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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