HomeMy WebLinkAboutPermit Mechanical 2004-8-25
\
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e=-CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01055
ISSUED: 08/25/2004
APPLIED: 08/25/2004
EXPIRES: 02/25/2005
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2389 DUBENS LN
ASSESSOR'S PARCEL NO.: 1703361105800
Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Install pellet stove
Owner: MONTGOMERY GARY D & JOYCE M
Address: 2389 DUB ENS LN SPRINGFIELD OR 97477
Phone Number: 541-689-5028
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
BRIAN JOSEPH FERNANDEZ
License
71191
Expiration Date
0612112006
Phone
541-689-5028
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group,
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
# of Stories,
Height of Structure
Type of Heat:
Water Type,
Range Type,
Energy Path,
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Vlhr
nla
I DEVELOPl\<'''l'. mruNvlATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback: ,
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
IV U II C E : I PUBLIC IMPROVEMENTS'
THIS Pr:rW,T S '
Street Iml!rov'ements:I HALL EXPIRE
JIG rHOR/7F.f} , IF THE WOR
Storm S~er."vailable:)NDER THIS PER K
specia~'insnWct;'ll~ED OR IS ABANDO MIT IS NOT
NY 180 DAY PERIOD NED FOR
Notes: .
Sidewalk Type,
Description
Type of Construction
Downspoutsmrains:
\I I -. 'l\...I,.V;l...~V"Ic:...Jjc;qujre::>yuuto
,ollu,.' rultis adopted by the Oregon Utility
'!o"i;c~'i;n Center. Those rules are set forth
~ <?~f! ,:752-001-001 0 through OAR 952-001-
-~"'~. ......, .n_" . "ULGIII l,;ufJleti or tile rUles Dy
I Valuation De~brYiiiori'(I1ter, (Note:,the tel~phone
-,. ,--, 'U. ".~ Oregon Utility Notification
$ Per Sq Ft Square'Footage10-332-23,V1\
or multiplier or Bid Amount a ue
Date Calculated
Total Value of Project
Paeelof2
r"
'.I"~.I..;'olc.rL lO..' ~..
.. . .--
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.
. CITY OF SPKll~hl'1Ji,LD
Building/Combination Permit
PERMIT NO: COM2004-01055
ISSUED: 08/25/2004
APPLIED: 08/25/2004
EXPIRES: 02125/2005
VALUE:
Statlls
IsslIed
225 Fif! h Slr('cl, Springficld, OR
:'<11-726-3753 Phone
,41-726-J('7(' Fa,
541-72(l-.17(llJ IIl~pcction Line
I Fees Paid I
)-"('1' Dt'Sfrilllinn
-.\h'Chanit'allsslI:lI1CC Fcc-
\- IW:I., t\c1l1linislrativc Fcc
_I- 7'Xl Slah' SlIrdl:lrgc
"linillllll11/Ad,illslmcnt .Mechanical
P.'lIet Slo\'cllns<.'rt
Amount Paid
Date Paid
Rcceifll Number
$10.00
$4.50
$3.15
$15.00
$30.00
8/25/04
8/25/04
8/25/04
8/25/04
8/25/04
120040001111000001262
121111400000000001262
12110400000000001262
120040001111000001262
121111400000000001262
Tntal Amount Paid
$62.65
I Plan Reviews I
Tn Reqllest all inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will he marle the same working day, inspectious requested after 7:00 a.m. will be made the fOllowing work
r1ay,
, Re('l'red InSllections I
I III.. I r
Pellet I nSl'rt: After installation
B)' ,igllalllrc. I 'laic alld agrec, that I have carefully examillcd 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
'he Ordillall('(" of thc City of Springfield and the Laws of the State of Oregon pertaining to the work de,('ribed herein, and
that 1\0 OCCCI',\:'iCY will he made of any structure withont permission of the Community Services Division, Building Safety.
I fllrther ('('I'I if)' lhal only COlltractors and employees who arc in compliance with ORS 701.005 will he uscd on this project.
1 furthu agn.'c 10 l'lISUre thut all required inspections are requested at the proper time, that each addrcss is readable from the
"r('ct,lhat the I'('l'Inil car" is located at the front of the proflcrty, and the approved sct of plans will rcmain on the site at all
firlll'S Irin:,: rUIl...trucfion.
.. __~ '711- ~~
0",ner6 Cnlllra('lors Signature () I
g / ;}S-~f-'
Date
Paee 2 of 2
225 Fifth Street
, ,
Sprill.;;flel~, Oregon 97477
541-'hfi-3759 Phone
Jnh/.lonrnal f','ullIht'r
COM2004.0 I 055
COO'12004-01055
COil12004.01055
COil'12004-0105S
COil'12004-0 I 055
1';:IYIlH'l1tS:
Type nf l)aYIlIl'lIf
Check
~/2512(}04
.
RECEIPT #:
~~Rl!!l!!"~........,.
wr'
.
~... i
... 1 '.
~'.'.."~""" '.- -, -
aY of Springfield Official Receipt
Wvelopmcnt SerYices Department
Public Works Department
1200400000000001262
Date: 08/25/2004
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Pellet StovelInsert
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
":lid By
JOYCE MONTGOMERY
1Iem Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
2029
In Person
Payment Total:
Page 1 of 1
9:03:31AM
Amount Due
3,15
4,50
30,00
15,00
10,00
$62.65
Amount Paid
$62.65
$62.65