HomeMy WebLinkAboutPermit Mechanical 2005-9-2 (2)
.
Status: Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01202
ISSUED: 09/02/2005
APPLIED: 09/02/2005
EXPIRES: 03/02/2006
VALUE:
SITE ADDRESS: 2482 DUMAS DR
ASSESSOR'S PARCEL NO.: 1703234400117
Springfield TYPE OF
Mechanical Only
PROJECT DESCRIPTION: Gas pipe and gas log install
TYPE OF USE: Addition
Residential
'Owner: TRUST OF DALE A COBLENTZ
. Address: 2482 DUMAS DR
SPRINGFIELD OR 97477
Contractor Type
Mechanical
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Yrimary Construction Type
Secondary Construction
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
Description
I CONTRACTOR INFORMATION I
Contractor License
AMBASSADOR PIPING INC _" \0121469
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\\~, I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% of Lot Coverage:
Phone Number: 541-741-1542
Expiration Date
03127/2007
Phone
541-726-5723
nla
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
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!pUBLIC IMPROVEMENTS I o\~S \'t \ \~~ \s ~\l'
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,I"'" c~,!dew,itI\~Jype: ~\S\)
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I Valuation Descrintion ,
$ PerSq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
1 of 2
Value
Date Calculated
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01202
ISSUED: 09/02/2005
APPLIED: 09/02/2005
EXPIRES: 03/02/2006
VALUE:
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fl'l's tlWU
Fee Description
.....Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Appliance Not Listed
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
510.00
$4.50
$3.15
$9.00
$4.00
$32.00
9/2/05
9/2105
9/2105
9/2105
9/2105
9/2105
Receipt Number
1200500000000001293
1200500000000001293
1200500000000001293
1200500000000001293
1200500000000001293
1200500000000001293 ,
Total Amount
$62.65
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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.
Rough Mechanical: Prior to Cover
Fioal Mechanical: When all mechanical work is complete,
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 further certify that any and all work performed shall be done In accordance
with the Ordinances of the City of SpringfieW and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCUPANCY wiD be made of any structure without permission of the Community Services Division, '
Building Safety. I further certify that ouly 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 requested at the proper time, that each address Is readable from
the street, that the permit card ..located at the front of the property, and the approved set of plans wiD remain on the site
at all times during construction.
~~/::;/~..;;:; 7'-2 -()5 ~
Owner or Contractors Signature
Date
2 of 2
225 Fifth Street
-'. .
Sp'fiitgfield, Oregon 97477
541-726-3759 Phone
.
.~.'..~
~
Aity of Springfield Official Receipt
.velopment Services Department
Public Works Department
JOb/Joamal Number
COM2005.0 1202
COM2005.0 1202
COM2005.01202
COM2005,Ol202
COM2005.01202
COM2005.0 1202
Payments:
Type of Payment
Check
:'
"
'/
::
9/2/2005
RECEIPT #:
1200500000000001293
Date: 09/02/2005
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Gas Outlets 1,4
Appliance Not Listed
Minimum! Adjustment Mechanical
-Mechanical Issuance F ee-
Paid By
AMBASSADOR PIPING INC
Item Total:
LoeeK Numoer Autnonzatlon
Received By Batch Number Number How Received
djb 8777 In Person
Payment Total:
I of I
8:55:01AM
Amoant Due
3.15
4.50
4.00
9.00
32.00
10,00
$62.65
Amount Paid
$62.65
$62.65