HomeMy WebLinkAboutPermit Mechanical 2003-01-28City of Springfield
Mechanica! Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
MEC2003-00004
u28t2003
u28t2003
7t28t2003
OWI\ERYAPPLICANT:
ERICKSON STEPHEN V & CATH]
2445 N IOTH ST
SPRINGFIELD OR97477
w rules a dopted byNotificationCenter.Thin OAR 952-001 -0010
0090 You ma:y obtain
New
Residential
PRODUCTS INC s4t-736-9876
97478
hkpirationDate: 08/2612004
SITE ADDRESS:
ASSESSOR'S PARCELNO.:
2445 1OTHST
1703261104s00
Springfield
TYPE OF WORK:
TYPEOF USE:
PROJECT DESCRIPTION: Install wood insert
An-
calling the center.
Descriotion
+ l0%o Administrative Fee
+ 7o/o State Surcharge
-Issuance Fee-
Minimum/Adiustments - Mech
Pellet Stove/Insert
Amount mkhter is 1
4.50
3.15
10.00
15.00
30.00
n Receiot Number
l 2002000000000006 I 9
r 2002000000000006 I 9
I 2002000000000006 I 9
l 2002000000000006 I 9
I 2002000000000006 l 9
0y2812003
0U2812003
0112812003
0U28/2003
0t/28t2003
To Request an inspection call the 24 hour recording at726-3769. All inspections requested before 7:00 a.m. will be made
the same working day, inspections requested after 7:00 a.m. willbe made the following working day.
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1 wood Burning r##&k?#*+f,$BflND0
rrED FOR
By Signature, I state and agree, that I have carefully examined the completed application and do hueby certify that all
information hereon is true and correct, and I furttrer certify that any and all work puformed 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
furtho certiff ttrat 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 ofplans, if applicable, will remain on the site at all times during construction.
/ ->r-
Owner or Contractors Signature
lofl
Date
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J
-'/7 z2
)'rlFiftln Street
{nrt::li,T;*":':e7477
t/28/2003
l:10:07pM
Ciry of Springfield
Development Servic". O"p".frr."ipublic Works O"i,.rtm..,i
Official Receipt
Receipt #z 120020000000000061 9
Date: 0112812003
IteFs:Line
Payments:
Jo,hdourndNumber
MEC2003-00004
MEC2003-00004
MEC2003-00004
MEC2003-00004
MEc2003-00004
-Issuance Fee-
Pellet Stove/Insert
+ 7Yo
+ l0%o
=o oo5
oao Iooocr
g.
Line Item Total:
How Received
In Person
Total:
Amount Paid
10.00
30.00
15.00
3. l5
4.50
$62.65
Amount paid
62.65
$62.6s
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TYPe of Payment Paid By
Check STEPHEN
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