HomeMy WebLinkAboutPermit Plumbing 2003-1-10
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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.: PLM2003-00003
ISSUED: 1/10/2003
APPLIED: 1/10/2003
EXPIRES: 7/10/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
1977 J ST
1703361201400
Springfield
TYPE OF WORK:
TYPE OF USE:
Repair
Residential
Repair sanitary sewer
OWNER! APPLICANT:
DEBORAH HOLDER
1977 J ST
SPRINGFIELD OR 97477
PLUMBING CONTRACTOR:
949-380-4161
Phone:
CCB#: 71162
EXPIRES: 01/16/200~
Descriotion
Amount Paid
Date Paid
Receiot Numbet:
+ 10% Administrative Fee
+ 7% State Surcharge
Sanitary Sewer - 1st 50 Feet
4.50
3.15
45.00
01/10/2003
01/10/2003
01/10/2003
1200200000000000525
1200200000000000525
1200200000000000525
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To Request an inspection call the 24 hour re~~~~i)~~ections requested before 7:00 am. will be made the same ~ day,
inspections requested after 7 :00 a.m. wi~~e~-~m~l$!PW-&f:h~ Clay. ~~ ~\J~<;)\
~tC>.tl. oY'\-.\ 4'\_" O~ <;;.~~ rIA .j'~ , \~
~v ~0v S'f(;I ~ ~'" ~\)". ~ ~ \, ~,. ~
Reouired Insnection1!0 ~~O~" ~~",(,O~~&.fbO' ..~0~,;,~O ~..fl~ o~~ <..~ ~(j
v~\ !Ell' ~0v ~~',.c ~\'Q 0" ~~ '(.1' f::> ~ ~'(,v
1 Sanitary ~(~~\~~: ~l~~ !~~,~~~q~l.uding required testing. ~~\,\, a. '\~ ~<v(j
~O~ '~O~ ~<:j ~\~ ~O ,,\~ ~~ ~~ '. (\ C::) SJ~'\'- 'f>..~~
By Signature, I st~~~,).l})\t<!A\.e~~r~~amined the complet ~)J .~~ ~A<\<V~~bY certify that all
information here~~~~~~'ciftoCA:-' ~ther certify that any and ~4 ~R ~~I~'done in accordance
with the OrdinanceS,{h ~ ~'S ~ ~ and the laws of the State of t~lI1e work described herein. I
further certify that ofl~ ~ ~\\J~~PIOyeeS who are in compliance wit~ b will be used on this project I
further agree to ensure th{\~r re~l~ed inspections are requested at the prope~ at each address is readable from the
street, and that the approved set of plans, if applicable, will remain on the site at times during construction.
v,,::iS:;: A/V'{JI^_f? --
dWner of'ontractors Signature
I / (() 10 "5
Date ( I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
PLM2003-00003
PLM2003-00003
PLM2003-00003
Payments:
Type of Payment
Check
Paid By
Description
Sanitary Sewer - 1st 50 Feet
+ 10% Administrative Fee
+ 7% State Surcharge
HOFFMAN NORTHWEST
Receipt #: 1200200000000000525
Date: 01/10/2003
Received By
Check Number Confirm No
djb
Page I of I
1/10/2003
10:52:19AM ;
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
45.00
4.50
3.15
Line Item Total:
$52.65
How Received
Amount Paid
In Person
52.65
$52.65
Payment Total:
"
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cReceipt.rpt