HomeMy WebLinkAboutPermit Mechanical 2000-10-10SPRINGFIELD
Job# 00-01523-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Addition:
Page 1 of2
THAI{ES:01*000I415
[ftTE:CI[T 10 1000
flllT HEID:I $ Ie.50
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 644 Mill St Spr
AssessorsMap#: 17033523
Lot: Block:
Job Number: 00-01 523-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 02500
Subdivision:
ctrY oF,gPRtNGFtEL4 OREaON
Owner: Propertic Properties
Address: PO Box 5387
Scope Of Work: Mechanical
New Gas Line
Phone Number:
City/State/Zip:
New
541-344-4619
Eugene, OR 97405
Value: $O
ContractorType Contractor
Manuf Home lnstall Ambassador Pipin
Po Box 70737, Eug
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
\s
Date
# Of Buildings:
Occupancy Group:
Phone
541-465-4737
La
Code:
Bedrooms:
Range:
To request an inspection call the 24 hour recording at 726-3769.
a.m. will be made the same working day,
working day
Source:
before 7:00
the following
o
Rough Gas
Gas Service
(Sq. Feet)
-After line is installed and
lot
connected to a minimum of one appliance. Pressure ter
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Main:Accessory:Total:
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? [
Job# 00-01 523-01 Page2 ol2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
One to Four Outlets
Minimum Mechanical Permit
Mechanical Administrative Fee
Mechanical lssuance
State Surcharge For Mechanical Permit
Total Mechanical
10t10t2000
10t10t2000
1 0/1 0/2000
1011012000
10110t2000
3435
3435
3435
3435
3435
1 $2.00
$13.00
$.+s
$10.00
$1.05
$26.50
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein 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. I further state that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
Signature Date
$26.s0
requested at the proper timg and that the project address is readable from the street./%',eE;/2