HomeMy WebLinkAboutPermit Mechanical 2007-11-13
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225 FIFTH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689
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City Job Number
Job Location:
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19sC; It ~ Sir -ee I
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Assessor's Map:
Tax Lot:
Owner:
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Phone:
t, sY () / '9 '-I
Zip: Cf7f 77
Address:
City:
State:
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Preliminary Inspection for wood bu~~ inserts is $61.50 (prior to insert),
Wood Stove/Pellet/Insert Permit is r,;,~O (includes applicable fees and surcharges).
fJ I ~ ATTENTION: Oregon law requires you ,t.o
fOllOW i'Dlil rmop,g.J<k,.Nu.'G"':~3nn ,-
Notification Center. Those rules are set forth
2-J)S)1-OO10through OAR 952-001-
contractoJ'W&i\tt~ity obtain copies of the rules by
Contractor: Em e rt:"Z I j Po~ J v.. ~ ~ ~Ing the center. (Note: the t,el~pho!,'e
Address: /g?S- j-!W}/ <=L9~er_forthe~~eg<m.~~~~,}~~:7096
f !. / '\ltllIlvl (j(j.\.;).;) oAf, 7
City: ~Dr.~ f't.,,/J State: CJJ!.. Zip: 9?.,. 7/
Construction ctontracfor's Registration #: //~ 9 f Expires:. /6 - 2'Z - 0 1
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 with
the Wood Stove Safety information for wood burning appliances and preliminary inspection
standards as set by the Oregon Department of Environmental Quality or the Federal
Environmental Protection Agency and I agree to provide the testing approval number to the
inspector at the time of inspection. I also understand that if I am requesting a preliminary
inspection, the wall covering may be required to be removed.
~{?~9 ~~~R~l~MIT'SmU.-~"~F~flli::9Jql!1<
L/ AUTHORIZEDUNDEBTHISPERMIT IS NOT
FOR OffiCE ustOMMENCED OR IS ABANDONED FOR
/; . /. ANY 180 DAY PERIOD.
II 13/zo07
,
Checked for Delinquencies: V-
Signature:
Date of Application:
Checked for Historical Status:
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Shared Drive(T:)/Building FormslWood Stove Permit 7,07.doc
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Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01668
ISSUED: 11/13/2007
APPLIED: 11/13/2007
EXPIRES: 05/13/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1955 16TH ST
ASSESSOR'S PARCEL NO.: 1703252402200
Springfield TYPE OF WORK: Wood Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install woodstove
Owner: NEAL MOORE
Address: 1955 16TH ST
SPRINGFIELD OR 97477
Phone Number: 541-654-0184
I CONTRACTOR INFORMATION.
Contractor Type
Mechanical
Contractor License
EMERALD SWIMMING POOLS OF ORE IN 11294
I BUILDING INFORMATION I
Expiration Date
10/22/2009
Phone
541-688-1090
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
n/a Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
~j[~MPROVEMENTSI
THIS PERMIT SHALL !Xp Sidewalk Type:
AUTHORIZED UNDER THI~:~.!Drains:
COMMENCED OR 'S ABANDONED FOR
ANY 180 DAY PERIOD.
Notes:
I Valuation DescriPtion'
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
.,'
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
Amount Paid
$20.00
$5.00
$2.50
$4.00
$17.00
$33.00
$81.50
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01668
ISSUED: 11/13/2007
APPLIED: 11/13/2007
EXPIRES: 05/13/2008
VALUE:
Total Value of Project
Fees Paid I
Date Paid
Receipt Number
2200700000000001696
2200700000000001696
2200700000000001696
2200700000000001696
2200700000000001696
2200700000000001696
11113/07
11113/07
11/13/07
11113/07
11113/07
11113/07
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 per~i card is locat~eat th front of the property, and the approved set of plans will remain on the site at all
times during copsfru tion.
-;Z; '?' C?X..- 11- / 3- tJ7
Owner or Contractors Signature . I Date
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-726':3759 Phone
/
Job/Journal Number
COM2007-01668
COM2007-01668
COM2007-01668
COM2007-01668
COM2007-01668
COM2007-01668
Payments:
Type of Payment
CreditCard
cReceintl
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2200700000000001696
Date: 11/13/2007
8:24:11AM
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
SHERI MOORE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 692959 In Person
Payment Total:
$81.50
$81.50
Amount Paid
Page 1 of 1
11/13/2007