HomeMy WebLinkAboutPermit Mechanical 2004-6-17
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRIrlit.-nELD
Building/Combination Permit
PERMIT NO: COM2004-00719
ISSUED: 06/17(2004
APPLIED: 06/17(2004
EXPIRES: 12/17(2004
VALUE:
SITE ADDRESS: 2508 DUMAS DR
ASSESSOR'S PARCEL NO.: 1703234400118
Springfield TYPE OF WORK: Mechanical Only
PROJECT DESCRIPTION: InstaU gas piping
TYPE OF USE:
Owner: JACOBS SHANNON V & DANA
Address: 2508 DUMAS DR SPRINGFIELD OR 97477
Contractor Type
Mechanical
I CONTRACTOR INFORMATION I
Contractor
AMBASSADOR PIPING INC
License
121469
I BUILDING INFORMATION I
~IJ\"
# of Units: ~ \"~~~fiSt~ies:
Primary Occupancy Group: ~t.~~ '\ ~~\\U;-~t of Structure
Secondary Occupancy Group: ~\..\.. ~-<v..\S '?~ ~~\)f.:yp'e of Heat: .
Primary constr.!'~~~y~S~ 1t.~VN' 'r-~\)\j Water Type:
Secondary CO{\~~~~ ' :U~\):'il 'r-~ Range Type:
# of Bedrooms,\\\\S R)~-V \) \)~ \\)\). Energy Path:
....'U\V/...f-'ft.rv~" '?~~ Sprinkled Building: nla
r _..to""\\'" nb.'
"'~~~ \'Ov · I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Addition
Residential
Expiration Date
03/27/2005
Phone
541-726-5723
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
%OfLot~ep'~
....-~-t>~
. Bl:t~R,..,~..iJ~ $'~
a,.~..~ U.~:-~.t ~~~~
\o\\Q'Cf "';'~ ~O'l1"""'~o\~~idewalk Type:
~o\\\\~ gS2..()Q'\~~~. \l'9~wnspoutslDrains:
",01'1 "oU It\e.'I _..Aat.~~ ~
90 'eCP'-;,.~Of\ .
00 r;a\\\flQ ~\ot t\e ()1
net _.... ..
-,\~ 'S".,n.w.
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Total Value of Project
Paee 1 of2
Total:
Handicapped:
Compact:
Value
Date Calculated
.
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00719
ISSUED: 06/17/2004
APPLIED: 06/17/2004
EXPIRES: 12/1712004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
l..Fp.p.~ P~id 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
541.00
6/17/04
6/17/04
6/17/04
6/17/04
6/17/04
1200400000000000925
1200400000000000925
1200400000000000925
1200400000000000925
1200400000000000925
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.
I Reouirp.d InsnectionsJ
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas 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 he 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 wIII he 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 furtber 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.
)'/4iv~
h~/)-.#C-/
Owner or Contractors Signature
Date
Pal!e 2 of2
.
225 Fifth Street
Spi'f'ngfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00719
COM2004-00719
COM2004-00719
COM2004-00719
COM2004-00719
Payments:
Type of Payment
Check
6/1712004
.
RECEIPT #:
.P"I"~..._'!.f.laO....... ... '..
Ul.;
~.;
llllii.ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200400000000000925
DescrIption
+ 7% State Surcharge
+ 10% Administrative Fee
Gas Outlets 1-4
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
Paid By
AMBASSADOR PIPING
Received By
djb
Page I of I
Date: 06/17/2004
Item Total:
l:beck Number Authorization
Batch Nnmber Nnmber How Received
7720
In Person
Payment Total:
lO:04:07AM
Amount Due
3.15
4.50
4,00
41.00
10,00
$62.65
Amount Paid
$62.65
$62.65