HomeMy WebLinkAboutPermit Mechanical 2002-6-17
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I Job# 02-00723-01 I
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00723-01
225 Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 4961
Assessors Map#: 18020422
Lot: Block:
Forsythia Dr Spr
Installing a 2 ton heat pump & coil
Tax Lot #: 03200
Addition:!'.! fi.:I~, 1~"SubdiitisI6ii,:,,,"~~lIes you, 10
1:_11_... _..I..~ ~.04........t"'........" tht:\r'\ronnn Iltlhhl
Ph~~~iN.ti~b~r:ln'S4.1T74;"1122)S are set forth
!'l nMl (l~?.001-001.0 through OAR 952-001-
CltY/State/Zlp:"y ,SprJngfield"ORf97,47,~les by
liv~U. TUU diu. lJl.,;lQn. "'''''I-'I~U OJ .' U
New calling thO center. (valife:the$o,lephone
numbllr for the Oregon Utility Notification
Center i131-P~('- M~_?344).
Owner:
Dave Rausch
Address:
4961 Forsythia
Scope Of Work: Mechanical
Contractor Type
Mechanical Contr
Contractor
Home Comfort Healing & Air Conditio
PO Box 24205, Eugene, OR 97402
Registration #
84164
Expiration Date
6/25/2003
Phone
541-345-2838
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use .
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 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
working day. NOTICE: XPIRE IF THE WORK
. :rUle: PFRMIT SHALL E - -'''T 1<' .."T
ReqUIred Inspectlonll' ' IZED UNUtl'l I nliJ H, ,.... .... - .
. I Mechanical ~~~~~NCED OR IS ABANDONED FOR
-Prior to cover. , DAY PERIOD.
- When all mechanical work is completep.lllY 180
Rough Mechanical
Final Mechanical
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
,Area (Sq. Feet),
I Main: , , Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
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Job# 02-00723-01
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Page 2 of2
Fee
Paid On Receipt# Value/Quantity
Mechanical I
06/17/2002 9624
06/17/2002 9624
06/17/2002 9624 1
06/17/2002 9624
06/17/2002 9624
Fee Amount
Minimum Mechanical Permit
8% Administrative Fee - Mechanical
Less than 100,000 BTU
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
$33.00
$3.60
$12.00
$10.00
$3.15
$61.75
$61.75
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
request?1~~7~~:::S.iS~blefrom the street.
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Date