS:
ASSESSORS PARCEL NO.:
PROJECT DESCRIPTIONI
635 S 35TH ST
1702314304700
Install Backllow Device at
Single Family Residence Under
Construction. See Job Number
00,01608-01
Sprinelield
TYPE OF WORK:
TYPE OF USE:
New
Residential
OWITTER/APPLICANT:
GOEKEN JOHN M
PO BOX 41630
EUGENE OP.974O4
PLUMBING CONTRACTOR:
DELTA LANDSCAPE
PO BOX 40217
EUGENE OR
Phone: 541-688-9144
97404
CCB#: 119285 EXPIRES: 0110612004
541-688-9144
Description
+ jYo State Surcharge
+ 8% Adminishative Fee
Backflow Device
Minimum/Adj ustment Plumbins
Amount Paid
3.15
3.60
14.00
31.00
Date Paid
r0/14t2002
t011412002
t0/1412002
1011412002
Receint Number
1200200000000000064
I 200200000000000064
I 200200000000000064
I 200200000000000064
Cashier
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To Reque$ an inryection call ttre 24 hour recording at726-3769. All inspections requested before 7:00 a"m. will be made the same working day,
inspections reque$ed after 7:00 a.m. will be made ttre following working day.
Required Inspections:
1 Backllow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
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 certify that any and all work performed shall be done in accordance
with the Ordinances of the City of Springlield 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 corstruction.
Owner or Contractors Sipyrature Date