HomeMy WebLinkAboutPermit Mechanical 2004-6-28
. CITY OF ~1"K11~ljl'1J<.;LU
Building/Combination Permit
PERMIT NO: cOM2004-00784
ISSUED: 06/28/2004
APPLIED: 06/28/2004
EXPIRES: 12/28/2004
VALUE:
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: H20 FAIRVIEW DR SPACE 18 Springfield TYPE OF WORK: Heating System
ASSESSOR'S PARCEL NO.: 1703273100600
PROJECT DESCRIPTION: Install heat pump
TYPE OF USE:
Residential
Owner: JIM CHRISTIAN
Address: H20 FAlRVIEW DR SP 18 SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor License
MARSHJ\."\<!Hl'i.~nn law requires y?~,~?. 25790
Al \,;..11_. ,.~- ...-...... -.. .
t II w rules adopter ~YILDlNGJNFORMJ\ifION I
o 0 C ter I ,,[,~- ' . 001
N titication en. . "h OAR 952- -
# of Units: 0 952-001-001 0 thrqj.~f"St~~\~~: rules by
Primary Occupancy Gro\lp9AR" U R.3. obtain COlflighq of Structure
.no..Q..O ,0 nrc:ry . . Tl'1P t'Cl\lo'PIIVl....
Secondary Occupancy G"'"'P' . . \M.center. (NeJllJ'pe of Heat:'Q\'\rtn
. . \\\ng ....,,\'...,{~n\lll"".. 'd
PrImary Construction TypeC8 f ~he OregonWa(erJ:r~pe:
Secondary Construction T)1Illfl\ber or ter is 1-BOOrourg.?:ry~t:
# of Bedrooms: Cen Energy Path:
Sprinkled Building:
Contractor Type
Mechanical
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
New
Phone Number: 541-726-5054
Expiration Date
12I23/2005
Phone
541-747-7445
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I IJW!tlC;liMPRQV~E If 1HE WOH~
lHIS Pt"'I\V~ID' UNDER lHIS PE~~JJ~.NRpe:
AlHHOR\ " "BANDONtD t~\!{
OMMENCED OR IS " "Oownspouts/Drains:
~N'< '\80 DA'< PERIOD.
Notes:
I Valuation Descriotion ,
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Total Value of Project
Paeelof2
Value
Date Calculated
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Heat Pump
Minimum/Adjustment Mechanical
Total Amount Paid
I Fees Paid I
Amount Paid
Date Paid
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2004-00784
ISSUED: 06/28/2004
APPLIED: 06/28/2004
EXPIRES: 12/28/2004
VALUE:
Receipt Number
1200400000000000991
1200400000000000991
1200400000000000991
1200400000000000991
1200400000000000991
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.
$10.00
$4.50
$3.15
$12.00
$33.00
6/28/04
6/28/04
6/28/04
6/28/04
6/28/04
$62.65
I Plan Reviews 1
I Reouired I nsnectionsJ
Rougb Mechanical: Prior to Cover
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 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
:~:l:jy~ft
Owner or Contractors Signature
Paee 2 of2
6 - 2fJ ~()(/
t'
Date
225 Fifth Sit,eet
Springfield, Oregon 97477
541-726-3759 Phone
.
~
jjiitY of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
1200400000000000991
Date: 06/28/2004
H:26:37AM
Job/Journal Number
COM2004-00784
COM2004-00784
COM2004-00784
COM2004-00784
COM2004-00784
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Heat Pump
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
Payments:
Type of Payment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
3.15
4.50
12.00
33.00
10.00
$62.65
Amount Paid
Check
MARSHALLS INC
djb
18042
In Person
Payment Total:
$62.65
$62.65
6/28/2004
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