HomeMy WebLinkAboutPermit Mechanical 2001-01-11SPRINGFIELD
Job# 0'l-00035-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of2
TRANSS: 01-00042i4
Df;TE:JAN 11 ?t]OI
AHT REIO:! $ 16.50
IHANEE:
CAEHIER:05?
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 3455 Oregon Ave Spr
AssessorsMap#: 17023134
Lot: Block: Addition
Job Number: 01-00035-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 00300
Subdivision:
ctTY oF SPRfiNGFIELq OREaON
Owner: William and Sabra Grover
Address: 3455 Oregon Ave
Scope Of Work: Mechanical
Naturalgas stove
Phone Number:
City/State/Zip:
Alteration
747-284-4
Springfield, OR 97478
Value: $O
Contractor Type
Mechanical Contr
Contractor
William and Sabra Grover
3455 Oregon Ave, Springfield, OR 97478
Registration # Expiration Date Phone
747-284-4
t-UU-l
Quad Area:
# Of Units:
Constr. Type:
Water Heater:Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording a1726-3769. All inspections 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
working day.
Required lnspections
Mechanical
Rough Gas
Gas Service
FinalGas
connected to a minimum of one appliance. Pressure ter
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
(Sq. Feet)
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Main:Accessory:Total
to,
and
IF
-After line
-When all ,PE
'toD.
Job# 01 -00035-01 Page2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
0111112001
01t11t2001
01t11t2001
01t11t2001
0111112001
4234
4234
4234
4234
4234
1 $2.00
$13.00
$.45
$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
requested at the proper time and that the project address is readable from the street.
$26.50
JA l^a_l- //-o I
Signature Date