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HomeMy WebLinkAboutPermit Backflow Test 2003-7-27 i . . City of Springfield Plumbing Permit Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: PLM2003-00007 1/27/2003 1/27/2003 7/27/2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 1278 DELROSE DR 1703234409200 Install backtlow device Springfield TYPE OF WORK: TYPE OF USE: New Residential OWNER! APPLICANT: BOFFING STEVEN J & PATRICIA A 746 D ST SPRINGFIELD OR 97477 PLUMBING CONTRACTOR: 0\t:jgO\lIa:I=~; f'.f\\:.\'-li\0\:dO?tedb'/t ~;;'&.l~I~~\.OR 97448 olloW lUleS n\el.1\1OSqlll eO~'t-\-\99g..1m9 \ '\icatiOn ce o~ot\"lIOUg\"l n\"le IU\~S tJ'J ~o~l>.f', 952'00~'0 btain cc~'li? fi..l:ll~?\1O~e EXPIRES: 02/28/200: \~~on '(01.1 (1'Ia'/ ~~."'r .l\'lote: ~~~ Nn\i\ica\\on AmOo'NWa\o!~t~efi'are~:lJ~3~:~:wi). Receinl Number UlnOt:jl '" ~.~uU n 4.5.!lentello 1 127/2003 3.15 01/27/2003 14.00 01/27/2003 31.00 01/27/2003 DescriDtion 1200200000000000606 1200200000000000606 1200200000000000606 1200200000000000606 \),?-'f.. . :\'(\'t. ~ ~\)'\ \,?-'i r. ~\\ \- R- To Request an inspection call the 24 hour recording at 726-3769. All ins~e ~ns.~qtl5~~~~O am. will be made the same working day, inspections requested after 7:00 a.m. will be made the folloll'i~.worki '<-'?- ,\'(1\ ~\)\)~ ....-<\\1 __)\\\ ", '" .?-~ '\\". '?~\'. \) V' \'0,. Reauired InsDections: \'(\\S '(\\)~1.~ ~\J \)'?- ,?-\\)\J' 1 Backflow Device: Prior to covering and P~d!t\~~!I'.~I~~ lest report on site at the time of inspection. c,\)~' ~\S'" By Signature, I state and agree, that I have carefull~~~ined 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 Ihe Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further certifY that ouly 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 Ihe approved set of plans, if applicable, will remain on the sile al all times during construction. + 10% Administrative Fee + 7% State Surcharge Backtlow Device Minimum! Adjustment Plumbing cg~~~ Owner or Contractors Signature /~ 27- 2<2&> ~ Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Line Items: Job/Journal Number PLM2003-00007 PLM2003-00007 PLM2003-00007 PLM2003-00007 Payments: TWe of Payment Check Paid By Descriotion Backllow Device Receipt #: 1200200000000000606 Date: 01127/2003 Minimum! Adjustment Plumbing + 10% Adm.inistrative Fee + 7% State Surcharge STAR LANDSCAPE Received By Check Number Cnnfirm No djb Page 1 of1 " ,.' City of Springfield Development Services Department Public Works Department Official Receipt Amount Paid 14.00 31.00 4.50 3.15 Line Item Total: $52.65 How Received Amount Paid In Person 52.65 $52.65 Pavmenl Total: . . cReceipt.rpt