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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: $0
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Contractor :$ ~ ;:;:: ~ ;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 (.~ ~ ~ ~ ~ ~ ~.~
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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
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