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HomeMy WebLinkAboutPermit Mechanical 2002-1-2 (2) - . I Job# 02-00001-01 I . Page 1 of 2 TRANS#:01-0007658 DATE: JAN 02 2002 AMT RECD:2 $ 61.75 CHANGE: CASHIER:061 ~ SPRINGFIELD ~ CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 02-00001-01 225 North Fifth Street Springfield, OR 97477 Office:: 726-3759 Inspection Line:: 726-3769 Location Of Proposed Site: 4795 Franklin Blvd 36 Eug Assessors Map#: 18030220 Lot: Block: Addition: Tax Lot #: 02900 Subdivision: Owner: Riverside Mobile Home Park Install gas furnace Phone Number: 541-746-6014 City/State/Zip: SpringfieldPOR .t(">c, ~......\ \..~,\"-" <~ <,,\' Value:\.\0 :'." ~l',(f? ,~.-:.':.~ I'>~<.J.. f'~ I ".... ..,.J' r: \"J 't:'\oJ "0' ("(.p,V."M,:.\"1 \>y..5:J ~,"<(\Q.J(;j u\,~s. ..\ )<(;.\"_.0.'0 ...._0\ .......or 'l.n.0 <'. ,..;,;"''0 _ \\ ':. - . .....:\, -'\."...... '.)~ 0' - e\(' ~\v' RESIDENTIAI,.,~ERr~ill:r:,.<,€:,' 'I:J'S~O ~'''''':'''0'0: ~~\u'l> C'ty Of S -.' fi 'Id' , (~' ~). ,:,o~. \,. ",0 I ~rmg Ie ".,F, ,':J .,.:,," (}\0' ""\~ . ,;-,. Community Seryic~s piVJ'tJo'l\:\ o':;:"',.~J<1~:t'!!mibll~: 02-00001-01 Building Safety. s.) <\\1> rf...e, ,~p . ~:.o'- ~. r....;..,).' c,.q' O',,j!"-;.J(\v'" .,,0 ",0 \.(,0:00 ,.9:.-' Office: 726-3759 \' ..,.?J'" "'('~ 0''1. \S>' ::I" ri{:-'v-f>\ ~ <~c.:lnspection Line: 726-3769 ;'~~'VQ v~' Franklin Blvd 36 Eug Alteration Address: 4795 Franklin Blvd Scope Of Work: Mechanical 225 North Fifth Street Springfield, OR 97477 Location Of Proposed Site: Assessors Map#: 18030220 Lot: Block: 4795 Tax Lot #: 02900 Addition: Subdivision: Owner: Cindy Ward 4795 Franklin Blvd sp 36 Install gas furnace Phone Number: 5410726~204 City/State/ZiP~\~~~8f 97405 c~~lterati~~\?l ~~?>~~~~e: $0 ~~~~~?>~~~~~\)~T\~~~\)O~~\)~O ~ .~a''@ _?\S~ p..U".- C'i:.vv O. Contractor CO\'J\~~~ ~'1 ~e!llttration # Expiration [)ate Service Specialists 1\.~'1 ",COO\) 140770 2/8/2002 45559 McKenzie Hwy, Vida, OR 97488 Phone 541-736-3940 Address: Scope Of Work: Mechanical Contractor Type Mechanical Contr Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupanc:y Group: Heat Source: Sq. Footage: ... . I Job# 02-00001-01 Office Use Land Use: Zoning Code: Bedrooms: Range: . Page 2 of2 , Quad Area: # Of Units: Constr. Type: Water Heater: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: To request an inspection call the 24 hour recording at 726-3769. All inspections requested bafore 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made ':he following working day. Required Inspections Mechanical Rough Mechanical Gas Service Final Mechanical - Prior to cover. -After line is installed and line has been connected to a minimum of one appliance. Pressure te! -When all mechanical work is complete. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? 0 ,Area (Sq. Feet) I Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: Fee Paid On Receipt# r- Mechanical 01/02/2002 7658 01/02/2002 7658 01/0212002 7658 01/02/2002 7658 01/02/2002 7658 01/02/2002 7658 Value/Qu antity Fee Amount One to Four Outlets Minimum Mechanical Perrilit Administrative Fee - Mechanical Less than 100,000 BTU Mechanical Issuance State Surcharge - Mechanical Total Mechanical 1 $4.00 $29.00 $3.60 $12.00 $10.00 $3.15 $61.75 $61.75 1 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 complianc:e with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are req~.I: pro er time and that the project address is readable from the street. Sign-ature '- ~ ~?.-