HomeMy WebLinkAboutPermit Mechanical 2003-12-016FElIHGFIELO
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: COM2003-01191ISSUED: 1210112003APPLIED: 1210112003
EXPIRES: 06/0112004
VALUE:
Owner:
Address:
SITE ADDRESS: t57lzTIJ ST SPACE I
ASSESSOR'S PARCEL NO.: 1703354100201
PROJECT DESCRIPTION: Replace furnace
CARR FLORENCE
I57I2TH ST SPACE O7O SPRJNGFIELD OR 97477
Contractor Tvpe
Mechanical
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: Alteration Residential
Phone Number: 541-741-6290
Contractor License
ASSOCIATED HEATING & AIR CONDITIO 106275
Expiration Date
08t3u2004
Phone
541-683-2590
CONTRACTOR INFORMATION
BUILDINC
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side I Setback:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
%o ofLot Coverage:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
R-3
VN
(
Sidewalk Type:
DownspoutslDrains:
;
:
REQUIRED PARJ(NG
Total:
Handicapped:
Compact:N$"Side 2 Setback:ft,.
Rearyard
Solar
Street
Storm Sewer Available:
Special Instruction:
Notes:
a*q
lod da
$(
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Pase I of2
Description Type of Construction Value Date Calculated
\
sS
Valuation Description I
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Ftx
541-7 26-37 69 Inspection Line
OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01191ISSUED: 1210112003APPLIED: 1210112003EXPIRES: 06/0112004
VALUE:
Fee Description
-Mechanical Issuance Fee-
+ l0o/o Administrative Fee
+ 77o State Surcharge
Furnace - up to 100,000 btu
Minimum/Adj ustment Mechanical
Total Amount Paid
Amount Paid
$10.00
$4.50
$3.1s
$12.00
$33.00
$62.65
Date Paid
12fit03
12flt03
t2nt03
t2nt03
12tU03
Receipt Number
2200200000000001819
2200200000000001819
2200200000000001819
2200200000000001819
2200200000000001819
Plan Reviews
To Request an inspection caII the 24 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.
I Rough Mechanical: Prior to Cover
2 Final Mechanical: When all mechanical work is complete.
nsnecfions
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 all
times during construction.
d/L/rL*-
Owner or Contractors Signature Date
PageZ of2
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DESCRIMION Of WORK:
NEW:
-
REMODEL:- ADDITION:- DEMOLISH:-OTHER VALUE:
CONTRACTOR'S NAME ADDRESS
CONST.
CONTRACTOR #EXPIRES |HONE
Gf,NERAL:
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ELECTRICAL:
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MECHANICAI, I'ERA4I'I'
Furnace
Exhaust Hood
No.
Wood Stove/lnsert/Fireplace Unit
Mechanical Permit
State Issuance
Adminisfrative Fee
State Surcharge
Total Mechanical Permit Fees
Demolition
State Issuance
Administrative Fee
State Surcharge
Total Miscellaneous Permits
MI SCILL,\NIOT,iS I'XRr\,U'I'S
I'LUMI}ING I'[RAA]T
ITE/VI
Fixtures
Residential Bath(s) No.
Sanitary Sewer FI.
Water FI.
Storm Sewer FI.
Plumbing Permit
Administrative Fee
State Surcharge
Total Plumbing Fees
Total Mechanical Permits
Total Plumbing Permits
Total Miscellaneous Permits
TOTAL
IEE
Vent Fan
M e g,,,,,,,,,,,,,,,, an f c al' P tu,mb in g' I{i*g,f*tffi"
CITY OT OREGON
2Y/-
ADDRESS:{?()
CITY:
225 Fifth Strbet
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Recdipt
Development Services Department
Public Works Department
coM2003-0r l9l
coM2003-01l9l
coM2003-01191
coM2003-01l9l
coM2003-01l9l
Minimum/Adj ustment Mechanical
Furnace - up to 100,000 btu
-Mechanical Issuance Fee-
+ 7o/o State Surcharge
+ ll%o Administrative Fee
33.00
12.00
10.00
3.15
4.50
Item Total:$62.65
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number Authorization Number How Received Amount Paid
Check ASSOCIATED HEATING Jmp 010979 In Person
Payment Total:
$62.6s
$62.6s