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HomeMy WebLinkAboutPermit Plumbing 2003-5-14 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.: PLM2003-00025 ISSUED: APPLIED: EXPIRES: 5/14/2003 5/14/2003 11/14/2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 5976 G ST 1702342200403 Backflow device Springfield TYPE OF WORK: TYPE OF USE: New Residential OWNER/APPLICANT: MEYERS KENNETH & SHIRLEY 5976 G ST SPRINGFIELD OR 97478 PLUMBING CONTRACTOR: ~ Descriotion ttOl\CE: ~ \f lHE WORK lH~S PERM\l SHALl1H,S PERM\l 'S NOT AUTHOR'ZEO UNO~: A~~eONEO FOR EXPIRES c:'&OMMENCE~ ~~f\\OO. A~"t\i\9~A Date Paid Receiot Number 05/14/2003 1200200000000001192 05/14/2003 1200200000000001192 05/14/2003 12002Q~~OJ!mOOOOll92 05/14/2003 (\J~002'0.u~QSil0000 1192 \~\iII '{e '{eQ,O'<' \. \o'{\t '{eQ,O'\\ \'(\e 0 a.'{e se 00'\' ...nn~'.u ~p.O 'O'J . ., tu\e~ 0. 9~~ _,.. '0\ ~'C.\..... a.oJ; ,\,,\\u"- ~ vi. '(\),'..r To R~quest a~ inspe~tion call the 24 hour recording ~t ~~d9~\~tm~~~~lj.s\'rJ~~~.!,@Q}e~o;~~~&t will be made the same workmg day, mspectIOns requested after 7:00 a.m. wlllb~(r,\\\~\fj}e:Jst.m>'\vl'I\g\~\\n1fIng da~e \e 'i..\~\ca.\\ NO" ,....Q'Sl: "'J 0'0 l~\O\e. ;'b,JNO . O~,. U "'V- \0\' \. \J\.\'\' AA)' Reouired Insoections: \~090'~~9 \'(\0 ce~ o'{eQ,O~~~~'2.~'2.~ 1 Backtlow Device: Prior to covering and provide a te~'t'_~\1:h'e'{t~(~~:)i~~n site at the time of inspection. n\)~TJ'O Ce'{\ 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 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, + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum! Adiustment Plumbing 4.50 3.15 14.00 31.00 g~-~ ~~~ i' Owner orContractorg:;gIgnature s-- (1-1 --O~ Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Development Services Department Public Works Department Official Receipt Receipt #: 1200200000000001192 Date: 05/14/2003 Job/Journal Number PLM2003-00025 PLM2003-00025 PLM2003-00025 PLM2003-00025 Item Total: Amount Paid 14.00 31.00 4.50 3.15 $52.65 Description Bac1d1ow Device Minimum! Adjustment Plumbing + 10% Administrative Fee + 7% State Surcharge Payments: Type of Payment Check Paid By KENNETH MEYERS Received By djb Check Number Confirm No How Received In Person Payment Total: Amount Paid 52.65 $52.65 5/14/2003 2:45:53PM Page I of 1 cReceipt.rpt ~. 0; ~, ~ ~ cd U .~ ~ , r--t+ () ~ < ~' .~ s; ~, ~.', ~j {l). u\ . ,.......q. >-. CU.. Cl ~' o .~ ~,.' ~ C).. > (i)~, ~ Od., ~: 0', ',: ./.(. ~" 3d:: u c\t ~.,,"" ~' 22S mil-I STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-37S3 . FAX: (S41)726-3689 ---- City Job Number P Lt/lIt 2..0(:):5. ~-o DO z~ lob Location S97(" spy-~ r-c. /'~ Jet / -1-' . Tax Lot OOYO'~ Assessors Map G-. S-f-)- .... ~ .,- 170L3'-(Z2 (")(J? Owner ~YJY1~-th ,/Y) p) b}{:.. Addres~ ~?(/) F;.. $ 7'H)~ --f Phonp 7lf! ~ I 7,() ~ Zip 97t{'fl City 5Prt' /' ~ ~ lJ. Stafp D I'- BACKFLOW PERMIT IS $52.65 (includes Permit Fee, State Surcbarge & Administt'ative Fee) Contractor Informat;on Contractor o L.../ tI CL Addre~s Phonp City Statp 'lip Expires By signing this pennit/application, I agree to call for an inspection once the backflow prevention devise has been installed and is visible for inspection (726-3769). I also state that all infonnation on this pennit/application is correct. Signature~':':- ~/ ~J JJ...- ~- Dat~ ~- / l{- 0_1 For Office Use Date of Application 0~~J ~ Checked for Historical Status ~ Checked for Delinquencipc;: Shared Drive (T:)/Building Fonns/Baekflow Prevention I-D3,doe