HomeMy WebLinkAboutPermit Mechanical 2001-12-11SHI^lGFIELD
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
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Page 1 of2
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2422 0001sth St Spr
AssessorsMap#: 17032433
Lot: Block: Addition:
Job Number: 01-01366-01
Office: 726-3759
lnspection Line: 726-3769
Tax Lot#: 00500
Subdivision:
clTY oF SPRINGFIELD, OREoON
Owner: Jim Lewis
Address: 2422151h Street
Scope Of Work: Mechanical
Phone Number:
City/State/Zip:
Alteration
541-7464458
Springfield, OR97477
Value: $0
Gas insert and replace water heater
Contractor Type
MechanicalContr
Plumbing Contr
Contractor
Ambassador Piping lnc
Po Box 70737, Eugene, OR 97401
Ambassador Piping lnc
Po Box 70737, Eugene, OR 97401
Registration #
121469
Expiration Date
3t27t2003
Phone
5414654737
54146547371214693t27t2003
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Rough Plumbing
FinalPlumbing
Rough Mechanical
Gas Service
FinalMechanical
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range:
-Prior to cover.
-After line is installed and line has been
-\y'/hen all mechanicalwork is complete
$'\.\
Gas ots
To request an inspection call the 24 hour recording a1726-3769.
a.m. will be made the same working day, inspections requested
working day.
Required lnspectionS "+t
Plumbing
following
\ag
\S NC,T
Pressure tes
ANY
180 DAY
m
-Prior to cover.
-When all plumbing work is complete.
Jt ecttanical
J
., Y'
Job# 01-01366-01
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Total:
Page 2 of 2
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq
Main:Accessory:
Fee Paid On Receipt# Value/Quantity Fee Amount
Plumbing
Minimum Plumbing Permit Fee
Number of Fixtures
State Surcharge - Plumbing
Administrative Fee - Plumbing
Total Plumbing
1211112001
12t11t2001
12t11t2001
1211112001
7474
7474
7474
7474
1
$31.00
$14.00
$3.15
$3.60
$51.75
Mechanical
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Gas Fireplace
Mechanical lssuance
State Surcharge - Mechanical
Tota! Mechanical
1211112001
12t11t2001
1211112001
1211112001
12t11t2001
12t11t2001
7474
7474
7474
7474
7474
7474
1 $4.00
$32.00
$3.60
$9.00
$10.00
$3.15
$61.75
1
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
Signature Date
$113.s0
requested at the proppr time and that the project address is readable from the street.
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