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Home My WebLink AboutPermit Mechanical 2003-06-17Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00517ISSUED: 0611712003APPLIED: 0611712003EXPIRES: 1211712003 VALUE: SITE ADDRESS: 6814 SIMEON DR ASSESSOR'SPARCELNO.: 1702341104800 PROJECT DESCRIPTION: Install gas fireplace and piping Owner: pHILLpS CLAUDIA M Address: 6814 SIMEON DR SPRINGFIELD OR 97478 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential Contractor Type Mechanical Owner Contractor AMBASSADOR PIPING INC PHILLPS CLAUDIAM License 121469 Expiration Date 03t27t2005 Phone 541-726-5723 CONTRACTOR INFORMATION ] INF'ORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 \rN ^$- i"q s)-^ \t Type: Downspouts/I)rains: REQUIRED PARKING Total: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Square FootageDescription Type of Construction $ Per Sq Ft Page I of2 Value Date Calculated I[X3.& $--^t€ J. Valuation Description I PRIN Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00517ISSUED: 0611712003APPLIED: 0611712003EXPIRESz 1211712003 VALUE: Fee Description -Mechanical Issuance Fee- + l$Yo Administrative Fee + 7Yo State Surcharge Gas Fireplace Gas Outlets 1-4 Minimum/Adj ustment Mechanical Total Amount Paid Amount Paid $10.00 $4.s0 $3.rs $15.00 $4.00 $26.00 $62.6s Total Value of Project Date Paid 6n7t03 6lt7t03 6n7t03 6n7t03 6fi7t03 6n7t03 Receipt Number 1200200000000001572 1200200000000001s72 1200200000000001572 1200200000000001s72 1200200000000001572 1200200000000001s72 Fees Paid Plan Reviews To Request an inspection call the24 hour recording at 726-3769, AII 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 Gas: After line is installed and required testing and capped if not attached to an appliance. 2 Rough Mechanical: Prior to Cover 3 Final Gas: When all gas work is complete. 4 Final Mechanical: When all mechanical work is complete. Recuired Insnections By signaturer l 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 times during construction./M-r Owner or Contractors Signature Pase2 of? Date b-/vas 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Development Services Department Public Works Department Official Receipt Receipt #: 12002000000000 0157 2 Date: 0611712003 coM2003-00517 coM2003-00517 coM2003-00517 coM2003-00517 coM2003-00517 coM2003-00517 Gas Outlets l-4 Gas Fireplace Minimum/Adj ustrnent Mechanical -Mechanical Issuance Fee- + 7%o State Surcharge + l0o/o Administrative Fee Payments: 4.00 15.00 26.00 10.00 3.15 4.50 Item Total:$62.6s o Check AMBASSADOR PIPING djb In Person Payment Total: 62.65 $62.6s 6lt7/2003 l:29:25PM Page I of I cReceipt.rpt lxlffitlHB8.