HomeMy WebLinkAboutPermit Backflow Test 2003-7-27
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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
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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
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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 __)\\\ ", '" .?-~
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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.
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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
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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
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Page 1 of1
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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:
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cReceipt.rpt