HomeMy WebLinkAboutPermit Mechanical 2003-6-16
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City of Springfield
Mechanical Permit
Status: Is~ued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.: MEC2003-00029
ISSUED: 6/16/2003
APPLIED: 6/16/2003
EXPIRES: 12/16/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
428 W CENTENNIAL BLVD
1703274404500
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Install pellet stove
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ROB RITZDORF 541-747-~~39 0 '0(-'
88041 TIKI LANE ,'Oo.>S 'O~O~ li>'O\. ~()
SPRINGFIELD OR 97478 O\'\\'().~~'o ~~li> '().'\~ ~<:>~\0li> '0"
, ,.O\'O~c>.O 'O~c,'o \>S&-'0. O~ '1.'(\0 \~O\\~ ~(\ CCB #
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Descriotion <'J~\ '\ li> '().o ~'o'\' Aniohn~Riid'O \.0 "i..,<:.\V Date Paid Receiot Number
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+ 10% Administ?a~&tF~eo\\ ~\,<:J '\O\.i;-\\1\~Q\.~~\.~\\'\ ~b.b.,. 06/16/2003 1200200000000001531
+ 7% State Surch~g.e\c.'().\\: S1:<:J ~ 0 'Od':-l?)~ v 2:?" 06/16/2003 1200200000000001531
~Issuance Fee~ ~o\.'\'\ ~~ 9) \> ~\'O- v'O\\~(l~!.0~<J(y'O~ 06/16/2003 1200200000000001531
Minimum/Adiustfnen'@ -~'dth ~e ~e 15..0'0 06/16/2003 1?f>t020000000000153 I
Pellet Stove/Insert \' ~()qj . ~\\\~ <1,.,\0" ;<"''0\'30.'00 06/16/2003 ^' "~200000000001531
r1): ~~-;,C>. v:"^' g.j ~...." ~'...Ct'\
To Request an inspeotibn call the 24 hour recording at 726-3762.~~ ~~uested before 7:00 a.m. will
be made the same working day, inspections requested after 7:~/i;~~t ~ ~g~~\ following working day.
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Reouired InsDections: ; ~1~ (\ ~\~\.~ ,,~~ 0,
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1 Freestanding Pellet Stove: After install~~\ ~~\. .;\ ~
By Signature, I state and agree, that I have c~~ 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
reman .~~~e t~~I:t~S ~u:;g construction.
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Owner or Contractors Signature r- Date /
OWNER! APPLICANT:
MECHANICAL CONTRACTOR:
OWNER
Expiration Date:
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield .
Development Services Department
Public Works Department
Official Receipt '
Receipt #: 1200200000000001531
Date: 06/16/2003
Job/Journal Number
MEC2003-00029
MEC2003-00029
MEC2003-00029
MEC2003-00029
MEC2003-00029
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Pellet Stove/Insert
Minimum! Adjustments - Mech
~Issuance Fee~
Amount Paid
Item Total:
3.15
4.50
30.00
15.00
10.00
$62.65
Payments:
Type of Payment
Check
Paid By
ROBERT RITZDORF
Received By
djb
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
62.65
$62.65
6/16/2003
8:16:07AM
Page 1 of I
cReccipt.rpt
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225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(54l)726-3753 . FAX: (541)726-3689
City Job Number, /If,It;cz:.oo3~ crUD 2. '7
Job Location
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Assessors Map
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Value of Wood Stove/Pellet Stove/Insert: ~f ~~ir'O' &0
(please circle appropriate appliance)
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Preliminary Inspection is $45.0? ~prior to i~sert) _,' }\'\'?/~ ~~ \'\\~~~.({" , . '
Wood Stove/Pellet/Insert PermIt IS $62.65 (mclud~sCPeI:mlr, fSSllaUCe Ii ee, State Surcharge & Admm Fee.)
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Construction Contractors Registration #
Expires
By signing this permit/application, I agree,to call for an inspection(!) a ltn~J~1-3769). I state that all .
information on this application /permit is correct and that I wM.~~ ~~~d Stove Safety
information for wood burning appliances and preliminary inS2.~~1 ~~~~~~ the Oregon Department .
of Environmental Quality or the Federal Environme~nl~fu~~ r.~~<A~t\j~~ provide the testing
approval number to the inspector at the time ob~ ~~~ ~ tb~'N\ equesting a
preliminary inspection, the wall covering may' ~~{~'"~ ~~'1ri oved. 0
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SignaturE'
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DatI'"
For Office Use
Date of Application
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Checked for Delinquencie~
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Checked for Historical Statuf
Shared Drive(T:)/Building FonnslWood Stove Permitl-03,doc