HomeMy WebLinkAboutPermit Mechanical 2003-4-10
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00256
ISSUED: 04/10/2003
APPLIED: 04/1012003
EXPIRES: 10/10/2003
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1105 A ST
ASSESSOR'S PARCEL NO.: 1703354103200
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Gas line to dryer
Owner: JANICE CARROL
Address: 1105 A SPRINGFIELD 97477
Contractor Type
Owner
Contractor
JANICE CARROL
I CONTRACTOR INFORMATION I
License
Expiration Date Phone
BUILDING INFORMATION I
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
SETBACKS
I DEVELOPl\<....". "".ORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
Total:
Handicapped:
Compact:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks: ATTENTION'Uregon law reqUIres you tv
NnTII'J:' . 11- - "_~~nn IltBih,
THIS PERMIT SHALL EXP!RE II'v!n'IC'IMI\ROVEMENTSj~~:a.;i~I~~:~~~;~Th-;;se'r~l~s are set forti
Street Impr6WJ,Ii!hl~IZED UNDER THIS PtKlVlI1 I:' NU I :.. .OAR ~~1I:-1)91Ulthrough OAR 952-001
C~Mfy1~NCED OR IS ABANDONED FOR In V htain copies of the rules b,
Storm Sewe~ V'~'!RlebAY PERIOD 0090. ~fjl,lw'llijlbRtslDr{ltl1Ste.the telephone
Special Instruc IOn:' call1l1g the center. 0 Ut' 'l'ty Notification
number forthe Oregon II
Notes: Center is 1-800-332-2344). .
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
Square Footage
Value
Date Calculated
Total Value of Project
Pagelof2
.
. CITY vt< ~nur~\..yNELD
Building/Combination Permit
PERMIT NO: COM2003-00256
ISSUED: 04/10/2003
APPLIED: 04/10/2003
EXPIRES: 10/10/2003
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
I FI'I''' Pairll
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Amount Paid
Date Pai
$10.00
$4.50
$3.15
$4.00
$41.00
4/10/03
4/1 0/03
4/10/03
4/10/03
4/10/03
Receipt Number
1200200000000000995
1200200000000000995
1200200000000000995
1200200000000000995
1200200000000000995
Total Amount Paid
$62.65
I Plan Reviews ,
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.
I Rl'llllirl'rI hW'l'rtinn"l
1 Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
2 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.
3 Final Gas: When all gas work is complete.
4 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 of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of tbe Community Services Division, Bnilding 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.
!t;l/})5 /~
<'/-;0-03
Owner or Contractors Signature
Date
Pal(e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.e Items:
Job/Journal Number
COM2003-00256
COM2003-00256
COM2003-00256
COM2003-00256
COM2003-00256
Payments:
.
Type of Payment
Check
Paid By
Receipt #: 1200200000000000995
Date: 04/10/2003
Descriotion
-Mechanical Issuance Fee-
Gas Outlets 1-4
Minimum! Adjustment Mechanical
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
Check Number Confirm No
AMBASSADOR PIPING
lkw
6868
Page 1 of 1
4/10/2003
2:59:19PM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Amount Paid
10.00
4.00
41.00
3.15
4.50
Line Item Total:
$62.65
How Received
Amount Paid
In Person
62.65
$62.65
Payment Total:
cReceipt.rpt
...l!.....ll Administrative fee
~ State Surcharge
.1....Ii Total Mechanical Permit Fees
-~1
j MISCELLANEOUS PERMlTS
I Demolition
I
~ State Issuance
r-l
ti J1 Administrative Fee
~1 State Surcharge
"'J\ Tolal Miscellaneous Permits
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CITY OF ~'r'iuNGFIELD, OREGON U'
225 FlITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689
City Job Numbe"
I)OS A 5/
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WCATION OF PROPOSED WORK:
ASSESSORS MAP'
TAX LOT:
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ADDRESS:'
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DJ:SCRwnON Of WORK:
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NJ:W:
RJ:MODJ:L:
ADDITION'
CONTRACfOR'S NAME
GENERAL:
CONST.
CONTRACTOR #
J:XI'IRES I'HONE
ADDRJ:SS
I'LUMBINr.'
MECHANICAL:
ELI:crRJCAL:
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MECHANICAL PERMlT
PLUMBING PERMIT
Furnace
J:xhausl Hood
Vent Fan No.
Wood Stove/Insert/Fireplace Unil
ITEM
fEE
fixtures
Residential Balh(s) No.
Sanitary Sewer IT.
Water IT.
Slorm Sewer IT.
Mechanical Permit
State Issuance
Plumbing I'ennil
Administrative Fee
Slate Surcharge
Total Plumbing Fees
~
Total Mechanical Permits
Total Plumbing I'ermits
Total Miscellaneous Pennits
TOTAL