HomeMy WebLinkAboutPermit Mechanical 2004-6-10
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00682
ISSUED: 06/10/2004
APPLIED: 06/10/2004
EXPIRES: 12/10/2004
VALUE:
SITE ADDRESS: 949FAIRWAYPL
ASSESSOR'S PARCEL NO.: 1703342200838
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: Install gas piping under slab
Owner: STOVALL M SCOTT & JONI M
Address: 949 FAIRWAY PL SPRINGFIELD OR 97477
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Contractor Type.
Mechanical
I CONTRACTOR INFORMATION"
Contractor
DEAN M SCHULTZ
Phone
541.767-0626
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
,.
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
',.'
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
License
133733
Expiration Date
02123/2005
I BUILDING INFORMATION I
# of Stories:
R-3 Height of Structure
Type of Heat:
VN Water Type:
Range Type:
NOTICE: EnerIlY.r"U1;.,.. \F-JHE WORK
THIS PER~I: ~~~~~tmp~i~\T IS Ncrta
~~~W,I;.n'E~kt.JI:iThf.ilNNOO~~N I
ANY 1BO DAY PERIOD.
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Sidewalk T18e:
O on law r~ulres you
ATTENTION: rag e ~~qg~lijrains:
follow rules adoPta~h~s~hrules are set forth
Notification Cen~10 through OAR 952-001-
In OAR 952-001-Obtaln copies of the rules by
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I calK"!! U '0 "".._n . . 'f tion
Valmftionup.sepntfbn n Utility Nob lea
Center IS 1 0-332-2344).
$ Per Sq Ft 'Square Footage Value
or multiplier or Bid Amount
Type of Construction
\~
Date Calculated
Total Value of Project
Pa2e 1 of2
.
. CITY OF ~rKlNhI<lJ!,LD
Building/Combination Permit
PERMIT NO: COM2004-00682
ISSUED: 06/10/2004
APPLIED: 06/10/2004
EXPIRES: 12/10/2004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
L.Fee~ PaW
Fee Description
-Mechanicallssuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
$10.00
$4.50
$3.15
$4.00
$10.00
$31.00
6/1 0/04
6/1 0/04
6/1 0/04
6/10/04
6/10/04
6/10/04
Receipt Number
1200400000000000880
1200400000000000880
1200400000000000880
1200400000000000880
1200400000000000880
1200400000000000880
Total Amount Paid
$62.65
I Plan Reviews I
To Request an inspection calI the 24 hour recording at 726-3769. AII 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 folIowing work
day.
I Reouiretl ue~tion~ I
Underslab Gas: After line is installed and required testing and capped if not attached to an appliance.
By signature, I state and agree, that 1 have carefully examined 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 accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure 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 requested at the proper time, 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 during construction.
c~ /(1 - 02-
Owner or Contractors Signature
Date
Page 2 of2
225 Fifth Street
Sp"ri,ngQeld, Oregon 97477
541-726-3759 Phone
.
8..P~'RJN~~~' _",._.~ "
Wit,
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.....ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000000880
Date: 06/10/2004
11:00:03AM
'-.
'.,
. Job/Journal Number
. COM2004"00682
COM2004"00682
COM2004"00682
COM2004"00682
COM2004"00682
COM2004"00682
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Gas Outlets I A
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
Minimum! Adjustment Mechanical
Payments:
Type of Payment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
3.15
4.50
4.00
31.00
10.00
10,00
$62.65
Amount Paid
Check
SCOTT STOVALL
djb
3764
In Person
Payment Total:
$62.65
$62.65
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6/10/2004
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