The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 2003-04-08Buildin g/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00249ISSUED: 0410812003APPLIED: 04/0812003EXPIRES: 10/0812003 VALUE: SITE ADDRESS: 810 22ND ST ASSESSOR'SPARCELNO.: 1703361207300 PROJECT DESCRIPTION: Install gas line, water heater and gas log Owner: GRIMSLEy CAGE W & THEO M Address: 8r0 22ND ST SPRINGFIELD OR 97477 Springfield TYPE OF WORI(: Single Family Residence TYPE OF USE: New Residential Contractor Tvpe General Mechanical Owner Plumbing Contractor KEITH LEESMAN KEITH LEESMAN GRIMSLEY CAGE W & THEO M KEITH LEESMAN License 72082 72082 72082 Expiration Date 0410412005 04t04t2005 Phone 541-995-6157 541-995-6157 04t04t2005 541-995-6157 CONTRACTOR INFORMATION I # of Buildings: Primary Occupancy Group: Secondary Occupancy Group : Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: #of Height Type Water Range Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLotcovtt6[E follow Sq Ft Other: Impervious Surface Area: R-3 vN REQUIRED PARIflNG Total: Handicapped: Compact: on law requtres you to DEVELOPMENT INFORMATION Notes: Page I of3 180 may cafling number forthe F Buildin g/C o mbination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00249ISSUED: 04/08/2003APPLIED: 04/0812003EXPIRES: 10/0812003 VALUE: Description Type of Construction $ Per Sq Ft Square Footage Total Value of Project Fee Description -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7o/o State Surcharge Appliance Vent Fixture Gas Outlets 1-4 Minimum/Adj ustment Mechanical Minimum/Adj ustment Plumbing Amount Paid Date Pai Total Amount Paid $11s.30 Value Date Calculated $10.00 $9.00 $6.30 $6.00 $14.00 $4.00 $35.00 $31.00 4t8t03 4t8t03 4t8t03 4t8t03 4t8t03 4t8t03 4t8t03 4t8t03 Receipt Number 1200200000000000972 1200200000000000972 1200200000000000972 r200200000000000972 1200200000000000972 1200200000000000972 1200200000000000972 1200200000000000972 tr'ees Paid Plan Reviews To Request an inspection call 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 Plumbing: Prior to cover and including required testing. 2 Final Plumbing: When all plumbing work is complete. 3 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. 4 Rough Mechanical: Prior to Cover 5 Final Mechanical: When all mechanical work is complete. Paee 2 of3 Valuation Descrintion I Reouired lnsnections I Buildin g/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2003-00249ISSUED: 0410812003APPLIED: 04/0812003EXPIRES: 10/0812003 VALUE: 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. Owner or Signature Date Page 3 of3 ( 4/8/2003 2:47:20PM City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97 477 54L-726-3759 Phone Receipt #z 12002000000000 0097 2 Date: 0410812003 Line ltems: Amount PaidJob/Journal Number Description coM2003-00249 coM2003-00249 coM2003-00249 coM2003-00249 coM2003-00249 coM2003-00249 coM2003-00249 coM2003-00249 Fixture Minimum/Adj ustment P lumbing Appliance Vent Gas Outlets l-4 Minimum/Adj ustment Mechanical -Mechanical Issuance Fee- + 7%o State Surcharge + lUYo Administrative Fee Payments: 14.00 31.00 6.00 4.00 35.00 10.00 6.30 9.00 Line ltem Total:$115.30 Type ofPayment Paid By Received By CheckNumber Confirm No How Received Amount Paid Cash CAGE GRIMSLEY djb In Person I15.30 Page I of I Total:$115.30 cReceipt.rpt tills$llllrlGLr! Construction Contractr,^ s Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38: 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. I 3A. My general contractor is k=r@ 7zo8L (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ar) 1/a-2, /SZ lL f e zo ? Permit *:LOtYlZr:-i - cPeY ? ,r'^l slAddress: gl O Issued by;G Date: y/g/r: (Date) (White "opyIo issuing agency permitfile, pink copy to applicant.) prop-own.doc 05122/00