HomeMy WebLinkAboutPermit Mechanical 2014-2-11 SPRINGFIELD 225 Fifth St
1 CITY OF SPRINGFIELD Springfield,OR 97477
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t� Phone: 541-726-3753
ORE°°" Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00243
www.springfield-or.gov permitcenter @springtield-or.gov
PROJECT STATUS: Issued ISSUED: 02/11/2014 EXPIRES: 08/10/2014
STATUS DATE: 02/11/2014 APPLIED: 02/06/2014
SITE ADDRESS: 1361 S ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703252301602 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: M-Washer/dryer relocate,with new water/sewer and feeder extensions
OWNER: HURD ZACHARY JUSTIN Phone Number:
ADDRESS: 1361 S ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
II
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor OWNER CCB 000000 08/01/2025
Mechanical Contractor OWNER COB 000000 08/01/2025
Plumbing Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
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 or 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. ■
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Owner •r Contractor Signature Date
Oregon law requires you to
ATTENTION
ted by the Oregon utility
follow rules adop h OAR 952-x01-
,,__ „ ._ .... :„:; enter. Those rules are set forth•NOTICE: OAR 001-0 . throng
n OAR obtain copies of the r hone Y
THIS PERMIT SHALL EXPIRE IF THE WORK 009o. You may (Note:the telep
AUTHORIZED UNDER THIS PERMIT IS NOT number the
for the Oregon Utility Notification
COMMENCED OR IS ABANDONED FOR Center is 1-800-332 2344).
ANY 180 DAY PERIOD.
Springfield Building Permit 2/11/2014 11:13:49AM Page 1 of 1
SPRINGFIELD - CITY OF SPRINGFIELD
.L-. :ea... . _.. 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-S PR2014-00243
www_springfield-ocgov 1361 S ST permitcenter@springfleld-or.gov
RECEIPT NO: 2014000272. RECORD NO: 811-SPR2014-00243 DATE:02/11/2014
!DESCRIPTION `' "-_ ACCOUNT CODE/TRANS_CODL, "=--.AMOUNT.DUE j
First Appliance Fee 224-00000-425604 1006 - 80.00
State of Oregon Surcharge(12%of applicable fees) •821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
,_PAYMENT'TYPE MPAYORcnsHIER:CCARPENTER _COMMENTS_ _ _
':AMOUNT PAID
Credit Card HURD ZACHARY JUSTIN 93.60
234880
TOTAL PAID: 93.60
•
•
• . Property Owner Statement
Regarding Construction -Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
•
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
•
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or •
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
Z
ignat e of Permit Applicant / Date
/ I�
Permit#: CILI - gq� 2'f2( 2Y3 o __
Address: f? /Ys _` %�s':
Issued by: ate: 2i
This Copy for Permit Offices