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HomeMy WebLinkAboutPermit Mechanical 2001-03-28SPRINGFIELD Job# 01-00296-01 RESIDENTIAL PERMIT City Of Springfield Gommunity Services Division Building Safety Page I of 2 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 6757 Simeon Dr Spr AssessorsMap#: 17023411 Lot: Block: Addition Job Number: 01-00296-01 Office:726-3759 Inspection Line: 726-3769 Tax Lot#: 03500 Subdivision: crTY oF SPRiNGF7ELD, OREGON Owner: Tim Gross Address: 6757 Simeon Dr Scope Of Work: Mechanical Phone Number: City/State/Zip: New 541-741-7615 Springfleld, OR 97478 Value: $O Adding an outside condensing unit for existing system Contractor Type MechanicalContr Contractor Registration # CentralValley Air 127032 6012 Liberty Rd South, Salem, OR 97306 Expiration Date 3t28t2001 Phone 503-932-8304 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 a|726-3769. 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. Feet) Main:Accessory: # Of Stories: Height (feet): Gurrent Units: Proposed Units Census Code: Does not apply Total Fee Paid On Receipt# Value/Quantity Fee Amount Minimum Mechanical Permit Administrative Fee - Mechanical Equipment Not ltemized on Permit Mechanical lssuance Mechanical 03t2812001 03t2812001 0312812001 03t2812001 $15.00 $.+s $.00 $10.00 4786 4786 4786 4786 Job# 01 -00296-01 Page2 of 2 Fee Paid On Receipt# Value/Quantity Fee Amount Mechanical State Surcharge - Mechanical Total Mechanica! 03t2812001 4786 $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 project address is readable from the street.per time $26.50 3-JF- a/"'*yy Signature Date