HomeMy WebLinkAboutPermit Mechanical 2001-4-16
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I Job# 01-00370-01 I
Page 1 of2
TRANS#:01-0004943
DATE:APR 16 2001
AMT RECD:2 $ 26.50
CHANGE:
CASHIER: 061
SPRINGFIBLD
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225 North Fifth Street
Springfield, OR 97477
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00370-01
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 257 Seward Ave Spr
Assessors Map#: 17032333
Lot: Block: Addition:
Owner:
Address:
Tax Lot #: 06300
Subdivision:
Gorden Goosela
Phone Number: 541-746-7225
City/State/Zip: Springfield, OR 97477
New Value: $0
Scope Of Work: Mechanical
257 Seward Ave
Contractor Type
Mechanical Contr
gasline, insert and gas water heater
Contractor
American Gas Appliance Service Inc
618 Hamilton 51, Springfield, OR
97477-3611
Registration #
77621
Expiration Date
10/31/2000
Phone
541-954-4686
Office Use
Quad Area: Land Use: # Of Buildings:
# Of Units: Zoning Code: Occupancy Group:
Constr, Type: Bedrooms: NOTICIE: Heat Source:
Water Heater: Range: THISPERMITSHALL~i\9:-,~~~t'1~~~'AIM"
. . . AUTHQRIZED! IN[)I=PTUI'" "'-n' ,,';:.'; -')'"
To request an inspection call the 24 hour recording at 726-3769',AlllnsRectlons requestea'beforei7.,OO T
a.m. will be made the same working day, inspections requested.~tiei:j!Oo'8'.mRwillltfe~riiad_€!~h~fo.!!'?Y"ing
working day. ANY 180 DAY PERIOD.
Required Inspections
Mechanical I
Rough Gas
Rough Mechanical
Gas Service
Insert
Final Gas
Final Mechanical
- Prior to cover.
-After line is installed and line has been connec.ted to a minimum of one appliance. Pressure te!
-After installation. /" ',,-':: ". -..,.'-.., --',~-":~"o
-WhenallgasworkiscomPlete~!I(h , '.' ' :'... .~rol;';'ji\l
Wh II h. I k . ",,"f"I' t'" Ie' . . ,
- en a mec anlca war IS comp' ~~~r ' ., ,-,,~ .l::~~ _ (r_ 3J(;:), .,',
If! UAH !:!::>~-UO,.UU /lI"IIULP'1 u,\,'l ~52-00 ,_
0090. ~ou n::", "hl";r '.~";.\ l' "h~ rul"s b
C:,lIlti' ;" , , " 'I ~ ~
... . '" ~.J . -, \".10..... .. .;l~ l:' dpt;ona
nUoIIU..JI.. I ',I II, l'f' j'
C ' 0," I,;) Ilca Ion
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I Job# 01-00370-01 I
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Page 2 of2
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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:
Fee
Paid On Receipt#
Mechanical
04/16/2001 4943
04/16/2001 4943
04/16/2001 4943
04/16/2001 4943
04/16/2001 4943
04/16/2001 4943
Value/Quantity
Fee Amount
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Gas Fireplace
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
By signature, I state and agree Ihat 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 wilh
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
req~~ ~er time and that the project address is readable from the street. t/-16-t:P /
Signature Date
1
$2.00
$8.50
$.45
$4.50
$10.00
$1.05
$26.50
$26.50
1