HomeMy WebLinkAboutPermit Mechanical 2004-7-16 (2)
.
.-
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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Bu_ing/Combination Permit
PERMIT NO: COM2004-00846
ISSUED: 07/16/2004
APPLIED: 07/12/2004
EXPIRES: 01/16/2005
VALUE:
SITE ADDRESS: 3600 FRANKLIN BLVD
ASSESSOR'S PARCEL NO,: 1703343101000
Eugene
TYPE OF WORK: Mechanical Only
TYPE OF USE:
Alteration
Commercial
PROJECT DESCRIPTION: Replace electric HV AC with gas units.
Owner: MYRMO & SONS INC
Address: PO BOX 3215 EUGENE OR 97403
Contractor Type
Mechanical
I CONTRACTOR INFORMATION I
Contractor
HARVEY & PRICE CO
Phone
541-746-1621
# of Stories:
Height of Structure
Type of Heat:
wa~er ype:
Ra I)',\?e:
.~~ y~th:
{.~p':~1illled Building:
-~ .~'\ /",<,
1 ~...... . ~-.. -- "
J<J>EWLot!I1ENT INFORMATION I
,,<<" '\~,.! ~~ ,0 REQUIRED PARKING
.'>..~ ~ o..~ .\o~ ,~~~_
S..... ~'<; ~" Overlay Dist: rt>'" VJ"" ,0' ~qtal:
~<i,. #- ~ ~~ ~ {;l ~~' # Street Trees Rqd: ~ (f~ c,*" ~a\ll'icapped:
~'\~ ~<<,,~ ~<<; ~ ~ f<,~ Paved Drive Rqd: ~...q; O...q; ,q0 O:l~<l,;:,,$O~pact:
~ ,'is? . ">.\:)~ _''.J<<; ~ ~ % of Lot Coverage: ,'I> .;s.0 :"'0C,0~ 0....:s o~~ ~
'\,. ~..... ~- ~,. O~;\....:s 'S' ff' ~O
~~~ ~~A4~~4
',,:~ . I PUBLIC IMPROVE~t~'1~~."~~~o~,'':<>~~~~~<J~~.
,- I ~~ ~,.i">.<,v ~0 .~ ~
^<v~. ~~p (;0 ~ 53 ~mtll?~.C:l:'l;
~. ~~.o~ !:l<;;) 0 \'~.. tjp
~ ~o, c.~ b'lJ ",,'1>~ ~nmu!O!}tDrains:
"i. ,~~qj 0:>" v U',,_
~O~O'?' 4,0 .;s.0 ~.;s.\{>
'\~ ",O:l<;;)' ~~o., \,0 ~q;
<;;)'"' v~ ~q; (;0
_,,f'
,
I Valuation DescriDtion I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
License
77
Expiration Date
10/3112004
BUILDING INFORMATION I
B
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
VN
n/a
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
"___ 1 _~"
.
\...11 r VI' ~rKl1'1uI'U..LU
BtpdinglCombination Permit
PERMIT NO: COM2004-00846
ISSUED: 07/16/2004
APPLIED: 07/12/2004
EXPIRES: 01/16/2005
VALUE:,
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
-Mechanical Issuance Fcc-
+ 10% Administrative Fee
+ 7% State Surcharge
Furnace - more than 100,000
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
Receipt Number
$10.00
$4.50
$3.15
$30.00
$4,00
$11,00
7/12/04
7/12/04
7/12/04
7/12/04
7/12/04
7/12/04
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
Total Amount Paid
$62.65
I Plan Reviews I
SUB Review
07/1212004
07/1612004
APP JF
hvac only.
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Reouil,-ed Insnections I
11111.1.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas work is complete.
SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
By'signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that
NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I
further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further,agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
tim uring constljJJCtiofi\ . ~
.1. U~~t/C-
/ 'jC {/~ t-o <
,_ I ~- 0'-1-
~
Owner or Contractors Signature
Date
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HARVEY & PRICE CO.
Fax Transmittal Sheet
CCB #77
Date:
, ~:;~4 d:;'~';:'ro."
r7;L/?___<:-n_
~$
Firm:
Atto:
Phone: Fax: ?;;...;;; ,?jf:'?h
From:~,,/)oI&~ ,
Re: ~:_A ~_, , / #~ .-...~ k~~
31060 f'~~<"l-l N / r
Number to call to confirm receipt: 541-746-1621
Sender's fax number: 541-746-8729 or
541-741-7646 for Brian Kuhoheno
Message:
E"-//
..<:'n~ 4?,&';;"'~_ ~<"
- , -
Col\<\ 'Z..oc4-- 00 '5' ~
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.~~uz
Fo S'T.'S-\'L
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p. 0, ~ 1910 ~, o;e 97440 ~,(5411 746-1621 7... (541) 746-U29
"'66@"....'I1Y~.-. <e4 ()()077
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Form 4b #/'1 riM f)
~ <;;'1$
Project Name:. Page: ( I
COMPLEX HVAC SYSTEMS
1. Simple or Complex System (Sections 1313.2 & 1313.si
Note: This lorm Is required lor complex systems only. If your plans qualify as a slmple system as
defined by the code. you can skip this form.
2. Simultaneous Beating and CoollDg (Section 1313.3.3.11
o No Cooling- The building plans end speciflC8tions can lor a heating-only system.
d' Complies. Temperature and humidity controls are capable 01 operattng In sequence the supply
r of cooling aOO healing energy to the zone as .res1uired by the code, Controls for this purpose are
ti detalled In the plans and specllicotions on: Mlf!:.P., ~~r
Excep. ODS 0 Exception_ The building or part 01 the building Qualifies for an exception lrom the code. The
Discussion of applicabIB code excepllon Is Section 1313,3,3.1, Exception:_ ' Portions of \he building thaI
qualifying --". qualify:
tions on page 4-20.
3. Humidity Controls (Section 1313.3.3.2) . .
;;r No Moisture Added to BuildIng. The building plans do not call for a means 10 add moisture 10
/" malntaln specllic humidity IBVBls, .
o Complies. All new humidily control systems are equipped with a humidistat as required by code.
Air
Transport
Energy
See TabiD 13-1.
page 4-24. (",
maximum horss-
power alJowed.
4 Air Transport Energy (Section 1313.3.4.2 & Table 13.LI
;;l Complies. The energy demaod 01 all HVAC Ian systems meets code requirements, Complete
I" the form below.
I.J Exception. The applicable code exception is SectIon 1313,3.4,2. Exception:_, Porllons at tho.
~ ~~ I ~ .
System Constant Design Motor Allowed Where noted In
10 Oescrtptlon Volume Airflow (elm) HP HP plans/specs
I
t:'t4-1 qPf..fb()l7. c,/
*",e..
3,'7
t:n~z 4(#-I6()12- e.'/
I
,
C/oc&-
3,7
building thel qualify:
5. Motor Efficiency (Section 1313.3.5 & Table 13-M)
o Not Regulated. There are no NEMA Dest9n A & B squlll'lll cage. T-frame induCllon. pennanenUy
wired polyphase motolS of ono horsepower or more which serve buin-up HVAC systems (regu.
ri latad motors),
);, Complies. The efficiency of ell regulated molars meets code requirements.
Exceptions 0 Exception. The applicable code excepUon is Section 1313.3.4,2. Exception:_ ,Portions 01 the
buUdlng thet qualify:
0iswssI0n or
quaBIyIng -
tionsMpDg.4-22. J Variable Speed Drives (Section 1313.3.5.1)
Not Regulated. The building plans and speclfica~ons do not call lor tan and pump motors 25
horsepower end greater that serve varlable.flow air or Uquld systems.
o Complies. All fan and pump motors 25 hp and grealer which serve variable-flow air or liquid
systems are controlled by a venable-speed drive.
(10.00)
Forms & Wor1<sheels
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Fonn 4a (con!.)
SYSTEMS - GENERAL
Project Name:
7. Off-hour Controls - HVAC Systems (Section 1313.1.3.31
Jii COmpiles. An new HVAC systems ere capable of eutomatlc setback or shutdown during periods
of non-use or alternate use of the space served by the system,
o Exception. Equipment has fun load heating demands of 2 WI (6,826 Bfulhr) or less and is
control1ed by a reedlly accessible manual off-hour control.
8. Off-hour Controls - Supply BDd Exbaust CrJ,,:_--,g 11313.1.3.3)
" COmpiles. Plans require that outdoor eir supply end exhaust systems have a means of auto-
matic (either ...',:_.:~_j or-gravity damper) lI01ume shutoff or reduction during periods of non-use
or alternate use of the space served by the system.
o Exception. The bUilding qualifies tor an excepllon to the requirement tor automallc: shutoff or
reduction, The appficable code exception Is Section 1313.1.3.3. Exc:eption _'
~ Heat PaDip Controls ISection 1313.1.3.4)
ya No Heat Pump. The plans/specs do not c:aillor a new heat pump,
o COmplies. AD new heat pumps equipped with suppl_.,,~,,;"1)' heaters are controlled as required
In Section 1313.1.3,4.
~ ',,01
quaIllinp ."""1>'
liansonpago4-lB
.
10. Equipment Performance (Section 1313.1.41
o No New HVAC Equipment. The building plans do not call lor new elecIrlcal HVAC equipment,
combustion heating equipment or heat-operated cooling equipment.
J4 Compiles. AD new HVAc equipment haS eflIclencles not less than those (BQulred l1Y \he code.
The following equipment efficiency worlalheels are atlaOhed: .fb<J...", f .d...A... .
11. Duct Insulation (Section 1313.2.281 1313.3.21
o No Duels. The building plans and specIti..".JL..~ do not c:ail1or new HVAC duds or plenums,
o Simple System: Compiles. The plans and ~~~..;;:...;.;;.., ~ c:aillor a Simple System. and all
exterior supplylretum air-handling ducIs end plenums and en outside air duelS are Insulated as
required by SectIon 1313.2.2.
,rI Complex System: Complies. The building planslspecs caD lor a Complex System, and all air-
T hanclling duelS aml plenums are Insulated as required by See, 1313,3.2.
,
~. Piping Inm1at101l (Section 13141
~ No New Piping. The buUding plans end specifications do not cell lor new piping serving a
.heating or cOoling system or part 01 a ctraJlellng service water heating system..
o Compiles. AD new piping servtng a healing or coo\Ing system or part of a clrculating service
waterheallng system compiles with the reqt~..., ,..:.>oltheCode, SecI10n 1314.1.
o Ex...~::.. ~ New piping quaJilIes for !he IolIowlng ~._~~~"": SectIon 1314, Exception _ .
Exceptions
Exceptions
Dioc<,.,.., 01
~-
_on_4-'8
9. Service Water BeatiDg (Section 1315)
14 No New Water Heating. The building plans and specifications do not call lor new wale. heaters.
hot water storage tanks. service hot water distribution systems. swimming pools or spas.
o Complies. AD new water heaters, hot water storage tanks, serVice hot water distrlbUlion sys-
tems. swimming pools or spas comply with \he requIrements 01 the Code,
o Exception. The appIlcabIe code exception Is Section . Exception _ ' Portions 01
\he building that qualify'
4-2
Forms & WOlkBhests
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Worksheet 4a
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project Name:
l;;l"tJJ ("tC-C(C::J
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Equipment Cooling Proposed Proposed
Seasonal or Part
0i3cu..... of Equip. Model Designation Capacity Steady Stata Load EffICiency Ref.
equipmonI ratings /0 (BtuIh) Efficiency (EER) Une
end equipment (SEER or /PL V)
de/inifions on pago
4-,g
I ##.16 ~/2- / 2-0 p~o //,()~ ?
z... qjH-/6 t112-- / ~o PI?O /I,t>() ?
Required
Document(l-
tion
Code
Required
Efficiencies
__01
eqvIpnionl oII/CIencles
.... f8f0tm8_ from
Ih8cod8, r_13-G
0...1;) 1:' r-: O..H
FORMS
OCT 2000
4-4
Indicate source of Information
----ARI Unitary Directory, Section AC. page:
ARI Applied Products Directory. Section ULE, page:
Product data (Attach data furnIshed by the equipment supplier. I,e.. "cut sheetsj
I 1/ or e i iea e se ed Dmvided
Equipment Type
Single Package
without a
heating section
or witfj electric
resistance heat
Sp/H Systam
withOut a
heetlnl1 section
or wItfj electric
resistance heat
Single Package
with 0 heating
section other
than electric
resistance heat
Sp'/H SYStem
with a fleeting
section other
than electric
resistanca heat
, Condensing Unit
Only
Cooling Capacity (Btulh)
Equal to or B
greater than ut less than
o
65,000
135,000
240,000
760.000
o
65,000
135.000
240.000
760,000
o
65.000
135,000
240.000
760,000
o
65,000
135,000
240.000
760.000
135,000
65,000
135.000
240,000
760,000
65.000
135,000
240,000
760,000
65,000
135,000
240,000
760,000
65,000
135,000
240,000
760,000
Forms & Worlcsheets
Minimum Rating
Seasonal or
Part Load
9.7 SEER
10,61PLV
9,91PLV
9.7IPLV
9.4IPLV
10,0 SEER
10.61PLV
9.9IPLV
9,7/PLV
9.4IPLV
Steady State
na
10.3 EER
9,7 EER
9,5 EER
9.2 EER
na
10.3 EER
9.7EER
9.5 EER
9.2 EER
na
10,1 EER
9.5 EER
9,3 EER
9,0 EER
ne
10.1 EER
Il,SEER
9.3 EER
9,0 EER
10.1 EER
Ref.
Uno
(1)
(2)
9,7 SEER
10.4 IPLV
9.7IPLV
9,5/PLV
9.2IPLV
10.0 SEER
10.4IPLV
9.7IPLV
9,51PLV
9.2/PLV
l'.2/PLV
(3)
(4)
(5)
.1
(10100)
nar-
Uf U"T J.J.;;"TOa
nc:l"-'Vlt!'~ ClInOl
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l:)...lJ
ARI* capacity lings
UNIT MOMIIlAL STMIlARD c:ootJNG
aHJ roNS CFU ~t
. EJRlO4 3 12C1O 38.000
- . "so 46,000
D/EJFOO6 5 1750 61.000
Il/EIAlO7 . 2UI. 74.000
MIRlO8 7.5 3000 80,000
M;JFl109 8.5 3000 102.000
llIEJFO.2 I. 3200 120.000
POI' 125 4300 139.000
"'4 125 4300 139.000
LEGEND
8cIs Somd LIN8b(1 bel = 10 dedbeb}
EER Enerw E/fIdenCy ReIio
IPUI - "0 ...... Part.l..OIIlId Value
SEER SeesonaI Enerw E1fidency Rallo
"'_' ...' ';..il. ..ng&r.. '~l ....:... 1nsGtuto.
tAclPIles orIy to inti; _ capodIy 0I6S,OOO IlIlA1 '" leSs.
"ThoIPl.lllsnol~to;.,.. . ............
NOlel:
,. _In ....'.., .. _ AlII _ 2'0/2<0 (004-0'2 ....) '" 360
(01......).... 270 (004-014 unIIs~
10TAL
IlW
3.21
4.25
S.SS
..70
8.18
9,44
10.91
14.04
14.04
2.
SOUND RA11NQ
~\
11.20 7.6
11.05 7.6
11.00 8.0
11.00 8.0
11.00 8.2 ".6
10.80 8..2 10.9
11.00 8,4 11.4
8.5 8.e SI.O
9.5 1.6 9A
Ratings are net....... ..1lB<ting Ihe _ of c:l1allaIIng Ian ...... Rallngs
ant baaod on:
~~.~~lndoorenterfng.elJlempeta!ureand95F
PLY Standard: sO F db" ff1 F wb /Moor lINerinO-air tarnperaSurn and DO F
db_en!orinll-Bir""""""", '
.
SEERt
EER
13..
,3..
1S.0
.
SIuC 004.012
Only
HEAllNG CAPAw,u:.3 AND EfFIciENCIES
208/2StH 060 - SINGlE STAGE GI\S HEAT
OUTPUT CAMClTY
.
UNIT
4IIKI
BI04
RI04
--
EOOS
RlOS
IlOO6
EOO6
RlO6
INPUT """""'"
1"~ _SIne
72.DfKJ
1\5,000
72.DfKJ
116.000
150.000
72.DOO
115.000
,so.ooo
1&1 SIa\1O
61)040'
92.000
......
93.'50
'2OJlOO
59....
83.150
'20.000
--
'I1!MPERA1VRE
R1SEI"Fl
t5-45
~
15-45
~
....,.
15-45
~
~
~
208/2StHo6O - SINGlE S'mGE GAS HEAT - LOW NO.
OUTPUT CAfIlCm'
UNIT
48lIJ
-
.....
l.nos
-
--
LOO6
-
.....
INPUT CAAU:ITY
'''~ _Sloae
60.000
.lum
60,000
80:000
.20.000
60.000
90,000
'20.000
.&1_
..s,ciioi
7..1100
48.ClOO
~ooo
98.000
4i.iiiiO
12JlOO
011.000
2nd __
1BIPERA1VRE
RlSEI"Fl
......
-
......
.....
40-70
......
30-80
40-70
.
UNIT
......
-
.....
. LIIll!l
-
NII05
.....
IlOO6
.....
INPUT CAAlClTY
208/2S0/460-S060 - SINGlE S'mGE GAS HEAT - LOW NOx
....-
OIITPIIT CAI'ACITY
1"_
60.000
90.000
",0lI0
90.000
'20.000
6O,OlIO
90.000
120.f'?9
1..!'!!l!"
....000
7?JlOIl
.a'iJOO
72.000
98(100
....000
72,000
~
.... ......
TEIIPERA1URE
RISE('FJ
......
-
a\.!;o
.....
.0-70
......
:'IH;O
~~
l"'b-tlli::'::J
p."
~
IPLV
e
S-.14 Only
EFf'CIENCY
AFUEll"1 _Slatell"'
..... 82
IlO'll. 80
.... 82
81% 81
.... SO
..... 82
81% 81
..... 80
EFf1CIENCY
AFUEll"1 -. Slate ""I
..... eo
80% eo
80% IKl
80% eo
80% eo
80% 80
80... 80
80% 80
EmCIEHCY
ARlEI""
""'"
"'1'"'
'"'"
.....
110%
8<'%
80%
~
__C,.I
'eo
IKl
eo
eo
eo
80
80
80
117
UP OfficeJet . .
Fax Log Report
Personal Printer/Fax/Copier
Jul-12-04 01:46 PM
ll!Im!ificatiog R!mll! ll!&!l! Ixm DlW; Iiml; ,Duratioll Diamostic
97443654 OK 05 Sent JuI-12 01:43P 00:03:23 002586030022
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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City Job NumberCO~ '2.OD4- ~'DO~ Date 0 l - \ L -06,-
o I & 2 Family Dwelling or Accessory 0 New Construction
o Multi-Family ~ AdditionlAlterationIReplacement
~ CommerciallIndustrial 0 Tenant Improvement
Job Address '3 ~<!>O PKlItN !CU~N BLvd.,
Lot Block Subdivision
Project Name M.~If"""o ~ SON!
Description ofWorkllocatior: on premises/special conditions RejJlftCE:. (,:{) VN iTS ~ r::.<lV i"N(j. (J Fi=/oce A.<eC';"
B P~opertyOumer
Name M'iI)~O 't ,rON~
Mailing Address iJ. 0, f3 /!) 1<- '3;J. I 5
City t::.U 6-SI/,; State Ol(!. Zip '7 7 ~ 3
Phone 7 ft7- 'T~'5 Fax
~.., 0 U'V
Owner Representative '-'< (C "" v.lt /I{ 0
Phone 7 If-7 - 'I S" !: Fax
.
!J'C....r"~:>"",. "';'"l. '_ -.)." ..c....''':.~''''_.T~.j<;?~.''~ft.."1'< ..,.,:,::r.;r>l.A....'~~":'--.;',;.,,'""'-.~ ~
O \~p!,I'f~li~::iift)N:-.~t-~&~~':;f~~!A1~~~~;1::;;;~,~._.~;:~f~.rf~~if~~~~'0:.;J~
"... <<. "'-.- ."'. "'"-'",.,..,Y:/.....i>.,''' .'?':..',..,,'._r..
Name /m1!Vo/ ~ f'/~'CC '-<).
Mailing Address tP_c)~ 130,1( ,1. Co
City E:v H-,9I/' ~ State O/t. Zip '77 'i'fO
Phone 7l'lD -{(j,~/ Fax 7~' - e-7~'1
, . " "
o ,'A~chite~t/D~signej./Engin~e~
Name
Address
. "',J".
State
Zip
City
Contact Person
Phone Fax
o fr9.~lj~.;.<<a,~,n:(,9}H.: . ".'"
Contractor's Name
.'
., "-'.,.,,;,,(
...:: "
J
General
Plumbing
Mechanical
Electrical
o " :C'!.~me;;cialllnclUstriClI Projects
Has site review application been submitted?
o Ves 0 No 0 N/A
If so, Name of Planner
Journal Number
SA,VI1 VOAA! E
1i/ftf.1I~ q/. ~'kt(cr ~/)If(\J'(
0.5
o
o
Demolition
Other
Bldg No, Suite No,
Tax Maprrax Lot 1'( 0 ~ ~4--3 \ 0 lOeo
1 & 2 Family Dwelling
SQFt
x $/SQ Ft
Value
New Dwelling Area
Garage/Carport Area
Other Structure Area
Total Value
f:ki<~'t.,.i":'::,~~';".>>~..,?":.''''''''"~,-;;''",,,,,,'',,':~ " .-' . "<l'~ > ,
,siJi/tnih'ct'i:i~lliridiJiHal/llfulti:F.izfuiiy';;~1.' :"i: I, '. ,:,;".,
SQ Ft X $/SQ Ft = Value
Existing Building Area
New Building Area
Total Value
Existing
New
Occupancy Group(s)
Const. Tvpe(s)
Number of Stories
, -",.".
Expiration Date
Phone #
CCB#
77
w-:n-oy.
7 'for.. -(&,;,;./
o RcsiclentiClI Projects
Heat Source: Primary
Water Heater Range
Do you require any of the following for this project?
, Over.width or Second Driveway 0 Ves 0 No
Temporary Power 0 Ves 0 No
Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon
under provisions of ORS 70 I and may be reauired to be licensed in the iurisdiction where work is bein::!. oerformed.
I:For Office Use Only . J
I PLAN CHECK FEE I I RCPT# I DATE !01-(vOll.-1 BV 1.Jl'A\'"
Secondary
Energy Path
APPLICATION
BUILDING
PERMIT
/-
Shared Drivc(T:)'8uildilll; Fonn..'ilIluilding reml;l Application IO.02.dOC'
I . 225 Fifth Street
Springfield, Oregon 97477
;1 541-726-3759 Phone
.
a~,_.','_",""'_'!','"
~.
.-:
1iiI.Y of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
2200400000000000909
Date: 07/12/2004
9:17:50AM
Job/Journal Number
COM2004-00846
COM2004.00846
COM2004-00846
COM2004-00846
COM2004.00846
COM2004-00846
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Furnace - more than 100,000
Gas Outlets 1.4
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Payments:
Type of Payment Paid By
Item Total:
l:heck Number Authorization
Received By Batch Number Number How Received
Amount Due
3,15
4.50
30.00
4,00
11.00
10,00
$62.65
Amount Paid
Check
HARVEY & PRlCE
jmp
81217
In Person
Payment Total:
$62.65
$62.65
7/12/2004
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