HomeMy WebLinkAboutPermit Mechanical 2002-12-30City of Springfield
Mechanical Permit
Status: Issued
225 Fifth Sheet
Springfield, Oregon 97 47 7
541-726-3759 Phone
541-726-3676Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
MEC2002-00131
12t30t2002
1213012002
613012003
SITE ADDRESS:
ASSESSORS PARCEL NO.:
6199 Thurston Rd
1702342403700
Springfield
TYPE OF WORK:
TYPE OF USE:
\o
CCB #
Date Paid
1213012002
1213012002
New
Residential
PROJECT DESCRIPTION: Install
o_IryNER/APPLI_CA![T!
JOHN SARGEANT
6199 THURSTON RD
SPRINGFIELD OR 97478
EANT
HURSTON RD
INGFIELD OR 97478
\Expiration Date:
Receipt Number
1200200000000000475
75
Description
+ 7Yo State Surcharge
+ 8% Administrative Fee
-Issuance Fee-
Gas Outlets l-4
Minimum/Adj ustments - Mech
3.1s
3.60
10.00
4.00
41.00
75
75
l 200200000000000475
To Request an inspection call the 24 hour requested before 7:00 a.m. will be made
the same working day, inspections req the following working day.
Required Inspections:
1 Gas Service: After line is installed and line has been connected to a minimum of one appliance. Presure ter
this point.
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certiff that all
information hereon is true and correct, and I further certiff that any and all work performed shall be done in accordance with
the Ordinances ofthe City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I
further certiff 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 addres is readable from the
street, and that the set of plans, if applicable, will remain on the site at all times
or Contracton Signature
I of I
Date
during construction.
I
I
\
D8012002
10:31:56AM
Ci6'of Springfield
Development Serviies PePartmenr" "' "'"';;ffi w'-tx' Dif, *Tit'rl
225Ftfth Street
Springfield, Oregon 97 477
541-726-3759 Phone
Receipt #: 12002000000000 0047 5
Date: 1213012002
Line Items:
Payments:
Job/Journal Number
MEC2002-00131
MEC2002-00131
MEC2002-00131
MEC2002-00131
MEC2002-00131
Gas Outlets l-4
Minimum/Adjustrnents - Mech
-Issuance Fee-
+ 7%o State Surcharge
+ 8% Administrative Fee
Line Item Total:
lfow Received
In Person
TotaI:
4.00
41.00
10.00
3.t5
3.60
$61.75
Paid
.15
Type ofPayment Paid By
Check JOHN SARGEANT
Received By Check Number Confirm No
Page I of I cReceiPt.rPt
Paid
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