HomeMy WebLinkAboutPermit Mechanical 2000-10-20 (2)
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I Job# 00-01570-01 I
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TRANS#:01-0003549
DATE:OCT 20 2000
AMT RECD:2 $ 53.00
CHANGE:
CASHIER:059
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01570-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3530 Game Farm Rd Spr
Assessors Map#: 17031540
Lot: Block: Addition:
Tax Lot#: 03100
Subdivision:
Owner:
Bill Ticer
3530 Game Farm #76
Phone Number: 541-746-6514
City/State/Zip: Springield, OR
Address:
Scope Of Work: Mechanical New Value: $0
Replace Heat Pump,~r2.Air handler .-J, ~
'f. --. .,-J...., -:.lIO(II':.o[,~. ,- ~ . to. '
oiificaTlor 0t:m' ~,.." ,1f ()reODr> IAI,"
'f/ OAI-1 l:!52 Ib, I nos~ {II/e' . .
Contractor Type Contractor U090 v -001-00W 'hrou Registhition # . Expiration Date Phone
. .QU 11l?",nr'la ' lJI/C1AH952-UO,
Mechanical Contr Associated Heating I!!~l{\~ E..?,W~" 1/, <;Dpies I)f Ih~ 'ules b, 541-683-2590
PO Box 412, EiJgene"(:m,9?;440',, IIVDta !n~ telepnone '
l:- U(..~n()r. J I.:':.. ..
;. H"h.' .' :' _.., .,..,';'.:J I \/VIfIlCaIlOn
Office Use. -- . "'If.
Quad Area: Land Use: # Of Buildings:
# Of Units: Zoning Code: Occupancy Group:
Constr, Type: Bedrooms: Heat Source:
Water Heater: Range: Sq. Footage:
To request an inspection call th~~JJJ(fecording at 726-3769. All inspections requested before 7:00
a.m. will be made the same worKM!fdayfiinspections r,eguested after 7:00 a.m. will be made the following
working day. AUTHORIZ~D ~~~LL eXPIRE IFTHE WORK
"ro",,_. . Efi TI:I/S 0100' :'~,~ '
....~"vcu~eqUlred Inspectlons,[,v.
AN " '''FI:JJJ,Nf;9~'r:
y 180 DAYlPlOou-,Mechanical.Of-URI
Final Mechanical -When all mechanical work is complete.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[Ar~a (Sq. Feet)
_ Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Mechanical
10/20/2000 3549
Value/Quantity
Fee Amount
Minimum Mechanical Permit
$5.00
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Job# 00-01570-01
Paid On Receipt#
Mechanical
10/20/2000 3549
10/20/2000 3549
10/20/2000 3549
10/20/2000 3549
10/20/2000 3549
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Value/Quantity Fee Amount
. .
Fee
Mechanical Administrative Fee
Less than 100,000 BTU
10,000 Cubic Feet or Less
Mechanical Issuance
State Surcharge For Mechanical Permit
Total Mechanical
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 Cily of Springfield and the Laws of
the State of Oregon. I further state that only contractors and employees who are in compliance with
ORS~01' 5 wi1used on t is project. I further agr. e to ensure that all required inspections are
request t the pr er tijPe d that th " v;c . . readable from the street.
/, / k- /!J-;?/!)--@)
~gnat ~ Date
1
1
$.45
$6.00
$4.00
$10.00
$1.05
$26.50
$26.50