HomeMy WebLinkAboutPermit Building 2004-8-25
.
e-:-CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01058
ISSUED: 08/25/2004
APPLIED: 08/25/2004
EXPIRES: 02/2512005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5028 FORSYTHIA DR
ASSESSOR'S PARCEL NO.: 1802042201300
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: New Heat Pump and air handler
Owner: LEIDALL BARBARA D
Address: 5028 FORSYTHIA ST SPRINGFIELD OR 97478 '
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
MARSHALLS INC
License
25790
BUILDING INFORMATION I
Expiration Date
12/23/2005
Phone
541-747-7445
# of Units:
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:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION'
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
Street Improvements:
Sidewalk Type:
Storm Sewer Available: DownspoutslDrains:
Special Instruction: ,quIres yoU to
ATTENTION: Oregon aw re , ,
Notes: follow rules adopted by the ~reg~ns~:I;~ NOTICE: RK
NntifirAtion Center. Those ru e~ a~ ^~n nnL TUIC: DI'RMIT SHflLL EXPIRE IF THJ= ~~:C.
In OAR 952-001-UU1U lI\1U~i:l" Yo... --', b AUTHORIZED UNDI::K IHI:> rtOIVlIl 'v I, ~
0090. You may obtain copies oflt~a'ffl~r.oX Descriotion I COMMENCED OR IS ABflNOONED FOR
h ter (Note' the '-' _"d - 00
calling t e ce,n, '.. ."""':fit-..li= 'NY 180 DAY PERI .
. . b . '-r. ,~..... n,,'nnn ~Ihty '1IM'l!"""I""'T Square Footage>
DeSCrIption num i1Jype or ",oll5Tructlo 2 2~"""ln It' I' B'd A t Value Date Calculated
Center is 1-800-3 -';>>'" u Ip ler or I moun
Total Value of Project
Paee I of2
, I
----~ --~
~If
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRIr~ut<lJ!,LIJ
Building/Combination Permit
PERMIT NO: COM2004-01058
ISSUED: 08/25/2004
APPLIED: 08/2512004
EXPIRES: 02/25/2005
VALUE:
I Fees Paill ,
Fee Description
-Mechanical Issuance Fe.....
+ 10% Administrative Fee
+ 7% State Surcharge
Air Handling Unit Up to 10,000
Heat Pump
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
Receipt Numher
$10.00
$4.50
$3.15
$8.00
$12.00
$25.00
8/25/04
8/25/04
8/25/04
8/25/04
8/25/04
8/25/04
2200400000000001094
2200400000000001094
2200400000000001094
2200400000000001094
2200400000000001094
2200400000000001094
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 Reauired I nsnections ,
Rough 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
"~;;;;;:"Jit;gf/ PJ- ;:S-o-{
O~ner or Contract';;'rs Signatur~ Date
Pa2e 2 of2
, 22c' Fifth' Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-01058
COM2004-01058
COM2004-01058
COM2004-0 1058
COM2004-0 1058
COM2004-0 I 058
Payments:
Type of Payment
Check
8/25/2004
.
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IfIiij.ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
2200400000000001094
Date: 08/2512004
Description
Air Handling Unit Up to 10,000
Heat Pump
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
MARS HALLS INC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
dim 18157 In Person
Payment Total:
Page I ofl
11:27:29AM
Amount Due
8.00
12.00
25,00
10.00
3.15
4,50
$62.65
Amount Paid
$62.65
$62,65