HomeMy WebLinkAboutPermit Mechanical 2010-5-18
City Of Springfield
225 Fifth S1.
Springfield, OR 97477
Phone: 541-726-3753
Email: permitcenter@ci.springfield.or.us
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Residential Mechanical Authorization To Begin Work
69600-BMC-1 0-001 00
Approval Code: 03540C 5/18/2010 11 :38 am
E-mailedTo:ambassadorpiping@hotmail.com
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Description Qly. E.. Total
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First Appliance Fee $79.00
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Subtotal $79.00
State surcharge {12% of permit $9.48
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Technology fee (5% of permit total) $3.95
TOTAL PERMIT FEE $92.43
O-:Ac""cessory
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Job Address: 195 38TH ST
CitylState/ZIP: SPRINGFIELD, OR 97478
Suite/bldg./aptno.:
Project Name: Trojan
Cross Street/directions to job site:
Tax map/parcel no.:
1702314200700
Name: Jerry Trojan
Phone: 541-520~6766
Fax:
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CCB lie. no.: 121469
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Business Name: AMBASSADOR PIPING INC
Contact:
Address: PO BOX 70737
City/StateIZIP: EUGENE, OR 97401
Metro lie. no.:
City lie. no.:
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Phone: 5417265723
Fax: 5417265174
Email:
Jpon review and approval by your local jurisdiction, your pennit will be e.mailed or faxed
'lithin one business day, with instructions on how 10 schedule your inspection.
~OTE: This Authorization To Begin Work expires within 180 days if a permit is not obtained.
Ille local buildIng department may determine that an Authorization To Begin Work i3 null and
foid if it does not meet applicable land use law3 and local ordinances.
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Inspections Phone: 541-726-3769
This Authorization To Begin Work must be posted at the job site until replaced by a Permit
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f} CITY OF SPRINGFIELD
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Building/Combination Permit
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Status Issued PERMIT NO: COM20IO-00634
225 Fifth Street, Springfield, OR ISSUED: 05/18/2010
541-726-3753 Phone APPLIED: 05/18/2010
541-726-3676 Fax EXPIRES: 11/18/2010
541-726-3769 Inspection Line VALUE:
SITE ADDRESS: 195 38TH ST Springfield TYPE OF WORK: Mechanical Only
ASSESSOR'S PARCEL NO.: 1702314200700 . -
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. (.,~~:,~., '. TYPE OF USE: New Residential
PROJECT DESCRIPTION: Installation of gas piping and gas furnace
Owner: TROJAN JERRY D & RITA D Phone Number: 541-520-6766
Address: 195 N 38TH ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION .
Contractor Type Contractor License Expiration Date Phone
Mechanical AMBASSADOR PIPING INC 121469 03/27/2011 541-726-5723
I BUILDING INFORMATION I
# of Units: # of Stories: Lot Size:
Primary Occupancy Group: Height of Structure Sq Ft 1st Floor:
Secondary Occupancy Group: Type of Heat: Sq Ft 2nd Floor:
Primary Construction Type Water Type: Sq Ft Basement:
Secondary Construction Type: Range Type: Sq Ft GaragelCarport
# of Bedrooms: Energy Path: Sq Ft Other: .
Spriukled Building: . nla Occupant Load:
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I DEVE~O~ME~T INFORMATION I REQUIRED PARKING
Frontyard Setback: Overlay Dist: Total:
Side I Setback: # Street Trees Rqd: Handicapped:
Side 2 Setback: Paved Drive Rqd: Compact:
Rearyard Setback: % of Lot Coverage: ATTENTION: Oregon law requires you to
Solar Setbacks: toUow rules adopted by the Oregon Utility
I PUBLIC IMPROVEMENT I. ............,....
OAR 952-001-0010 through OAR 952-001.
Street Improve!"ents: u90. '{R*,W!lt'k~1R copies of the rules by
calling e cen . INote: the telephone
Storm Sewer Available: ',.'" '-,.r "~".' numbDokln,jpalO;D;JeibUliIily Notification
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Speciallnstructi.~'3T'CE: E iF~HE WORK; Center is 1-800-3:32-2344).
Notes: THIS PERMIT ~~~~~ ~~~ PERMIT \S NOT
UTHOR.I,~EP" f'ID Ie: ilRANDONED fOR
\)UIVli\lIL-\~V"""""" ~. I Valuation Description ~
{\NY 1 SO DAY PERIOD
Description Type of Construction $ Per Sq Ft Square Footage Value Date Calculated
or multiplier ': ~ or Bid Amount
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Page I of2
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Total Value of Project
Fees Paid-,
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount paid,/",j
$9.48 " i"
$3.95""")
$79.00'
~p. ~"
Total Amount Paid
$92.43
I ' Plan Reviews ~
. Date Paid
5/18/10
5118/10
5/18/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20]0-00634
ISSUED: 05/18/20]0
APPLIED: 05/18/2010
EXPIRES: 11/]8/20]0
VALUE:
Receipt Number
2201000000000000528
2201000000000000528
2201000000000000528
To Request an inspection call the 24 hour recording l!t 726:3769. 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
work day.
LReouired InsDections ~
Rough Mechanical: Prior to Cover
Final Gas: Wben all gas work is complete.
Final Mechanical: When all mechanical worWis complete.
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By signature, I state and agree, that I have carefully:'g;'mined 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 accOl'dance with
the Ordinances of the City of Springfield and the Laws of tbe State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any struclure 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 reqnested at the proper lime, 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 dnring constrnction.
Owner or Contractors Signature
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Page 2 of 2
Date
225<li'ifth. Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000528
Date: 05/18/2010
1:52:45PM
Job/Journal Number
COM20 I 0.00634
COM20 I 0-00634
COM20 I 0-00634
Description
I st Appliance
+ 12% State Surcharge
+ 5% Technology Fee
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Amount Due
79.00
9.48
3.95
$92.43
Item Total:
Payments:
Type of Payment
ONLINE CHGS
cReceintl
Paid By
ONLINE PERMIT CHGS
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
NJM
ONLINE AMBASSA
DOR
$92.43
In Person
Payment Total:
$92.43
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5/18/2010