HomeMy WebLinkAboutPermit Mechanical 2007-9-19
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225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 ยท FAX: (541)726-3689
City Job Number
Job Location:
CoW/( ZOO 7 - 0 /L( Z <I
::l.53tJ 0 ({ 0 s T
I ?l> J 2 4lf.. L(
Tax Lot:
oz:,OOeJ
Assessor's Map:
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Owner: 0 t:.l.lr_ t:. ( >" ) /~.
Address: <2:s W ~/) . c:; f
City: ~ C:;p .1Lt/
v
State:
CJr,
Phone: 72/&-<7 ~3g
. Zip: 77l/7'/
Preliminary Inspection for wood burning inserts is $61.50 (prior to insert).
Wood Stove/Pellet/Insert Permit is $71.50 (includes applicable fees and surcharges).
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Contractor Information
Contractor: fJr1-t 06-S5?t1cn P r /t1..<.. YY1C,
Address: ;2 7 ~7 /J /1/ IY) . c J:t:i I L
City: <;oflcI - / State: (jr
v -
Construction Contractor's Registration #: J zIti & 7.
Phone: 72?- 5 7;;;S,
Zip: 0")1/ ? ')
Expires:
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By signing this permit/application, I agree to call for an inspection(s) as required (726-3769).
I state that all information on this application/permit is correct and that I was provided~'th
the Wood Stove Safety information for wood burning appliances and prelimin~~ n
standards as set by the Oregon Department of Environmental Qualitm~t ~cNff\s \,\0
Environmental Protection Agency and I agree to ll~l.the t~~ i:~'fi.lb8\~ the
inspector at the time of inspection. I also undeTtiMn~:t ~~.~~~ ~~1mnary
inspection, the wall covering may be required to\lM~~ ~ U ~ \~ (>..Y>~
~~\~~t.\'\Ct.\) ~t.\\\O~.
~ ~'I>\)\l~ Date
Signature:
7--/'7~~
l~".~
Date of Application, 7'1 'i ~ "7
/ C---
Checked for Delinquencies:
FOR OmCE USE requtres you .t~
~ENT\ON~ Oregon \a~he Oregon Ut\\I\V
~\i?~ f~~~Sc~~~~:.e~:Jse ru~e~~~ :~~~g~~
t1S~~9152.001-UCJ1otRr9U.C Hhe ru\es by
\n OAR bta\n COpies 0 h Oe
Checked for Hist~~tY<<DM: ~~te: the te\~t:! o.
ca\\\ng the h Or'egon Uti\ity Nobhcation
number tor t e. 1_800-332-2344).
center'S
Shared Drive(T:)/Building Fonns/Wood Stove Pennit 7-07.doc
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01424
ISSUED: 09/19/2007
APPLIED: 09/19/2007
EXPIRES: 03/19/2008
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2330 OTTO ST
ASSESSOR'S PARCEL NO.: 1703244402000
Springfield
TYPE OF WORK: Wood Stove
PROJECT DESCRIPTION: Install wood stove
TYPE OF USE: New
Residential
Owner: DA VID GREUFE
Address: 2330 OTTO ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
AMBASSADOR PIPING INC
License
121469
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
R-3 Height of Structure:
. Type of Heat: U \0
VB wateretes '/O\j\\\\W
. Oteg~~ e~egon e\ \ot\n
~'n:,N\\O~' dO?\~'f~ ~h:a.te \2-QQ~.
~I\O~ tU\eS a: .....tet. S'~lJ(..dWIiIfIi\~!!:u\es '0'/ n/a
'01 \'~..... cep . _.1'\ thtOUlJ' ':nhe '.;-
~0~~R95~P~~itl~~~~romN I
\~Q9Q:\,~~~ne cen\e ;e~on ~~~~i~~~)'
Ca.\ 'Det 'ot \ne .~~eiD'r'I'TIst:
nUf{\ cen\et 'J Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Phone Number: 541-746-9638
Expiration Date
03/27/2009
Phone
541- 726-5723
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
NOTICE: D\,~~p'Q ts!llr~' ~
THIS PERMIT SHALL t:^t'I~t: It d!fr: WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
.'\rlY 1~? ['.~v DJ:Rlnn
I Valuation Description I
Notes:
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Pa!!:e 1 of2
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Minimum/Adjustment Mechanical
Wood Stove/Insert
Total Amount Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01424
ISSUED: 09/19/2007
APPLIED: 09/19/2007
EXPIRES: 03/19/2008
VALUE:
Total Value of Project
L-Fees Paid.
Amount Paid Date Paid Receipt Number
$20.00 9/19/07 1200700000000001210
$5.00 9/19/07 1200700000000001210
$2.50 9/19/07 1200700000000001210
$4.00 9/19/07 1200700000000001210
$17.00 9/19/07 1200700000000001210
$33.00 9/19/07 1200700000000001210
$81.50
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
Wood Stove: After Installation.
Reouired Insoections I
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.
1Jf~/~fl 9-/7-07
Owner or Contractors Signature
Date
Pae:e 2 of2
225 Fifth. Street
. '
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01424
COM2007-01424
COM2007-01424
COM2007-01424
COM2007-01424
COM2007-01424
Payments:
Type of Payment
CreditCard
cReceint I
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200700000000001210
Date: 09/19/2007
9:02:26AM
Description
Wood Stove/Insert
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Amount Due
33.00
17.00
20.00
2.50
4.00
5.00
$81.50
Paid By
MATTHEW CLEMENT
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 005 I 28 In Person
Payment Total:
$81.50
$81.50
Amount Paid
Page 1 of 1
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