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Home My WebLink AboutPermit Mechanical 2004-5-10 . .. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00550 ISSUED: 05/10/2004 APPLIED: 05/10/2004 EXPIRES: 11/10/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3620 GA TEW A Y ST ASSESSOR'S PARCEL NO.: 1703153300300 Springfield TYPE OF WORK: MecbanicalOnly TYPE OF USE: Alteration PROJECT DESCRIPTION: update existing equipment for walk-in freezer at State Police Office. Commercial Owner: OREGON DEPT OF TRANS HWY COMMISSION Address: 355 CAPITOL ST RM 119 SALEM OR 97310 Phone Number: 541-726-2536 I CONTRACTOR INFORMATION I Contractor Type Mecbanical Contractor AMERICAN REFRIGERATION 1NC License 112736 Expiration Date 04/0212005 Phone 54 I -688-0939 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: B # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Patb: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: VN I DEVELOPMENT INFORMA TION.IE '. , . N IIOI~:ure9REQMREpII'~~ . follow rules adopte bv the Oregon urn Overlay D.st: Notification Cente otlll: I I Y # Street Trees Rqd: in OAR 952-001-0~'1 .Pn1!IMuJ/i'elI~re set forth Paved Drive Rqd: 0090 !:lgP. OAR 952-001 . ,You may obtain copies of the rules b Rearyard Setback: % of Lot Coverage: calling the center. (Note: the telephone - Solar Setbacks: number.for the Oregon Utility Notification NOTICE: I PUBLlC IMPROVEMENTS I """"" ,::; '-OUU-;J;J2-2344). Street Im~m~IDEytMIT SHALL EXPIRE IF THE WORK Sidewalk Type: Storm Sel;t;tt~~n4IHe::J UNDER THIS PERMIT IS NOT DownspoutslDrains: Special h'e\'j\\~ljl\."l\jCED OR IS ABANDONED FOR Notes: ANY 180 DAY PERIOD. SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee I of2 c. . . CITY OF ~rKlI~,-,FIELD ' Building/Combination Permit PERMIT NO: COM2004-00S50 ISSUED: 05/10/2004 APPLIED: 05/10/2004 EXPIRES: 11/10/2004 VALUE: C'~ Status: Issued 2~5 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541.726-3769 Inspection Line I Fees Paid I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Appliance Not Listed Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $9.00 $36.00 5/1 0/04 5/10/04 5/1 0/04 5/1 0/04 5/10/04 2200400000000000502 2200400000000000502 2200400000000000502 2200400000000000502 2200400000000000502 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 aftcr 7:00 a.m. will be made the following work day. I Reouired Insoections I I ROllgb Mechanical: Prior to Cover 2 Final Mechanical: Wben all mcchanical work Is complete. By signature, I state and agree, that I havc carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I furtber 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 tbat only contractors and employees who are in compliance with ORS 701.005 will be used on this projcct. 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. ~A-: 'd, ~/,~/ Owner or Contractors Signature /- s:;- - / (') -/? l/ Date Palle 2 of2 . ~, SiiiIfr of Springfield Official Receipt .elopment Services Department Public Works Department " 225 Fifth Strect , Spring'field, Oregon 97477 C,' 541-726-3759 Phone (4 Job/Journal Number COM2004-00550 COM2004-00550 COM2004-00550 COM2004-00550 COM2004.00550 Payments: Type of Payment Check 5/1 0/2004 RECEIPT #: 2200400000000000502 Date: 05/10/2004 Description Appliance Not Listed- -Mechanical Issuance Fee- Minimum/Adjustment Mechanical + 7% State Surcharge + 10% Administrative Fee Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received AMERICAN REFRIGERATION jmp 2831 In Person Payment Total: Page I of I IO:28:13AM Amount Due 9,00 10,00 36,00 3,15 4.50 $62.65 Amount Paid $62,65 $62.65 , ~.l" .,...., .~. . . . '. '" ..' :1",,,, "J',.,;,;tt'"'ci~;;J!(T.EiY"'G>E<~' ) GEIEE:0"QREGONt':n.,,,,,.u,,,,:'1i't" "s:tJ'r:'j"';~"\,,,,4.~'~ ''''~,..... 'I't!:-t'l' ..r.t -c:- ~t.,.,w ~'", .~, ,:1-l.'...... ..,.-,.:'"~"'''';:\~~ .. '-\".~\ "\,l~'),. '..~:t"l"~"""'.,",1~......~ ,.~,j'1i.f.\t .. _ 'hJ.fi..::;J~ '1YAh,~"",.~'i.:i:;.',"",. ,'}*-0< l.....r. ."'~ y'"" "I"'.".,.... " 1-\ L. ~PRIN"GF,~ELD~._. to ~..M.,~, ,,' :H. ~~' 4-';; 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 .- f City Job NumberC0N!.. 'LOollc-,..I()O'~SO Date ",/7/nd D I & 2 Family Dwelling or Accessory D New Construction D Demolition D Multi-Family Eil: AdditionlAlterationlReplacement D Other I;J Commercial/Industrial D Tenant Improvement Job Address n~I'r.J)M <::'TWI'l:' PnT T"t:' <h?n r,lI'1'T<WlIY <::'1'. Bldg No. Suite No. Lot, Block Subdivision Tax Maprrax Lot ('1 0:' l S ';;, ~ 0 0 ,>00 Project Name n~l:'".J)M <::'1"""'DI)Ll"t:' Dl:'DT ,"=1'l' ",: EXIl<TINC FX111TPMF.'1'l' Description ofWorkllocation on premises/special conditions ITPDlI'1'l:' OF FYT<::'1'HTr, EOUIPMENT FOR WALK IN .FREEZER ""i;p..,._....""~;~'~4'li_"";'l\:<"','~,..,.JiE"",w.;>,,~"'l Ir;4f.;'i:'"!~~'~I'~D'''''''''II''''.'''';;C;'#<''''''''I'>,c'''~H~;;.~:w''''''''';''''',",."1l1., ' LJ I" rt?P~";:t~v~}"~~~&~~~~1J ~~.'.~~~m..l..YL...!!'LW9~~,,~_';f..rC'..ffF.jll~;~' "l-.""'. .~, 0J~ I 'J Name OREGON STATE POLICE Mailing Address 3620 GATEWAY STREET SQFt X $ISQ Ft = Value City SPRINGFIELD Phone _77h-7",10, State OR Fax Zip g7477 New Dwelling Area Garage/Carport Area Other Structure Area Total Value ~~~~~1filQW4~~Wi.Y:;i!r@:1JJ.ii~'~t~~ SQ Ft X $ISQ Ft = Value Owner Representative HIKE BLOOM, Phone 726-2536 Fax D ~,'~>:<',"~ij;<'~''!m~ll'J.~'~l'1'i1#i~~~t1 @ppllCant,;'~r~'i.""" . ",,"'l.~'>d: ." '" . Name Mailing Address City Phone Existing Building Area . New Building Area State Zip Fax Total Value D 1r:4""'~h:~""t """'fD4\ f"'''~~'f1'E~'"C'''''.''''-''l;''jill''j,j,'lJl%\'.~; ;11" \51'.3 ,< ,re t ect,--S..~g1!.t:;rh.2!g_ill.~~rJr.~1zt~.aw.Mf':!ti!:ii~)~~ Name Address I:1i<'Jil'i!":If~~~~W"'!I!':!l!f"ff{"""':'''''''''''.'''MI!f''';'WMll'lJ<lf.~~ mi~' l{. '..",~.. ....~.~' ~~..l~,#~~~ ~~ia:'i~~~:t~t~~~~~eJ~~ Existing New City Contact Person State Zip Occupancy Group(s) Consl. Tvoe(s) Number of Stories Phone Fax D ~c"""'fi,""".t'''''''''(''''''''). ~. "~.'_"f.iL"eti"~"'~~~~"""'!'i'l.",,!\:l!;'""~i~"-~"\l\l";O\"i\'l'l,'.'iM!,~.'~A,'IitI.,,~,1l>"';'''''$.'k;.,llO. '1!:)'^":!. O!l_J!C._Q~ $......~i~;:)ji}'t.C{~~,_"r;.:(ttj>;a ,~,..,-",?t~;1'ti!N'rl;;'i'~~;;rt;. . ~~;_.,.-.,tIt.\T"<>,.~-~~s~~~ Contractor's Name CCB# Expiration Date Phone # General Plumbing Y Mechanical Electrical D Q(jJj[ifiW~-Ciiiifjfrt}ltiSiffial(Pf6~-(!1~"# ~-_.......__.I.....,.__.=...-..,,,..~..._~,~ Has site review application been submitted? DYes D No D NIA If so, Name of Planner Journal Number ..., AMERICAN REFRIGERATION. INC. 112736 4/2/05 541-688-0939 D [ij.fjYa~1fi!?HJ1!i1JJ;ct'[i~h~~~~~~~~~~tE,~ Heat Source: Primary Secondary Water Heater Range Energy Path Do you require any of the following for this project? Over-width or Second Driveway DYes D No Temporary Power DYes D No Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon under orovisions of ORS 70 I and may be re~uired to be licensed in the jurisdiction where work is bein'l performed. L:~:~~C:~~S:~~ll~Glr~~~el~~t~~~~:r$&~~tWfi~~!(~~r~~:;2~~;~~~~;~tl\~~1:~~+j BUILDING PERMIT APPLICATION Shared Orive(T:}lBuilding FonnsJBuiJding Pennil Applic3tion lo..o2.doc ,,'-~~~--~, ci 4'l',':: .,..,. ..., < " ",",.';. . ;