HomeMy WebLinkAboutPermit Mechanical 2007-11-27
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SPR!lNGF!lELD
225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689
City Job Number
Job Location:
c..olAA 'Zoo7-0 /733 I
g-,O S. 7/11- S I
I 8'0 Z. 01.:2 '1
Tax Lot:
oZJOo
Assessor's Map:
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Owner:
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Sta te:
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Phone:
7;;{~ ~ YcJ/G/
Zip: 9?Y) 6-
Address:
City:
Preliminary Inspection for wood burning inserts is $61.50 (prior to insert).
Wood Stove/Pellet/Insert Permit is,$i'i.50 (includes applicable fees and surcharges).
SI~
1:, Contractor Information
Arv, ~55~ ~~ij
Address: f? 0 (3-) X 76');;S?
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Construction Contractor's Registration #:
Contractor:
Phone:
);(&- 5 ?;<'s
C)) '10/
State: -.0 r ..
/2/ LJ h 7 .'V'_\ \0
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By signing this permit/applicatioh,,i agfe~t~~t~H9\a~~~~~s) as required (726-3769).
I state that all information on this.apPlie,a~i~n~p'et~'MS>t~~~that I was provided with
the Wood Stove Safety informati0!1/or:~6~~~~~.~'t1~)~e~ a~d preliminary inspection
standards as set by the Oregon Depa.rtine'~j{~Ert~<illi\'t ~Quahty or the Federal
~nvironmental P~otecti~n Age~~y.,~.n~~~"~fI~~~i{}Q~1l'f .e testing appr?val num~er. to the
mspector at the tIme of mSpeCtI6h.i,uairm(\1fJ'lderstand that If I am requestmg a prehmmary
inspection, the wall covering m\l~\be r~Wuired to be removed.
City:
Zip:
Expires:
Signature:
(){}-~~S(~7~
Date:
Date of Application:
/(-27-67
/1- ;;;)-07
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Checked for Histor~~s\R,Qs?~
FOR OmCE USE
Checked for Delinquencies:
Shared Drive(T:)fBuilding FormsfWood Stove Pennit 7-07.doc
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2007-01733
ISSUED: 11/27/2007
APPLIED: 11/27/2007
EXPIRES: OS/27/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 890 S 71ST ST
ASSESSOR'S PARCEL NO.: 1802022402300
Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Freestanding pellet stove
Owner: RA YMOND WILDE
Address: 890 S 71ST ST
SPRINGFIELD OR 97478
Phone Number: 541-726-4014
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
AMBASSADOR PIPING INC
. License
121469
Expiration Date
03/27/2009
Phone
541- 726-5723
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: R-3 Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type VB Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: Ener.~path:
ENTION: Oregon law requires ~fU1ff', d Building:
ATT J '_.. .ho nrP.Qon
fO\l?f~ ~~~~Sc~~~~r:"Th~se r~tlEmn=Ab~;;~T INFORMATION I
Notllca 001 0 throu~1I 8~
in OAR 952-001- t' copies of the rules by
Frontyard SetlOO9.e.. You may o~~I(Note: the tel~ Dist:
Side 1 Setback: calling the c~n Oregon Utility Notlif~[)l\rrees Rqd:
Side 2 Setback: number tor t a.s 1-800.332-2a44)11aved Drive Rqd:
Rearyard Setback: Center' % of Lot Coverage:
Solar Setbacks:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Description
Type of Construction
Square Footage
or Bid Amount
Value
Date Calculated
Notes:
Pae:e 1 of2
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01733
ISSUED: 11/27/2007
APPLIED: 11/27/2007
EXPIRES: OS/27/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
L Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Minimum/Adjustment Mechanical
Pellet Stove/Insert
Amount Paid Date Paid Receipt Number
$20.00 11/27/07 1200700000000001437
$5.00 11/27/07 1200700000000001437
$2.50 11/27/07 1200700000000001437
$4.00 11/27/07 1200700000000001437
$17.00 11/27/07 1200700000000001437
$33.00 11/27/07 1200700000000001437
Total Amount Paid
$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 ~he same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Reouired Insoections I
Freestanding Pellet Stove: 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
tim'#~;aAAf-'" 11_ :2 rd7.
Owner or Contractors Signature Date
Pae:e 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-7~6-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-01733
COM2007-01733
COM2007-0 1733
COM2007-01733
COM2007-0 1733
COM2007-0 1733
Payments:
Type of Payment
Cred itCard
cReceintl
RECEIPT #:
1200700000000001437
Date: 11/27/2007
Description
Pellet Stove/Insert
Minimum/Adjustment Mechanical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
~Mechanical Issuance Fee~
Paid By
MA TTHEW CLEMENT
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 035698 In Person
Payment Total:
Page I of I
9:36:48AM
Amount Due
33.00
17.00
2.50
4.00
5.00
20.00
$81.50
Amount Paid
$81.50
$81.50
11/27/2007