HomeMy WebLinkAboutPermit Mechanical 2003-03-19City of Springfield
Mechanical Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97 477
541-726-37 59 Phone
541-726-3676Fax
541-7 26-37 69 Insp ection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
MEC2003-00017
3n9t2003
3n9t2003
9n9t2003
SITE ADDRESS:
ASSESSOR'S PARCELNO.:
2546 21ST ST
1703244200900
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Residential
PROJECTDESCRIPTION: Pelletinsert
OWNERYAPPLICANT:
WILLIAM GRUWELL
2546 2IST ST
SPzuNGFIELD OP.97477
541-988-5968
MECIIANICAL CONTRACTOR:
AMBASSADOR PIPING INC 541-726-5723
PO BOX 70737
EUGENE OR 97401
CCB # 121469 Expiration Date: 03127/2003
Description
+ l0% Administrative Fee
+ 7%o State Surcharge
-Issuance Fee-
Minimum/Adiustments - Mech
Pellet Stove/Insert
Amount Paid
4.50
3.15
10.00
15.00
30.00
Date Paid
0311912003
0311912003
03119/2003
03119/2003
0311912003
Receipt Number
1200200000000000850
1200200000000000850
12002000000000008s0
1200200000000000850
1200200000000000850
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To Request an inspection call the Z4hotx recording at7264769. 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.
1\\E ..-[\
$s
Required Inspections:
1 Pellet Insert: After installation
By Signature,I state and agree, that I have carefully do hereby certiff that all
information hereon is true and conect, and I frrther certiff that shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the the work described herein. I
further certify that only contractors and employees who are in 701.055 will be used on ttris project. I
further to ensure all required are requested proper time, that each address is readable from the
the set ofp will remain on the site at all times during construction
or
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311912003
9:06:26AM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
Receipt #: 1200200000000000850
Date: 0311912003
Line Items:
Job/Journal Number Description Amount Paid
MEC2003-00017
MEC2003-00017
MEC2003-00017
MEC2003-00017
MEC2003-00017
Pellet Stove/Insert
Minimum/Adjustments - Mech
-Issuance Fee-
+ 7%o Stale Surcharge
+ l0%o Administrative Fee
Payments:
30.00
15.00
10.00
3.15
4.50
Line Item Total:$62.6s
Tlpe ofPayment Paid By Received By Check Number Conlirm No How Received Amount Paid
Check WILLIAM GRUIil/ELL djb In Person 62.65
Total:$62.6s
Page I of I cReceipt.rpt