HomeMy WebLinkAboutPermit Mechanical 2001-07-13gPRINGFIELD
Job# 01-00713-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 1639 00016th St Spr
AssessorsMap#: 17032531
Lot: Block: Addition
Job Number: 01-0071 3-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 03700
Subdivision:
GITY OF SPRINGFIELD, OREGOTV
Owner: Brandon Mathews
Address: 1639 16th Street
Scope Of Work: Mechanical
lnstallgas piping
Phone Number:
City/State/Zip:
New
541-747-1933
Springfield, OR97477
Value: S0
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour
a.m. will be made the same working day,
working day
Rough Gas
Rough Mechanical
Gas Service
FinalGas
FinalMechanical
Construction Types:
Occupancy Groups:
-Prior to cover.
-After line is installed and line has been connected to a mini
-When all gas work is complete.
-When all mechanicalwork is complete
mum of one appliance. Pressure te:
V!ORK
ls No't
U
# or storie$$Tl0E:
current unit$ii;l ;:'i i1!"lrl
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory:CC
AY PEP].CD
Census
Tota!
IS ABANDC
NED FOR
,T SH
L9:t
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
One to Four Outlets
Minimum Mechanical Permit
07113t2001
0711312001
61 39
61 39
$2.00
$8.50
1
Job# 01-00713-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Administrative Fee - Mechanical
Gas Fireplace
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanica!
0711312001
07t1312001
07t13t2001
0711312001
61 39
61 39
61 39
61 39
1
$.45
$4.50
$10.00
$1.05
$26.s0
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 project. I further agree to ensure that all required inspections are
that the project address is readable from the street.
natu re Date
the nd
$26.s0
'7-t7-b