HomeMy WebLinkAboutPermit Mechanical 2005-2-7
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Status
Issued
225 Fifth Street, Springfield, OR
, 541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-00150
ISSUED: 02/07/2005
APPLIED: 02/07/2005
EXPIRES: 08/07/2005
VALUE:
SITE ADDRESS: 400 BROADWAY
ASSESSOR'S PARCEL NO.: 1703263404700
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE: Repair
PROJECT DESCRIPTION: Repair gas line damage. NW Natural making repairs to service.
Owner: DOUGLAS NELSON
Address: 400 BROADWAY ST
SPRINGFIELD OR 97477
Contractor Type
Contractor
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
, Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
Residential
Phone Number: 541-
I CONTRACTOR INFORMATION.
'*:.ticense
Expiration Date Phone
R-3
BUILDING INFORMATION I
#JblsWi{;~ON: Oregon law requires you t~' .
IfIei~ o~~~Jt~ted by the OregOn"~fdl~~ Floor:
~~a.P'enter. Those rules are 5el t..:J.nd Floor:
.,...t:\Ao.Qt;9...J)01 -001 0 through OAR 1~tIVT. t.
I1l\areP~;V h semen .
~e ~ fllay obtain copies of t e 11.tW:.rage/carport
Eruw~~ft center. (Note:.~he tel~. ~'-Other:
sN,inWbat lbdtiJlia3)regon Utibw Notif ~nt Load:
€,;.~-I.:riE 1..aO>>I;l?_'.>~,\-
I DEVELOPMENT INFORMATION.
VN
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
NOT'CE: Sidewp~~lrFTHE WORK
1HIS PERMll SHAtno~~~o~~ro~&f5 N01
~~~~r~~~OU~~~:;BANOONEOtOR
ANY 180 DAY PERIOD.
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00150
ISSUED: 02/07/2005
APPLIED: 02/07/2005
EXPIRES: 08/07/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
,541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
Receipt Number
$10.00
$4.50
$3.15
$4.00
$41.00
2/7/05
2/7/05
2/7/05
2/7/05
2/7/05
1200500000000000161
1200500000000000161
1200500000000000161
1200500000000000161
1200500000000000161
Total Amount Paid
$62.65
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 work
day.
LReouired Insoections I
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point. '
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon 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 pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 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, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
JJ l~ J?1n ~
\
Owner or Contractors Signature
Q ~?~ aeJ"
Date
Pa2e 2 of2
225. Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
elopment Services Department
Public Works Department
Job/Journal Number
COM2005-00150
COM2005-00 150
COM2005-00 150
COM2005-00150
COM2005-00 150
Payments:
Type of Payment
Cash
2/7/2005
RECEIPT #:
1200500000000000161
Date: 02/07/2005
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Gas Outlets 1-4
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
Paid By
DOUGLAS NELSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb In Person
Payment Total:
Page 1 of 1
9:05:09AM
Amount Due
3.15
4.50
4.00
41.00
10.00
$62.65
Amount Paid
$62.65
$62.65