HomeMy WebLinkAboutPermit Miscellaneous 2013-9-30 •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Spnngfeld,OR 97477
Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02029
www.sprin gfield-or.gav permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/30/2013 EXPIRES: 03/29/2014
STATUS DATE: 09/30/2013 APPLIED: 09/09/2013
SITE ADDRESS: 960 16TH ST,Springfield,OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1703362204603 TYPE OF STRUCTURE:
PROJECT DESCRIPTION: Install suppression system
OWNER: MCKENZIE MEDICAL LLC Phone Number:
ADDRESS: 541 WILLAMETTE ST STE 109
EUGENE OR 97401
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Fire Contractor SANDERSON SAFETY SUPPLY CO CCB 64969 03/29/2014 503-238-5700
_ INSPECTIONS REQUIRED II
Inspections
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 or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further
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certify that only contractors and employees who are in compli-• - with ORS 701.005 will be used on this project. I further agree
to ensure that all required inspections are requested at t.- .roper time,that each address is readable from the street,that the
permit card is located at the front of the property, a s e approved set of plans will remain on the site at all times during
construction.
9A04, 3
O,r
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er or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you to
THIS PERMIT SHALL EXPIRE IF THE WORK
follow rules adopted T ose rules Oregon tfort
Notification Center. Those rules are set forth
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
-%0MMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
" 190 DAY PERIOD. calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 9/30/2013 2:17:35PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
iiaLl." 225 Fifth St
,6FF5ri1i.1hio. TRANSACTION RECEIPT Spdngfield,OR97477
"" OREGON - 541-726-3753
811-S PR2013-02029
www.springfield-or.gov 960 16TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2013002173 RECORD NO:811-SPR2013-02029 DATE:09/30/2013
DESCRIPTION'` ; rae at 'ACCOUNT CODE/TRANMCODE AMOUNT OUE--
Admin fee(10%of applicable fees) 224-00000-426605 1098 12.00
Balance of$120.00 Minimum Fire Fee 100-00000-424002 9116 96.00
Percent of fire system bid/contract value (3%) 100-00000-424002 9116 24.00
TOTAL DUE: 132.00
KCPAY,MENT TlF'ERMPAYOR"�, cdstiiER::dut RsoiaRaWaOMMENTrj--7 -: a ea1/4,MOUNVIAID; „n'� r-illni
Check SANDERSON SAFETY SUPPLY CO 132.00
261422
TOTAL PAID: 132.00
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