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Home My WebLink AboutPermit Mechanical 2003-09-25OF SPRING Building/Combination Permit PERMIT NO: COM2003-00972Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line ISSUED: APPLIED: EXPIRES: VALUE: 09125t2003 09125t2003 0312s12004 SITE ADDRESS: 941 sTH ST ASSESSOR'S PARCEL NO.: 1703352101700 PROJECT DESCRIPTION: Connect 2 new gas r{pffipgffl Owner: STEVE BARNES Address: 941 sTH ST SPRINGFIELD OR Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: New new gas service AUTHOBIZED UNDER THIS umber: 541-746-4816 rz+ffigg5NCEb OR IS IS NOT Expiration Date 06tzst2007 Residential Phone 541-345-2838 PERMIT Contractor Tvpe Mechanical Contractor HOME COMFORT HEATING & AIR License 84164 IILDING INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Center is 1 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: Lot Size: Sq Ft lst Floor: Ft 2nd Floor: FvBfsErntot: Sidewalk Type: Downspouts/Drains VN Area: PARKING Handicapped Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page 1 of2 PUBLIC IMPROVEMENTS Description Type of Construction Value Date Calculated Valuation Descrintion I F Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00972ISSUED: 0912512003APPLIED: 0912512003 EXPIRESz 0312512004 VALUE: tr'ees Paid Fee Description -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7oh State Surcharge Appliance Vent Gas Outlets 1-4 Minimum/Adj ustment Mechanical Total Amount Paid Amount Paid Date Paid 9125t03 9t25t03 9t25t03 9125t03 9t25t03 9125t03 $r0.00 $4.s0 $3.15 $12.00 $4.00 $29.00 Receipt Number 1200200000000002212 1200200000000002212 1200200000000002212 1200200000000002212 1200200000000002212 1200200000000002212 $62.65 Plan Reviews To Request an inspection call the24 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 Rough Mechanical: Prior to Cover 2 Final Mechanical: When all mechanical work is complete. 3 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 4 Final Gas: When all gas work is complete. Renrrired Insneet 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 construction. ZSlJ, Owner or Contractors Pase2 of2 Date o3 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:rys!4!4ggq permit#: C-Ou,1Zc -, ^oO't7 L Address: 7'/ t S+'' + Issued by:bK Date: ?^zs-os Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residenttal construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and eitherbox 3A or 38: ff f . I own, reside in, or will reside in the completed structure. E-I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Constnrction Contractors Board. OR Ek- lg. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. 2 I hereby certify that the above information is correct and that I have read and Notice Property Owners about Responsibilities on the reverse U, (Signature of applicant) (White copy to issuing agency peftnitfile, pink copy to applicant.) do understand the Information side of this form. 5 ? Property_owner.doc 03/ I l/03 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Receipt #: I 200200000000002212 Date:09t2st2003 ll:40227A.NI Amount Paid coM2003-00972 coM2003-00972 coM2003-00972 coM2003-00972 coM2003-00972 coM2003-00972 + 7%o State Surcharge + llYo Administrative Fee Appliance Vent Gas Outlets l-4 Minimum/Adj ustrnent Mechanical -Mechanical Issuance Fee- 3.15 4.50 12.00 4.00 29.00 10.00 Item Total:$62.65 TypeofPayment PaidBy Received By Batch Number Authorization Number How Received Amount Paid CreditCard STEVEN BARNES djb 000179 009421 In Person Payment Total: $62.65 $62.6s lffit** )