HomeMy WebLinkAboutPermit Mechanical 2004-09-21CITY O
Building/Combination Permit
PERMIT NO: COM2004-01163Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
ISSUED:
APPLIED:
EXPIRES:
VALUE:
09t2u2004
09t21t2004
03t2u2005
,i
fl \
SITE ADDRESS: 2760 WAYSIDE LN Springfield TYPE OF WORK:
ASSESSOR'S PARCEL NO.: 1703224403100
TYPE OF USE:
PROJECT DESCRIPTION: Gas fireplace and gas line (replacing existing wood stove).
Owner: GOLES LMNG TRUST
Address: 2818 WAYSIDE LN SPRINGFIELD OR 97477
Owner: GOLES DONNA JEAN TE
Address: 2818 WAYSIDE LN SPRINGFIELD OR 97477
Contractor Type Contractor
Duplex
Remodel Residential
License Expiration Date Phone
CONTRACTOR INFORMATION
BUIL
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
Yo ofLot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
R-3
VN
nla
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
DEVELOPMENT INFORMATION
PUBLIC IMPROVEMENTS
Notes:
Pase I of2
rL
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2004-01163ISSUED: 0912112004APPLIEDz 0912112004
EXPIRESz 0312112005
VALUE:
Description Type of Construction
Fee Description
-Mechanical Issuance Fee-
+ lOoh Administrative Fee
+ 77o State Surcharge
Gas Fireplace
Gas Outlets 1-4
Minimum/Adj ustment Mechanical
Total Value of Project
Date Paid
9tzu04
9t2u04
9t2u04
9t2u04
9t2u04
9t2u04
Value Date Calculated
Receipt Number
1200400000000001370
1200400000000001370
1200400000000001370
1200400000000001370
1200400000000001370
1200400000000001370
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Amount Paid
$10.00
$4.50
$3.15
$1s.00
$4.00
$26.00
Total Amount Paid $62.6s
To Request an inspection call the24 hour recording at 726-3769. All 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.
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Fees Pa
Reouired Insoect
By signature, I 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 aII
times during construction.
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Owner or Contractors Signature
Pase? of?
Date
L f,
Valuation Description I
-225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
F:ty of Springfield Official Receipt
-velopment Services Department
Public Works Department
RECEIPT #: 1200400000000001370 Date: 0912112004 11:02:13AM
Job/Journal Number
coM2004-01163
coM2004-01163
coM2004-01163
coM2004-01163
coM2004-01163
coM2004-01163
Description
Gas Outlets l-4
Gas Fireplace
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
+ 7%o State Surcharge
+ l0% Administrative Fee
Amount Due
4.00
15.00
26.00
10.00
3.ls
4.50
Item Total:$62.6s
Payments: check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Check DONNA J GOLES dlm In Person
Payment Total:
$62.6s
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6589
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