HomeMy WebLinkAboutPermit Mechanical 2004-06-29G
i3 uil ding/C ombination Permit
P IIRMIT NO: COM2004-00792Status Issued
225Fifth Street, Springfield, OR
54'1,-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
ISSUED:
A I'PLIED:
EXPIRES:
\,,\LUE:
06t29t2004
06t29t2004
12129t2004
IN{ P
INFORMATI(}\
SITE ADDRESS: 6682 SIMEON CT
ASSESSORTS PARCEL NO.: 1702341106300
PROJECT DESCRIPTION: Change AC
ROD ADAMS
6682 SIMEON CT SPRINGFIELD OR 97478
Sprirrglicld l'YP:l OF WORI(: Heating System
'fYl'}l: OF USE: Repair Residential
Phonc Number: 541-744-1976Owner:
Address:
Contractor Type
Mechanical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
ContradtdlTl Expiration Date
06t27t2005M\T
Square Footagt'
or Bid Anrouni
CE:
of Stories:
Height of Strrrcture
Typc of Heat:
Watcr Type:
Range Type:
Energl'Path:
Sprinl<led Builrlino'
Overlay Dist;
# Strcct Trecs lLqd:
Paved Drive Itqd:
'% of Lot Covc
SHALL EXPI 9$0{e
lHIS PER
nla
Lot Size:
Sq lrt lst Floor:
Sq I;t 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occrrpant Load:
RE IT Phone
541-726-0100
GO MME
ANY DAY r180
R-3
VN
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
$ Per Sq Ft
or multiplicr
REQUIRED PARKING
Total:
Total Valuc ol' I'roject
Valuation Description
Description Type of Construction
Palc I )
Value Date Calculated
rutes
CIl'
Ii uil ding/C ombination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
P' .RNl IT NO: COM2004-00792
II SUED: 0612912004
A i'PLIED: 0612912004
E \PII{ES: 1212912004
\'\LUE:
Fee Description
-Mechanical Issuance Fee-
+ l0o Administrative Fee
+ 7o/o State Surcharge
Air Handling Unit Up to 10,000
Minimum/Adj ustment Mechanical
Total Amount Paid
Amount Paid Date Paitl
6129t01
6129t01
6t29t01
6129101
6129101
$t 0.00
$4.s0
s3.15
s8.00
$37.00
Rclcipt Number
I t00400000000001001
I 100400000000001001
I 100400000000001001
r r00400000000001001
r 200400000000001001
$62.65
Plan l{evicu s
To Request an inspection call the 24 hour rccording at 126-3769. A ! inspection ,'equs5ted before 7:00 a.m.
will be made the same working day, ins;lections requestcd after 7:0 ' a.nr. will bc made the following work
day.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical uork is corrtplctc
By signature, I state and agree, that I have carclirllr cxirrnirted tht conrpletetl rrpl ricatiort and tl,, hereby certify that all
information hereon is true and correct, and I frr rth cr ccrtilv that r,rr r' :r nd all rr o r ' pet.lirrmed s l:rrll be done in accordance with
the Ordinances of the City of Springfield and the Lau's ol'the Stalc ol'Oregorr pl tailrirrg to thc rvork described herein, and
that NO OCCUPANCY will be made of any stnrcturc u'ithout pcrrnission ol'the omrrrunity Scr vices Division, Building Safety.
I further certify that only contractors and emplol'ccs u'ho are in crrrupliancc rr itlr ORS 701.005 rr ill be used on this project.
I further agree to ensure that all required inspcctions arc requestcrl at the pr'ol)c!' timc, that each address is readable from the
street, that the permit card is located at the frorrt ol'the propertl . rrnd lhe appror td sct of plans rvill remain on the site at all
times during construction.
6tzx / ort
or Signature Dat c
Pa!c 2 of2
]
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
c;ty of Springfield Oflicial Receipt
velopment Services Department
Public Works Department
RECEIPT#: 1200400000000001001 Date: 0612912004 2:13:40PM
Job/Journal Number
coM2004-00792
coM2004-00792
coM2004-00792
coM2004-00792
coM2004-00792
Description
+ 7o/o State Surcharge
+ l0% Administrative Fee
Air Handling Unit Up to 10,000
Minimum/Adj ustment Mechanical
-Mechanical Issuance Fee-
Amount Due
3. l5
4.50
8.00
37.00
10.00
ltem Total:$62.65
Payments:
Type of Payment Paid By
Check Number
Received lly llatch Number
.\uthorization
Nuntber Horv Received Amount Paid
Check COMFORT FLOW djb ln Person
Pal,urent Total:
$62.6s
-562"6-t
26380
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