HomeMy WebLinkAboutPermit Mechanical 2001-04-12Job# 01-0036s-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
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SPRINGFIELD
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 551 0001gth St Spr
Assessors Map#: 17033613
Lot: BIock: Addition
Job Number: 01 -00365-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot #: 09000
Subdivision:
crrY oF SPRINGFIELD, OREGOI'
Owner: Mark Miller
Address: 567 19th Street
Scope Of Work: Mechanical
install gas line
Phone Number:
City/State/Zip:
New
541-
Springfield, OR97477
Value: $0
Contractor Type
GeneralContr
Contractor
Mike Girke
4135 Camellia St, Springfield, OR97477
Registration #
141151
Expiration Date
2t25t2002
Phone
541-746-6213
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection callthe 24hour recording at726-3769. All inspections 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
working day.
Rough Gas
Gas Service
FinalGas
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:
Required lnspections
Mechanical
-After line is installed and line has been connected to a minimum of one appliance. Pressure ter
-When all gas work is complete.
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Cen
Accessory Total:
0n
Job# 01-00365-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanica!
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
04t1312001
0411312001
04t1312001
0411312001
0411312001
4930
4930
4930
4930
4930
$2.00
$13.00
$.45
$10.00
$1.05
$26.50
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
nere6y 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 I further agree to ensure that all required inspections are
project address is readable from the street.requested at the and th
$26.50
4-tsa)
Signature Date
1