HomeMy WebLinkAboutPermit Mechanical 2002-9-3
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Job# 02-01053-01
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Page 1 of 2
TRANS#:01-0010500
DATE:SEF' 03 2002
AMT RECD:2 $ 61.75
CHANGE:
CASHIER:061
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RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-01053-01
225 Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Lin~: 726-3769
Location Of Proposed Site: 757 Water St Spr
Assessors Map#: 17033522
Lot: Block: Addition:
Tax Lot #: 10300
Subdivision:
Owner:
Hillary Gessford
757 Water Street
Phone Number: 541-747-4748
City/State/Zip: Springfield, OR 97477
New Value: $0
Address:
Scope Of Work: Mechanical
Install gas service and insert
Contractor Type
Mechanical Contr
Registration # Expiration Date Phone
~O~ \~'\; 541-747 -47 48
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Range: .~ot'\\\~\c~ ~~~~'n.~ O~~~~\~F~g~~~j2,~b.();l'
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To request an inspection call the 24 hour recording at 726-3769\\.~~c.if.lS~<(~~~l~~~stecr-~efore 7:00
a.m. will be made the same working day, inspections requested after 'O,Q0 aJt1\C'wil\@'e'made the following
working day. '(\'0~'O Ge~
Contractor
Hillary Gessford
757 Water Street, Springfield, OR 97477
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Rough Gas
Rough Mechanical
Insert
Final Gas
Final Mechanical
Required Inspections ':&
I Mechanical I ,\\t. 'NO" l\
-After line is installed and capped if not attached to an apPI~~t. \~ ~\, \~ ~O
- Prior to cover. t~. ~~\..\.. ~~ ~t." ~Q~
-After installation. \\\)"~ \\~\\ ~ ~t.~ \~ ~'UQ~t.'U
-When all gas work is complete. \\\\~ ~t.: ~tt.'U ~~ \~ ~'ON
-When all mechanical work is comPlet~\\'\ai.~Ct.'U Q~~\Q'U'
Ca~~ ~\) 'U~~ ~ '
, ~~~ \ '
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
-\
-I
Job# 02-01053-01 I
Paid On Receipt#
Mechanical
09/03/2002 10500
09/03/2002 10500
09/03/2002 10500
09/03/2002 10500
09/03/2002 10500
09/03/2002 10500
Page 2 of 2
Fee
Value/Quantity
Fee Amount
One to Four Outlets
Minimum Mechanical Permit
8% Administrative Fee - Mechanical
Gas Fireplace
Mechanical Issuance
State Surcharge - Mechanical
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
rea;;:zer ti~ject address is readable from the street. t/--:; ~
Signature t: I / tate
1
$4.00
$32.00
$3.60
$9.00
$10.00
$3.15
$61.75
$61.75
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TRANS#;0l-0010500
DATE:SEP 03 2002
IH"M't, CtC'f'lfl'i') $ 1~1 M{5
r: -r I \LL:L- ~ L. U~L 11
CHANGE:
CASHIER:061
225 FrITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
02 - 0 10 S-3 ,- 0 1
City Job Number
7 5 7 W,I}-Tc'(L
Job Location
s -(
Assessors Map
17033'S-ZL
Tax Lot
/0'1,00
1/;//"7 &e~J:')
Address 7.> 7 LtI~f~r ~
~rIA~h:tJ
'/ /
Value of Wood Stove/Pellet Stove~ ~'21I..(oo""
Owner
Phone 7'/7- i7'ff!
bK:..
Zip
7?Y77
City
State
(please circle appropriate appliance)
Preliminary Inspection is $45.00 (prior to inseli)
Wood Stove/Pellet/Insert Permit is $61.75 (includes Permit, Issuance Fee, State Surcharge & Admin Fee.)
Contractor h5L'7' 7
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Address ~ ~ '7~~~O~~r
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City ';J~f/l "o'{\ ~\(\e zF-~'( n.<=-'~~tat'~'l O~
/ .0"'0':.1 6'0')- '(\}\'Q~~ ~e""
)\-..\'. 'f)\e QCbe ~', ....'(\e 'OI:~ Nt:-IZ... -
Construction Contrapt0tS"-R eg.i~rat{b~ tf;-"o\}~ - .0' ~ , ^~ ,u,'<' F.xpires
\, v . ~e'?' ~\'<J' 4.0 '\",' 'f'i\e.... \10\- :~', c,'()....
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~y SIgtiI~g thIS p~tnl1W~~i\1~tro~e~~~r~~t)'l:c~ktof'an mspectlOn(s). as req~Ired (726-3769). I state that all
mformatlOn on th\s\~J\cn'fio%\(tp~rwli1)l~ ~Qp'ect and that I was provIded WIth the Wood Stove Safety "Q\t.
information for woo<<;;jo'f:,mftin~\appr~J.\c.ei'a~d preliminary inspection standards as set by the oreJr\I~};tI!1lLtnent
of Environmental Qualit~,\o'f.l'fh~'Feaeral Environmental Protection Agency and I ~-ir~~\td~,,! ~~~\
approval number to the "inspector at the time of inspection. I 'l.~"'i~P;ta~ ~~~~~<jl1~ID' 1-0'\\
preliminary inspection, the wall covering ma e required to ~~,~~ U~t)t.~ ~~\}O~tJ
\ :\f\O\\\tt.U O~ \$ ~i
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Signatlw t /Ut?'fr ~ C~~'l ~'Dll \)fl,~ Date '1~ 3~ 0 L
PhOnp
7"-(7 - '-/7L( 5/
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~( 6-.5. / 5>.6 zs
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For Office Use
Date of Application
070302-
Checked for Delinquencies
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rl-,pcked for Historical Statu~
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Shared Drive(I:}/Building Fonns/Wood Stove Pennitl-02.doc