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