HomeMy WebLinkAboutPermit Mechanical 2007-4-20
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00579
ISSUED: 04/20/2007
APPLIED: 04/20/2007
EXPIRES: 10120/2007
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4127 CAMELLIA ST
ASSESSOR'S PARCEL NO.: 1702323303901
Springfield
TYPE OF WORK: Pellet Stove
PROJECT DESCRIPTION: Install pellet insert
TYPE OF USE: New
Residential
Owner: CANDICE SHEPARD
Address: 4127 CAMELLIA ST
SPRINGFIELD OR 97478
I CONTRACT~~~FORMA TION I
eS "\ 0\~~
Contractor eo..-0.\'I.. 00 ~ \0'0-'0 License
AMBASSADOR P~~?~?\!~~~~~~e ~:f)-\)~~1 121469
...\' O\eg J\'BUJLDlNG\~FOO'MAJ'ION I
-;\\0\..... 60'Q'V. '\'<'V 00~' 0\ \.\,J ,~pu'. 0'(\
# of Units: :<\'\<(..~ 'l..0\eS ~e0\e'l..~\\) ~ 8QSto~~'O\\{\\C-o.\~
Primary Occupancy Group~ 0\\0~ ~c!t-:r\)\)\,\J :\.i-\\ffe\J!tt ~f:\,~frW~~re:
Secondary Occupancy GrouWb\.\\,\c<O: Q,'::>?; -0."\ 0'0 e,<.'WR~Q(\.'lI~'ti!l.
Primary Construction Type~ (\ O~\\ .{0ll,\\\ e ce0'V. O,<wal:f~~_"J~e:
Secondary Construction Type: \)~\)'. 00.l \'<" :<. \'(\e. R.a'ft~e Type:
# of Bedrooms: \J C~\\ ~e'< \0 <;\\e\ \~nergy Path:
0\)\\\ (je Sprinkled Building:
Contractor Type
Mechanical
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist: ~
# Street Trees Rqd: x.. ~f()~ \\
Paved Drive Rq~:\~ fo ~f()
% of Lot G~~li2~~\\ ('\0..
~i-'< ~~~\ ~~~
-:(: \"' ~~~ ~\..\.. ""~\~ 0~~\)
~~,,\\\>> ~U(\~"R~ENTS I
~S ~ t-t> :
\~ :\'0\J~\ ,,~\) ~ ~\\J\)'
~\) ~~~~ ~ ~~
c,'\) \ 9:>~ \)
~~"
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Paee 1 of2
Phone Number: 541-206-2010
Expiration Date
03/27/2009
Phone
541- 726-5723
nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDrains:
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid-t
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Minimum/Adjustment Mechanical
Pellet Stove/Insert
Amount Paid
Date Paid
$10.00
$4.50
$2.25
$3.60
$15.00
$30.00
4120/07
4/20/07
4/20/07
4/20/07
4/20/07
4/20/07
Total Amount Paid
$65.35
I Plan Reviews I
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00579
ISSUED: 04/20/2007
APPLIED: 04/20/2007
EXPIRES: 10/20/2007
VALUE:
Receipt Number
1200700000000000441
1200700000000000441
1200700000000000441
1200700000000000441
1200700000000000441
1200700000000000441
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.
Reouired Insoections I
Pellet Insert: After installation
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.
(f)~ )/~ng <f- 2IFO)
.., -' ~
Owner or Contractors Signature
Pal!e 2 of 2
Date
225 Fifth Street
Springfi.erd, Oregon 97477
541-726-3759 Phone
.
CjhT of Springfield Official Receipt
l Jopment Services Department
Public Works Department
Job/Journal Number
COM2007-00579
cOM2007-00579
COM2007-00579
cOM2007-00579
COM2007-00579
cOM2007-00579
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
1200700000000000441
Date: 04/20/2007
Description
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Pellet Stove/Insert
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Paid By
MATTHEW CLEMENT
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 00570B In Person
Payment Total:
Page 1 of 1
9:08:55AM
Amount Due
2.25
3.60
4.50
30.00
15.00
10.00
$65.35
Amount Paid
$65.35
$65.35
4/20/2007