HomeMy WebLinkAboutPermit Mechanical 2000-10-13
Job# 00-01538-01
Page 1 of 2
TRANS#:01-0003475
DATE:OCT 13 2000
AMT RECD:2 $ 26.50
CHANGE:
CASHIER:059
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 00-01538-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 404
Assessors Map#: 17032334
lot: . Block:
Blackstone Ct
Spr
- Tax lot #:
Subdivision:
07600
Addition: .
V'
Karl Grimes ^~~ I) , Phone Number: \
("'v ""V< ,,,Q; ..C"
'0.... 0;.;' ,~ ~ '
404 Blackstone Court(!)~ .0-"''0''-' .~~O . y.ity/State/Zip: Springfield, OR
-," ~" :!j.' O~ ~ ~~.
Scope Of Work: Mechanical., ,,'j. fl).;;y. D?j ~ ~ f?>\o d'AI&,[ation Value: $0
",0 ....Q .",,0 1,<1. _:l> ~~ ~ ."
New Heat Pumr;ta~~~.tr~r1~ndler> ,,'~s:-'" ./).,v
..',r \.) _"V 9,j"~, :,r-, .....<.' '5'
.,l.> ,~'o" ,.~. ..'.: -'<. ~
4-o"\~~~ f?)~ d) " ',::';;,'
Contractor Type Contractor'~ ~ ,",' .::) r Registration # Expiration Date
U' ~ ~Qj r--0. . ..' _~
,~ 01'" c,'" <to ,'t:',' ~-
Mechanical Contr HO%$88i11foR I:leating &'Air Condit* 84164 ;.. ~ oC) 6/25/2001
PO:l'BP:r~~2-:42{)~t~lu'g'~,ne: OR 97402 lJ~CO A~~ -1 ,.
.')i _"- _\(\ , . '<I. , V ~ '^ ,'ry
",- 'IJ/ ~ '0 b' c)' ~ V:J..... ~
.,,~.I'? :.~. Office Use ~' ~ # (bO 0
Quad Area: ,.') land Use: .o~ 0'-<>0 <;;;:-C:> .J> ~'Y# Of Buildings:
# Of Units: Zoning Code: rt- (b&:A.:f .~ Occupancy Group:
Constr. Type: Bedrooms: ~ ~-f ~ Heat Source:
Water Heater: Range: ....~(j AtJ "'~ Sq. Footage: .
v ~'{~ .
To request an inspection call the 24 hour recordin~~2~~3I$@, All inspections requested before 7:00
a.m. will be made the same working day, inspectionS#,qUe)ted after 7:00 a.m. will be made the following
working day. .... (j r'\.~
')' ~v
ReqUi~d Inspections
Mechanical
Owner:
Address:
Phone
541-345-2838
J -
Rough Mechanical
Final Mechanical
- Prior to cover.
- When all mechanical work is complete.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: ' . Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
~
..
Fee
Minimum Mechanical Permit
Mechanical Administrative Fee
10,000 Cubic Feet or Less
UniVHeater
Mechanical Issuance
State Surcharge For Mechanical Permit
Total Mechanical
Grand Total
Job# 00-01538-01
Paid On Receipt#
Mechanical
10/13/2000 3475
10/13/2000 3475
10/13/2000 3475
10/13/2000 3475
10/13/2000 3475
10/13/2000 3475
Page 2 of2 :.
Value/Quantity
1
1
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.
/'i4~ ~ ~
Signat~ U 0
/
I :,
Fee Amount
.$5.00
. '$.45
$4.00
$6.00
$10.00
$1.05
$26.50
$26.50
/(7 -/3 - ~OJ
Date