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HomeMy WebLinkAboutPermit Miscellaneous 2000-10-10 } '. Job# 00-01525-01 Page 1 o~~ANS#: 01-0003438 DATE:OCT 10 2000 AMT RECD:2 $ 26.50 CHANGE: CASHIER: 059 'e, RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-01525-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 510 Assessors Map#: 17032242 Lot: Block: Brookdale Ave Spr Quad Area: # Of Units: Constr. Type: Water Heater: ~ ,'-- (r'C' Patricia Landers ~ ~ c:r Phone Number: 541-741-8037 510 Brookdale AvefE & ~ CitY/S@t@Zi~:g ~fdfi~field, OR 97477 lL.. 0: LJJ 0 ::> CD ~ ~ c: :;:: ijj nLJJ 0< AlteratioQ; c: U) gs 2,g ~Value: $0 0':' ' ('l) 0 ~ Q) Q.;;:: :!.:: C/) C.) .~ !l' co cr ...c: ~ :;:: _ Q =r= Z :.::J ~. __ .q' ..... '" 0 ~ fU I-- co 250JPU6o;<~ -JCJ:'<:(' . "Q);:'..c::w..c::.c.('\ -J IJJ C/) a s .,r: '-= 0> Q) .....:.::: ' Contractor :$ ~ ;:;:: ~ ;Re~g'~isCPrali~.il} _:::E~p" iration Date ...... <;................ '..c:; 0-"" , (" Orleys Cr.a.ftsJ.9v€c~tE/f g ~ ;:5 ~.S ~ g ~. 1875 W:Sfh;g'v1ffr-~e~, OR 97402 (.~ ~ ~ ~ ~ ~ ~.~ L - a. 0 UJ 0 .~ co CD .- ~ oj Q) ." If- C/) ;r ~ ~ Office Use ".~ ::. () g co ():S ~i: o - t-: ~~-.S! c: I E Q) '- c '. ;Z ~ ~ ()o I.'flnd Use: i~ e.2 & ::J :S oS,.~ # Of Buildings: ...... - ~'s""'O:>OOi""0 Zbning Code: J::'.!E .g cr ~ g ~ Occupancy Group: Bedrooms: ~ :8 =s g g "& ~ Heat Source: ' Range: ~ .f; g C Sq. Footage: Addition: Tax Lot #: Subdivision: 03900 Owner: Address: Scope Of Work: Mechanical Gas Insert Contractor Type Mechanical Contr Phone 541-485-0533 To request an inspection call the 24 hour recording at 726-3769. 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. Preliminary Inspection Insert Required Inspections I Mechanical I - Prior to the installation of solid fuel appliance which will be vented through an existing chimney. -After installation. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 -Area (Sq. Feet) Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: ... . . Job# 00-01525-01 Page 2 of 2 Fee Paid On Receipt# Mechanical 10/10/2000 3438 10/10/2000 3438 10/10/2000 3438 10/10/2000 3438 10/10/2000 3438 Value/Quantity Fee Amount Minimum Mechanical Permit Mechanical Administrative Fee Gas Fireplace Mecl:lanicallssuance State Surcharge For Mechanical Permit Total Mechanical Grand Total By signature; I state and agree that I have carefully examined the completed application and do hereby certify that all information herein is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon. I further state 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 ~.u9t~d at ~~e proper time and that the project address is readable from the street. LfO-tUCLCU ~~.dtc ~ . IV -IV -60 Signature . Date 1 $10.50 $.45 $4.50 $10.00 $1.05 $26.50 $26.50 "