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HomeMy WebLinkAboutPermit Mechanical 2003-6-16 \- 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 ~\o ....-:-\0 ~\~'\ 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 # V' 'QY "\ \'- 0\)"':) U' ~'o'(. ?;-"'- Descriotion <'J~\ '\ li> '().o ~'o'\' Aniohn~Riid'O \.0 "i..,<:.\V Date Paid Receiot Number ~"'\V" .s.-'O G'O-(\ ~"\"" VV~ . \\' ~O + 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. I .0.'\\ C~~. ,,~~\\\1 ,. t\\\ ~'0.\~" ~~ ~ )..\i o~~v.- Reouired InsDections: ; ~1~ (\ ~\~\.~ ,,~~ 0, . 'O~ \~'O1 ~\o~'";) , 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. 'K .s t....~ ~ 0-]i, ~ t ,,~ 1 L " '<::>/...... 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 ~..\' y~ i_fI .@~ ~A ~'V C!Il) , ~: ~ r+ ~14,i r;.. " , ,~~ ~ >> 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 q~ W" ~~rlVJ~ /703271..(1{ ~~}1-1' ~ Assessors Map Tax Lot OLfS"DO Owner ~~bY}- '-'V. ~ I '~~.Y ~~~, 1i'kt, L~ '~f)--\~ ~. State ~\f~ Address Phone ..., ,-\'l - ~ "Z- :> \.. Zip Ci''1'7g City Value of Wood Stove/Pellet Stove/Insert: ~f ~~ir'O' &0 (please circle appropriate appliance) , . ~\U 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.) , \'o.'l't 0'''' ':J e S'O' f\O' , _r-.'0, ,,,,-p, "'~ _rvv , , v\'<:i~ 'O~~' ~e-:> . YJJ~, S \J . Contractor &...&~. 0-\\0 r:J:J,,\Jv,..i\(\ ,..e'.. ~o u'-V';~Y::~hc _t'..f')' , r.'O I~O ,L"\\'\" . A"\, ~Q~" 5(\ ':?.... {\\'3-":l - ~e"\' ,. :{\ \)'1.,. ?,.';)Vt~ I 8~o~, J~2~r\ \::l~,^"e ce~ (),\e~~(\.';)~7-' 0\.)"0 - ~ ~\; . \\'':'. '\,,0" c'(}. '\ e'\ \0'\ :\e'\ \S ..,-ct\'O r.p,f:' <;tate .,~ \ '''''''.- Phonp 'T'--\:'"1-'3;I.-~' Zip OJ '1'-\ "7 i. Address City (,1 ~\ n tJv 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 ~()~ ~~\. ~, , ~~a~ j ~~.Jl.~}- '- - ~~, SignaturE' ~-) t-(j, DatI'" For Office Use Date of Application Oblb6'] v Checked for Delinquencie~ v Checked for Historical Statuf Shared Drive(T:)/Building FonnslWood Stove Permitl-03,doc