HomeMy WebLinkAboutPermit Building 2000-10-31
.",-
~
.
.
Page 1 of 2
TRANS#:01-0003653
DATE:OCT 31 2000
AMT RECD:l $ 30.00
CHANGE:$ 3.50
CASHIER: 059
I Job# 00-01609-01 I
CITY OF SPRINGFIELD, OREGON
225 North Fifth Street
Springfield, OR 97477
COMMERCIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01609-01
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 5111 Main St Spr
Assessors Map#: 17023332
Lot: Block: Addition:
Tax Lot #: 06102
Subdivision:
NOTICE: Alteration
THISP1=Pft".,.n" _
AUTHORIZED U~~? C:)(t'IRE IFTHE WORK
COMME R THIS PEP~AlT.'S t ' ,- .
NCEDORISARegistration# Expiration Date
John Janecek ANY 180 DAY PER/OD_oPUVUONEDFOR
5111 Main St. Springfield, OR 97478
Owner:
John Janecek
Address:
5111 Main St
Scope Of Work: Commercial
Gas Service
Contractor Type
Mechanical Contr
Contractor
Phone Number:
City/State/Zip:
Springfield, OR 97478
Value: $0
Phone
Office Use
Quad Area: Land Use: # Of Buildings:
# Of Units: Zoning.Code: Occupancy Group:
Constr. Type: Bed~l~o~j~:( 'UN:uregv .;'\ _ Heat Source:
IV 'uwrule~ad . .......,"'".,;;. .
Water Heater: R!lnge:at. ;:" Opted by !he Oreoo' ',' Sq. Footage:
VI..I{.,; Inn I .,..,....,j,_. _. n Jt....
'fl OAR952_n";~-;';-';:,' ",u~e rUleS~reset In
To request an inspection call the 24 hour re.P9.r:di(l!Mlll!i~?,691 tAII)in~p.~tipr.!j..r~qy,ested before 7:00
a.m, will be made the same working day, inspections requestedraftelj?iOO,a,m,\vill'belmade the following
k' d "00", 'y rnf' center IN ,'-, 'J' "'1:' rUleS (j
wor Ing ay, """lh2rfo'thPO ate thftalaphone
'. d I reon.r, 11'm'" '''-''''
ReqUire 'nspectlon~ - ""va"u/
"'l
I Mechanical I
Gas Service -After line is installed and line has been connected to a minimum of one appliance. Pressure tei
Final Gas -When all gas work is complete,
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[Ar~a (Sq. Feet)
_ Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
.
--- ,."
Job# 00-01609-01
.
Fee
Paid On Receipt#
Mechanical
10/31/2000 3653
10/31/2000 3653
10/31/2000 3653
10/31/2000 3653
10/31/2000 3653
Page 2 of2
Value/Quantity Fee Amount
One to Four Outlets
Minimum Mechanical Permit
Mechanical Administrative Fee
Mechanical Issuance
State Surcharge For Mechanical Permit
Total Mechanical
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
requested at the proper time, that the project 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.
1
$2,00
$13.00
$.45
$10.00
$1.05
$26.50
$26.50
~j,~O 1<. iT'qJf1t4,/
Signature
~(J~3/,(J~
Date