HomeMy WebLinkAboutPermit Mechanical 2003-2-11
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Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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City of Springfield
Mechanical Permit
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PERMIT NO.: MEC2003-00008
ISSUED: 2/1112003
APPLIED: 2/11/2003
EXPIRES: 8/11/2003
SITE ADDRESS: 6375 MAIN ST
ASSESSOR'S PARCEL NO.: 1702344300801
PROJECT DESCRIPTION:
OWNER! APPLICANT:
GARCIA JOSE A & LINDA L
6375 MAIN ST
SPRINGFIELD OR 97478
Descriotion
+ 10% Administrative Fee
+ 7% State Surcharge
-Issuance Fee-
Minimum/Adjustments - Mech
Wood Stove
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Residential
Wood Stove installation
MECHAMCAIDCONTRACTO~
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JOE,~&RC1~C\ V \o~
63'75 MAIN,ST, c,e\ _,,"\
.0\e~0\'~~IN~5~l>:O ~~;974m
~ \ \0~' 60~\e~WJ3)1 \~\"\ 01'-~ e~xPili~on Date:
......~ . _Co -0: .<""\ _^,\\Jf".. \'\1 __^(\
r" 'V'- 00\\"- '--'''p. "Qo:';:>>'" ~ev'- '0\\
Amount,P'liiill"l ",\0<;1 ,,^ .1;)0"\ Date''Paid,e \e .\\\ca.\\ Receiot Number
,- '~Ca.' .O\" ~a."" \ \e." ~o'
4.5Q\0\\\f>..~9~~ \"\"I0-'l 0~\~g.2),i'Icq,~q3~\\'l '!JI>.I>.'\. 1200200000000000682
3.15\<;10 ~ 'l01} 'X,Iece<;l (Qfflj/2_00).J~''2: 1200200000000000682
10.00 009 '~\\~'I. \\'X,Ie .02{Ji!'f2003 1200200000000000682
15.00 Ca: ~e\\O ~e\"021l1/2003 1200200000000000682
30.00 <;11}\"\"1 Ce<;l 02111/2003 1200200000000000682
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made
the same working day, inspections requested after 7:00 am. will be made the following workinlL<!ay.
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Reouired InsDections: 'i:.'f..?\?'i:. W ;, \~ ~Q\
Q1\tt". ~ 'iI~t-\.\. ,\~\'iI ?'i:.~ ~\) ~O?
1 Wood Stove: After Installation. ~ u.\'iI V'i:.?\l\~l'\ U~'O'i:.? ..~t>.~'OO~
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By Signature, I state and agree, that I have carefull~ ~d:th9 ~d application and do hereby certify that all
information hereon is true and correct, and I further certi~ ~I ~oik performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws ofthp.~t of Oregon pertaining to the work described herein. I
further certify 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 address is readable from the
street, and that the approved set of plans, ifapplicable, will remain on the site at all times during construction.
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Owner or Contractors Signature
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Date
1 of 1
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2/11/2003
11 :32:58AM ..
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Receipt #: 1200200000000000682
Date: 02/11/2003
.
Line Items:
Job/Journal Number
Description
Amount Paid
MEC2003-00008
MEC2003-00008
Wood Stove
30.00
MEC2003-00008
MEC2003-00008
Minimum/Adjustments - Mech
+ 7% State Surcharge
15.00
3.15
4.50
10.00
+ 10% Administrative Fee
MEC2003-00008
-Issuance Fee-
Line Item Total:
$62.65
Payments:
T)Ile o(Payment
Cash
Change
MICHAEL SNOW
MICHAEL SNOW
Received By Check Number Confi rm No How Received Amount Paid .
djb In Person 65.00
djb In Person (2.35)
Payment Total: $62.65
Paid By
Page I of2
cReceipt.rpt
....
2/11/2003
11 :32:58AM ..
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Receipt #: 1200200000000000682
Date: 02/11/2003
.
LlOe I terns:
Job/Journal Number
Description
Amount Paid
MEC2003-00008
Wood Stove
30.00
MEC2003-00008
Minimum/Adjustments - Mech
15.00
MEC2003-00008
MEC2003-00008
MEC2003-00008
+ 7% State Surcharge
3.15
+ 10% Administrative Fee
4.50
10.00
-Issuance Fee-
Line Item Total:
$62.65
Payments:
Cash
Change
MICHAEL SNOW
MICHAEL SNOW
Received By Check Number Confirm No How Received Amount Paid .
djb In Person 65.00
djb In Person (2.35)
Payment Total: $62.65
TWe of Payment
Paid By
Page 2 of2
cReceiptrpt
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City Job Number tM ~c..ZOo 3 -oooo'i$'
/70 z... 3l.t1.(:J
.5/)r; /1e' ~ r- / d'
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t'7~ 97y 7g'
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Tax Lot
jos~
G~IA
Phone
7.2(, -;;2/83'
Zip 97</7%
City. ".fJ/7~' ~'p/d
Value o~ellet Stove/Insert.
State_/JL;'"
(please circle appropriate appliance)
Preliminary Inspection is $45.00 (prior to insert) .
Wood Stove/Pellet/Insert Permit is $62.65 (includes Permit, Issuance Fee, State Surcharge & Admin Fee.)
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infonnat~on on ~~~~~~SR~~{b"'{~r.is'~~!1~~:,~~c!d~~t'l was provided with the ~ ~~ Safety
mfonnatlOn for \"8.oil'~ufilmg appha~~,,,s!an~'Breh!}l!flary mspectlOn standards~~~ ~"\~egon Department
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approval numbe~\~he iR.ilp.SC~~ ~Nt~~ tjrii~of inspection. I also un}s.W~~ . requesting a
preliminary inspection;,1Iiev~all'co~ering may be required t~!' r~~~<';"~ ~~~
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Shattd Drive(T:)lBuilding FormslWood Stove Permitl~3.doc