HomeMy WebLinkAboutPermit Mechanical 2004-11-17 (2)
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.- CITY 01< ~rKlNGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01419
ISSUED: 11117/2004
APPLIED: 11/17/2004
EXPIRES: 05/17/2005
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 3553 GARDEN AVE
ASSESSOR'S PARCEL NO.: 1802064200500
Springfield TYPE OF WORK: Mechanical Only
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Gas pipe and install of LP insert.
Owner: PARMENTER CHERYL R
Address: 3553 GARDEN A VENUE SPRINGFIELD OR 97478
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I CONTRACTOR INFORMATION I
Contractor ':0<<:-*- ~ License
AMBASSADOR PIPINGIJ~(cf ~':0 121469
" , ,- -
I . BUlbDING'INFORMA TION I
9.~-~'V'~'V
# of Units: <J:9 ~pfStories: . Lot Size:
Primary Occupancy Group: R.3>, 'X-"~ ~~eight of Structure Sq Ft 1st Floor:
Secondary Occupancy Group: "':>~~~<<:, ~ Type of Heat: ~,.o '" ~q Ft 2nd Floor:
Primary Construction TYlle~' J:' VJII ~ ~ ':0'\)' Water Type: c,,,,,0 ~# oSq ft Basement:
Secondary constructiongy'p'e:8' ~'\) ~ \:5 f<-<:f' Range Type: J>f?, 0<:- i;-'i ~ifF~Garage/Carport
# of Bedrooms: .;j;. ,;J::> '< ':0~ ':ii:-,$ ~ ~ Energy Path: ,q,($ 0,q,C$ ~q, '0 <>><:>'t~gJ;t Other:
,,'\ " ~X' ",,{f ~ '\) Sprinkled Building: ,'1>~ ,&-q, ~!,/'l-fl:' ,OcSIi'li"tlt Load:
~~~ ^.~~n~~~
~~~ . , DEVELOPMENTINEORM1TJON;I'c,~-'~~0~0J
'{' ,~ e ~
~. 0'< '~'~'.'S' ,-~. REQUIRED PARKING
,0 '1>?j ~q," ,'" 00 ~q,' .~.,., rJ"
Overl~Y-'j)i~!f' cl' ,5:J'" ~i><:- ~O >;oS X'li
. # Str~q;te.e~(]{qd:' (f) q," 100 ~'O'O
Pa~"'D-<;ive-Rg'(C ",q>\ q,~ O,f?, <0<:5
~....,v,,~ ," G e. ~'
% of ot'COverage:~q, ~ ',Co
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Contractor Type
Mechanical
Expiration Date
03/27/2005
Phone
541-726-5723
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
..... I'. -
I PUBLIC IMPRdvE~ENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Paee 1 of2
,
.
.
. CITY OF ~rK11~ld<1]<'LU
Status
Issued
Building/Combination Permit
PERMIT NO: COM2004-01419
ISSUED: 11/17/2004
APPLIED: 11/17/2004
EXPIRES: 05/17/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Ff'f'S tilW
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
LP Gas Tank & Piping
Miscellaneous Mechanical
Amount Paid
Date Paid
$10.00
$4.50
$3.15
$12.00
$33.00
ll/17104
11/17/04
ll/17/04
11/17/04
ll/17/04
Receipt Number
2200400000000001423
2200400000000001423
2200400000000001423
2200400000000001423
2200400000000001423
Total Amount Paid
$62.65
I Plan Reviews I
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.
~ Reouired Inso~
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.
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
times during construction.
JV\OlJ \1ll~!
Date
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Owner or Contractors Sig
Pal!e 2 of2
225-Fifth'Street
, Springfield, Oregon 97477
J 541-726-3759 Phone
Job/Journal Number
COM2004-01419
COM2004-01419
COM2004-01419
COM2004-0 1419
COM2004-01419
Payments:
Type of Payment
,. Check
.'
It
11/1712004
.
RECEIPT #:
6
.ity of Springfield Official Receipt
~evelopment Services Department
Public Works Department
2200400000000001423
Date: 11/17/2004
Descriptioo
LP Gas Tank & Piping
Miscellaneous Mechanical
-Mechanical Issuance F ee-
+ 7% State. Surcharge
+ 10% Administrative Fee
Paid By
AMBASSADOR PIPING, INC.
Received By
jmp
Page I of!
Item Total:
Check Number Authorization
Batch Number Number How Received
8166
In Person
Payment Total:
1:47:14PM
Amount Due
12.00
33.00
10.00
3.15
4,50
$62.65
Amount Paid
$62.65
$62.65