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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 6l;15djb