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HomeMy WebLinkAboutPermit Mechanical 2002-8-1 " . I Job# 02-00934-01 I . Page1of2 V TRANS\! , 0l-ClOJ.J'.4:' DATE:AUG 0::' ;l'U~ AMT RECJ:2 ) ~2j 50 CHA;'lG:. ' ::;ASH:,::r,: 00: CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety 225 Fifth Street Springfield. OR 97477 Location Of Proposed Site: 2223 Rose Blossom Dr Spr Assessors Map#: 17032611 Lot: Block: Addition: Owner: Jerry Rybka 2223 Rose Blossom Drive Phone Number: 541-746-3802 City/State/Zip: Springfield, OR 97477 New Value: $0 Address: Scope Of Work: Mechanical Install new heat pump and revise ductwork Contractor Type Mechanical Contr Contractor Comfort Flow Heating Co 1951 Don Street. Springfield, OR 97477 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: Job Number: 02-00934-01 Office: 726-3759 Inspection Line: 726-3769 Tax Lot #: 03225 Subdivision: Registration # Expiration Date Phone 00460 6/27/2003 541-726-0100 \laO~'~~: .., ~\.l~' I EXPIRE IF 1HE~ORI\ \ "I;:) f .J;l.~'" DER 1HIS \'t~lVlll ,:, 1.01 t>.U1HORIZED ~~NQ ABANDONED FOR COM\\~CBDlIgln . ANY ~~~j:lV bbp: Heat Source: Sq. Footage: To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:0,0"" reqUII3S you.t.o a.m. will be made the same working day, inspections requested after 7:00 a.m..will.be-made(thINoliO\Ning OI<)Oon \)1'\:.Y working day. J.\ \ \ t;;1'l \~-;; adopted b~' tI,o \ s ;re set \oiti , !aIlOW IU \'\tel ,hose III e 5?-001- Construction Types: Notllication Ce 0010 through OAR 9 \ s by Occupancy Groups: il'\ OAR 952-001- btain copies 0\ the r~o~e # Of Buildings: # Of Stories: Heiglinfe'eti~ tnaYeOnter. 'Note: the te'et'~'lc~\iOn 1\,~"\heC , .,'ty\\!O II U # Of Bedrooms: Current Units: Proposed Units: he Oregon UII 1 3A ") O f\Ulilbenul I 00 33?-? ....' . Handicap Access? Census Code: Does not apply C2i\tet is 1-8 - -- rArea (Sq. Feet) Main: Accessory: Total: Paid On Receipt# Mechanical 08/01/2002 10142 08/01/2002 10142 08/01/2002 10142 08/01/2002 10142 08/01/2002 10142 Fee Minimum Mechanical Permit 8% Administrative Fee - Mechanical 3hp - - 100,000 BTU Alter/Add to ea Appl Unit or System Mechanical Issuance ValuelQuantity Fee Amount 1 1 $3.00 $3.60 $12.00 $30.00 $10.00 , . Fee State Surcharge - Mechanical Total Mechanical Grand Total Job# 02-00934-01 Paid On Receipt# Mechanical 08/01/2002 10142 . Page 2 of 2 Value/Quantity Fee Amount $3.15 $61.75 $61.75 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 compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time and that the project address is readable from the street. Si9~ (~ B)\ [CYL Date