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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. neo uirea r nseecti oniij,f 'o'n il|'j ; il 3 i h t lt, iTJ,! J 11, yff 3l 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 0 -\(/ tHnmm$ J -'/7 z2 )'rlFiftln Street {nrt::li,T;*":':e7477 t/28/2003 l:10:07pM Ciry of Springfield Development Servic". O"p".frr."ipublic Works O"i,.rtm..,i Official Receipt Receipt #z 120020000000000061 9 Date: 0112812003 IteFs:Line Payments: Jo,hdourndNumber MEC2003-00004 MEC2003-00004 MEC2003-00004 MEC2003-00004 MEc2003-00004 -Issuance Fee- Pellet Stove/Insert + 7Yo + l0%o =o oo5 oao Iooocr g. Line Item Total: How Received In Person Total: Amount Paid 10.00 30.00 15.00 3. l5 4.50 $62.65 Amount paid 62.65 $62.6s = o TYPe of Payment Paid By Check STEPHEN By CheckNumber ConfirmNo E oE o c = @(D o -+5 (o(, t\)Ioo o c 6'(n cr )o EJo3o z o5 Page I ofl cReceipt,rpt ='C z. o€ g 6'a q)o-oEo CL C)(D =oI