HomeMy WebLinkAboutPermit Mechanical 2001-7-2
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Job# 01-00672-01
Page 1 of 2
TRANS#=Ol-0006039
DATE:JUL 02 2001
AMT REeD:2 $ 26.50
CHANGE:
CASHIER~061
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00672-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 5738 Camelia St Spr
Assessors Map#: 17023344
lot: Block: Addition:
Tax lot #: 01203
Subdivision:
Owner:
Address:
Daniel Howes
5738 Camelia St
Phone Number: 541-747-4845
City/State/Zip: Springfield, OR 97478
New Value: $0
Scope Of Work: Mechanical
Install gas line
Contractor Type
General Contr
Contractor Registration # Expiration Date
Daniel Howes
5738 Camelia St, Springfield, OR 97478
Phone
541-747-4845
# Of Buildings:
Occupancy Group:
ATTENT!ON:OrfH~af1SoUfce:jires you to ,
fo~I.?w ~ules ad01Sq~F~dtagQ:regon Utility
I\lot!fll'~::!tl()n r:Antpr rhnc::c. r111~c:: ,;,ro c::ot fnrth
. . I d' 263 6 io ()I-.AR 952-001-0010fhr.aua.h OAR Q52-001-
To request an inspection ca I the 24 hour recor Ing at 7 - 7 9. If-I gr:lS~ectlons reguestea D,efore. 7~OO '
a.m. will be made the same working day, inspections requested aft~r 'i:pdJM.m.a~iWDT~1lR1g88~"'~ 76lioWiR~es by
working day. cal mg me center. (!\Iote. the telephone
number for the Oregon Utility Notification
Required Inspections ~:::;-:~.:;;.::. ~ ::: ;:;:;::;::;:~~/'
Mechanical
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
land Use:
Zoning Code:
Bedrooms:
Range:
Rough Gas
Rough Mechanical
Final Gas
Final Mechanical
- Prior to cover.
- When all gas work is complete.
- When all mechanical work is complete.
[,:.... :..r:;'i~Sf'~.
~i:..~ t ,fr.$~,
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-A~ea (Sq. Feet)
Main: Accessory:
T >(,::;';J;IUL EXPIRE IF THE WORK
r'... 1 i'~;; ;. ;,;;!N:DER THIS PERMIT IS NOT
# Of Stories: (,", H~i'~h?"d~~BANDONED FOR
Current Units: ' ANY l8X) P'rbp8g~Uhits:
Census Code: Does not apply
Total:
...
Job# 01-00672-01
Paid On Receipt#
Mechanical
07/02/2001 6039
07/02/2001 6039
07/02/2001 6039
07/02/2001 6039
07/02/2001 6039'
..
Fee
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
Page 2 of 2
Value/Quantity
Fee Amount
1
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
requested at the proper time and that the project address is readable from the street.
(~ ( j2~
Signature
/ /z /0 f
,
Date
$2.00
$13.00
$.45
$10.00
$1.05
$26.50
$26.50