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HomeMy WebLinkAboutPermit Mechanical 2007-11-27 ~' ;;-.oi M'~ j 0: .\:>~'; ~ ~~ 0: ., .,. '.1: I' ~, ~i <.,.1 ,././"- :;-. j ,. , , ~i ~,l 0.: ,,:.- ...:4 ..,~'. ~~ ~:,\ ~ . GV. ~~ 00, ~'.,..: ,! \ . I ~: ~. ~. (1).'. 00) [1j ~,~ ~; >, O. ~. r:'I"\. VJL>~" .l..:....",h I'?yp; 0, ,.:.," .. .. .. .. ,~} 0) ~' "" ,', r'" 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: I "",I.'''.~ "''', ......_... .."...;.....'..._~'"'''' ;.II~I...."..,'.,' ,I.~ ;;,'''''''',.,,_,," , ..,..""..'" ".'" ,..... .,,,,, " ""..,,,- - Owner: ~/.: "J tA}.'l / it 87// ;// ~+- 5 J: C;~~/ ~, - {; ~ Sta te: {Yr. 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? Z~ Construction Contractor's Registration #: Contractor: Phone: );(&- 5 ?;<'s C)) '10/ State: -.0 r .. /2/ LJ h 7 .'V'_\ \0 o.u\~es 'l \)~\X\\'f ..... ......... .." ,.. .... "."'. ,.......,. ",..., ..~,... '.'.'_"'.'" ''''''.' . ,......" . J :r'l't'.~~."-:'i'???n.". ~tC'\\~,. ,., _.. ,........,. .. , ,." _,... ,.". .... ,... -<,' r<~'. o~e9~6 'O'l \\;\\:lu\es a.~e ~;2'OO . 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 '~'O?'" , , \f \\-\'t. ~'l ~ ~O~~~~~~ s~t~~~~~~~g f~:O \~1\-\O~\lc~t)U nR \5 ~~~~U COW\W\E~G ~ ~t.~\OU. 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