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HomeMy WebLinkAboutPermit Mechanical 2001-12-11SHI^lGFIELD RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety h Page 1 of2 IFtAfiS*:01*C0C7474 ilf;I[:Dt[ 1i r00i At{T fit0D:2 s Li3.5$ IHAi..IGE: r-AilljTfEr,llrlUnLJI iIL:\ r UUJ- 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. f/Wr5 d,*-/2 /-al