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Home My WebLink AboutPermit Mechanical 2003-4-9 ;....... ~.;; . Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 617 COLONIAL DR ASSESSOR'S PARCEL NO.: 1703221201303 PROJECT DESCRIPTION: Pellet Stove OWNER/APPLICANT: HARRISON RODNEY W 617 COLONIAL DR SPRINGFIELD OR 97477 Descriotion Amount Paid + 10% Administrative Fee + 7% State Surcharge -Issuance Fee- Minimum/Adiustments - Mech Pellet Stove/Insert 4.50 3.15 10.00 15.00 30.00 . City of Springfield Mechanical Permit PERMIT NG.: MEC2003-QO020 ISSUED: 4/912Q03 APPLIED: 4/9/2003 EXPIRES: 10/912003 Springfield TYPE OF WORK: TYPE OF USE: New Residential MECHANICAL CONTRACTOR: MIDGLEY'S 343-1131 1678 W. 7TH AVE EUGENE 97401 CCB # 019364 Expiration Date: 11/20/2003 Date Paid Recciot Number 04/09/2003 04/09/2003 04/09/2003 04/09/2003 04/09/2003 1200200000000000975 1200200000000000975 1200200000000000975 1200200000000000975 1200200000000000975 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. Reouired Insoections: 1 Pellet Insert: After installation 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 70 I .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 st\eet, and that the approved set of plans, if applicable, will remain ~artal[lti'/li.egra\\'ti'fi'!!%'1'\fj~{,lH~fi8fl.~~ili~Y ~ ~ow rules adopted oy tne oreg n <.1M --:UMti'\"\ r."ntAr. Those rules are set fortI ..xowner or CqA .~\ti~lW1 0 through OAH ~:>.:-vv j 0090. You may obtain copies ofJr;~h~b bj calling the center. (Note: the let:~ . nUIIlber for the Oregon Utility Notification Center is 1-800-332-2344\. n 1-/1113 ;vate NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. 22[; FIrm STRt:ET 0 SrRINGrIt:W, OR 97477 0 rH:([;41)72(;-37[;3 0 fAX: ([;4 J )72(;-3(;89 ~1 ~~ City Job Number o (p11 tOLONl/d..- ()ft- 0., ,...~Ij Job Loca'tion t-) ~J Assessors Mar ~ ..)~: '. I~ Owner f> jj Address ~ 21 ~1 City l Value of Wood Stove/Pellet Stove/Insert: ~1 ~l ~ OJ ,,..-.Ij 'l~ ~ ~ 'Co~;t;(/c;~r Infol'lI/otion fJ~j1 : utal Contractor ~l ~j rr='I1 tt ~ Ci1lJ ~j ..-l I, Ij ............... GIJlj ~ ~ 1~ ~ ~i 'v) Q ~ ~ --' '~, . . CITY OF SPRINGFIELD, OREGON S()-h..D I Tax Lot Ron ~1h1. fl.t,'V::>A) ~17 r!o LON,f!-C,.- 5(Jho OIL, Phone 7L/7-7 7'/ C- Zip Cf7t.f77 ~P . 02..- ~ ]-fYD D -" (please circle appropriate appliance) Preliminary Inspection is $45.00 (prior to insert) Wood Stove/Pellet/Insert Permit is $62.65 (includes Permit, Issuance Fee, State Surcharge & Admin Fcc.) _>-.J Addres~ YhIOLtLE'IS , /67'i? fr.; " 771-1 A-vf f3-vt (,1;J.}l- ,Tn Phol'P jLf3- /13) q 74D2- 01L ~tqt.,. City Construction Contractors Registration # 0/ 93{" cf Fxpires //- ~D -0;' By signing this pernlitlapplication, I agree to call for an inspection{s) as required (726-3769). I state that all information on this application /permit is correct and that I was provided with the Wood Stove Safety information for wood burning appliances and preliminary inspection standards as set by the Oregon Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the wall covering may be required to be removed. . : U--z Signatw'p ~!.IM , / Date '-I11J ~ For Office Use Date of Application Checked for Delinquencipo {'hecked for Historical Stat..o Shared Drivc(T:l'lluilding Fomls/Wood Slove l'ennill-03.doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone .e Items: Job/Journal Number MEC2003-00020 MEC2003-00020 MEC2003-00020 MEC2003-00020 MEC2003-00020 Payments: . Type of Payment Check . ; \ . Paid By Description Pellet StovelInsert -Issuance Fee- Receipt #: 1200200000000000975 Date: 04/0912003 Minimum/Adjustments - Mech + 7% State Surcharge + 10% Administrative Fee RODNEY HARRISON Received By Check Number Confirm No Ikw 1415 Page I ofl 4/9/2003 II :02:05AM City of Springfield Development Services Department Public Works Department Official Receipt Amount Paid 30.00 10.00 15.00 3.15 4.50 Line Item Total: $62.65 How Received Amount Paid In Person 62.65 $62.65 Payment Total: cReceiptrpl