HomeMy WebLinkAboutPermit Mechanical 2001-5-7
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Job# 01-00463-01
Page 1 of 2
TRANS#=01-0005184
DATE=t1AY 07 2001
AMT RECD:2 $ 26.50
CHANGE:
CASHIER:061
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00463-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 4842 Camellia St Spr
Assessors Map#: 17023244
lot: Block: Addition:
Tax lot #: 01500
Subdivision:
Owner:
Mrs Britton Jonesburg
4842 Camellia Street
Phone Number: 541-746-7160
City/State/Zip: Springfield, OR 97478
New Value: $0
Address:
Scope Of Work: Mechanical
gas fireplace and piping
Contractor Type
Mechanical Contr
Contractor
Marshalls Heating
4110 Olympic Street, Springfield, OR
97478
Registration # Expiration Date
Phone
541-747-7445
Office Use
# Of Buildings:
Occupancy Group:
Heat S,ot/tce'; yoU to
'0 goo lCiw I~..,_J. "'t
Range: ATTENTION. ra S~.tF.o(l)tage':,n Uti I Y
_I_~ <>rlnnted UJ .1... - - __ _ot fnrth
tOIlOW 'u''''- -. Those ruld::' 0.' '" - - 1-
To request an inspection call the 24 hour recording at 726-379~lti:4:lI~iR~egfi'~~d~~W.~.sJ~gtbefO~9~O~00bY
a.m. will be made the same working day, inspectionsl requestEl~ e:f.te"ft v:,(!)Q'~~m. wi~i?le~Ili1,9.qe tlil<e,\f0118*ih'g
working day. ,'0090. You may om (Note: the telepho~e
. calling the ~en;~~:"nn Utility Notification
ReqUired Inspectlon!?\er TOI LI'''' . .... 1":2 2344)
nUll I.... '" '", 1-800-3;'; - .
Mechanical I Centd 10
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
land Use:
Zoning Code:
Bedrooms:
Rough Gas
Rough Mechanical
Final Gas
Final Mechanical
- Prior to cover.
- When all gas work is complete.
- When all mechanical work is complete.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
'0' ",,"'i!'~('c. WORK
""u~. RE IF lHE
.' . ,;-1' m SHAll EXPI NOl
) h,,\l" , PERMll IS
R\7ED UNDER lHIS
# Of Stories: AUTHO ,... Heigh.tI{f.-tY,NDONED FOR
A'=NCE1J em ~'1~ '
Current Units: COM\\.Il...,. Pro%~e~~nits:
Census Code:DoesM;Q't!a~plpAY p
Total:
Job# 01-00463-01,
Fee
Paid On Receipt#
Mechanical
05/07/2001 5184
05/07/2001 5184
05/07/2001 5184
05/07/2001 5184
05/07/2001 5184
05/07/2001 5184
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Gas Fireplace
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
)
Page 2 of 2
Value/Quantity
fee Amount
1
$2,00
$8.50
$.45
$4.50
$10.00
$1.05
$26.50
$26.50
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.
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5 ign'cfture
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