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HomeMy WebLinkAboutPermit Mechanical 2001-03-19Job# 01-00254-01 RESTDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page '1 of 2 SPRINGFIELE, h, 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 2441 0001sth St Spr AssessorsMap#: 17032433 Lot: Block: Addition Job Number: O1-00254-01 Office:726-3759 Inspection Line: 726-3769 Tax Lot#: 01800 Subdivision: crTY oF SPRTNGFIELD, OREGOTV Owner: Lloyd Simmons Address: 2441 15lh Street Scope Of Work: Mechanical Gas line, W/H & gas insert Phone Number: City/State/Zip: New 541-746-0083 Springfield, OR97477 Value: $O Contractor Type Mechanical Contr Contractor ABC Stove Service PO Box 108, Dexter, OR 97431 Registration # Expiration Date Phone 541-937-8618 Quad Area: # Of Units: Constr. 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 recording at726-3769. 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. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq. Main:Accessory: # Of Stories: Height (feet): Current Units: Proposed Units: Census Code: Does not apply Total: Fee Paid On Receipt# Value/Quantity Fee Amount Mechanical One to Four Outlets Minimum Mechanical Permit Administrative Fee - Mechanical ApplianceVent (Not Covered in Schedult Gas Fireplace Mechanical lssuance 0311912001 0311912001 0311912001 0311912001 0311912001 0311912001 4703 4703 4703 4703 4703 4703 $2.00 $13,00 $.45 $.00 $.00 $10.00 Job# 01-00254-01 Page 2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount State Surcharge - Mechanical Total Mechanical Mechanical 0311912001 4703 $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 req at the roper time project address is readable from the street Date $26.50 7r-d/