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Home My WebLink AboutPermit Mechanical 2002-9-6 I Job# 02-01070-01 I . dV . . ~. ." ''\ . . " RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page 1 of 2 TRANS#:01-0010548 DATE:SEP 06 2002 AMT RECD:2 $ 61.75 CHANGE: CASHIER: 032 CITY OF SPRINGFIELD, OREGON Job Number: 02-01070-01 225 Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 900 Kelly Blvd Spr Assessors Map#: 17033414 Lot: Block: Addition: Tax Lot #: 00100 Subdivision: * Owner: Kelly Seal 900 Kelly Blvd Phone Number: 541-726-0647 City/State/Zip: Springfield, OR 97477 New Value: $0 Address: Scope Of Work: Mechanical Pellet Stove Contractor Type Mechanical Contr Contractor David Mason 864457 Greenbriar Drive, Eugene, OR 97402 \n..I,~~L.\ Registration # Expiration Date Phone ~-~~~ Quad Area: # Of Units: Constr. Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage: 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 working day. Required Inspections ...qUI. . . - " " Or' '0:, \..I ' Mechanical Freestanding PelletC)l)i2C ,"Aii~finsialiation. " ~",\It " . ..!l'-'. _'" 'e~.~ f~"'OS~ ill.";:;' ""--- I."::' ..(:, . 1"'" ...ft~ . ."'\ 0/)\\1. ~..J- "'i,~;.:ii':~:O ,.,.... OQ10i'o.OUQh '111.~' 'OG":'Z-ca.. '. ieso!tht'. '-, . ' .l..,. ' , ~bta\n CO\> \ ")' ". " Construcllon,i!ypes:J I 'Note' the te c. '~. '0...\J. ,... _ _ "ef \ . '\ :",t.,Uu\. Occu'pancy,Grciups?n,. Utilit\' "c," v' ,\. . "1100reoon ....' #OfBuildings::(\" ~ . :_~.' -~ # Of Stories: 1.' " .... . . # Of Bedrooms: Current Units: Handicap Access? D Census Code: Does not apply jArea (Sq. Fee( I Main: Accessory: Total: I NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY.PERIOD, Height (feet): Proposed Units: Fee Paid On Receipt# r-- Mechanical 09/06/2002 10548 Value/Quantity 1 Fee Amount Minimum Mechanical Permit $15.00 , Fee Job# 02-01070-01 Paid On Recelpt# r Mechanical 09/06/2002 10548 09/06(2002 1 0548 09/06(2002 10548 09/06/2002 10548 . ~ - ,;.... c" '.. . Page 2 of2 Value/Quantity Fee Amount 8% Administrative Fee - Mechanical Freestanding Pellet Stove Mechanical Issuance State Surcharge - Mechanical Total Mechanical 2,000 $3.60 $30.00 $10.00 $3.15 $61.75 Grand Total $61.75 By signature, I state and agree that I have carefully examined the completed application and do hereby certify that all information herein 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. I further state that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I furtheJ:..agree to ensure that all required inspections are requested at the proper time and that the projeCt address is readable from the street. y:.; ~/~."Y 6 9/~/z- Slgflature r ,)' Date 225 FlITH STREI:T . SFRINGFlELD, OR 97477 . FH:(541)72G-g75g . FAX: (541)72G-gG89 a City Job Number o .. ,,....,4 Job Location ~ ~ Assessors Map ~ .,~ " ~ Owner ~ ~ ~: Address < City ~ o ..~ j~ ~ ~ I COli tractor IlIformatioll ! C,"'=" Address ~ City 't ~ ~ ~ ~ > ,2 rtI11 ~ o Date of Applicatior ~ Ch~k,d ro< D"mq~"" . . .- ~ CITY OF SPRINGFIELD, OREGON ~06 V,e.\\y !3\vc> , 17. t3 "3f(Li"'S.(::c..l-U I OQ.. . Tax Lot fJ-r; (~ 3t.f. 14 kGll,/ A. 13SAL- ~DO ke.\\" 6\VD. , Sv rUry, J ~~ lot - b ~41 Value of Wood Sto €I e1let Sto elInsert:,..J'-K .?-OOO Phone -q. z. (p 0 <.0 4: 'l- '4r-4-:J--:L c (Z. Zip Stat~ (please circle appropriate appliance) Preliminary Inspection is $45.00 (prior to insert) Wood StovelPelletJInsert Permit is $61.75 (includes Permit, Issuauce Fee, State Surcharge & Admin Fee.) DA-V' \:) H jI\'S 0 (\ I< M lD'I-::,or.. Swee...ps'\ 9; to L{ S -:j... G:: ~~ ~ c'^ U ^ , Phon~ -=2.. <.. ~ <....J (J("J~ r= ~ J V -.-J <:tate ~~~ Zin C11- 4 ()? o ' os ll/ L\- Construction Contractors Registration # ~c..c.& \214':5 4 Expire. 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. Signatu~ --// /# A-13JlY ~'- ~" nate ctJto/O'L- ,---, For Office Use rhecked for Historical Statur Shared Drivc(T:)lBuilding Form.YWood Stove Permill..o2.doe ~ CCB - Find A Licensee - R. " " . ~u-:--....o ';;.~<O:.""l'.",-? "~""':'J'\'"-'I"~' 1......"'......_""...'.. '(I:I'J.,ii: .'11"1.:.,1;\: ~, 1-; '~" :'l't<_MtJ; 0 ".,\';i ""1":1.', l'-!x,lI."_,,...;;, ., '\\.~:'~~.JY;.y x..'~~;/,""", ,;~.!.:,,:-~.,........ . lfiC:i~ SEARCH BY: - LICENSE NUMBER - TELEPHONE NUMBER -NAME SEARCH BUILDING CODES DIVISION FOR PLUMBING & ELECTRICAL CONTRACTORS . Page I of I Find A Licensee Other Contact Us Links About the CCB Programs Consumers Contractors Laws Find A Licensee - Results Click HERE for a printer friendly version LICENSE 121434 NUMBER: NAME: DAVID STEPHEN MASON ADDRESS: 86457 GREENBRIAR DR EUGENE OR 97402 WORK PHONE 541-538-4009 NUMBER: LICENSE STATUS: Active EXPIRATION 3/25/2003 DATE: DATE FIRST 3/25/1997 LICENSED: ENTITY TYPE: Individual LICENSE Specialty CATEGORY: Contractor/Res Exempt (Cannot EMPLOYER Have Employees - STATUS: Has No Workers' Comp Coverage) INSURANCE AMERICAN COMPANY: ECONOMY INS CO INSURANCE $ 1000000 AMOUNT: INSURANCE EFFECTIVE TO: 8/5/2003 VIEW X- VIEW INSURANCE REFERENCE HISTORY LICENSES MID CENTURY BOND COMPANY: INSURANCE CO BOND AMOUNT: $10000 BOND EFFECTIVE 3/25/2003 TO: VIEW BOND HISTORY VIEW CLAIMS HISTORY VIEW ASSOCIATED NAMES VIEW SPECIALIZED TRAINING VIEW BUILDING CODES DIVISION LICENSE DETAILS VIEW SIC CODES [ Home] [ Up ] Send mail to Web Administratorwith questions or comments about this web-site Ori'#!!CtiliJii Q' .~- State of Oregon Liability Statement http://ccbed.ccb.state.or.us/New _ Web/asp/new _search JesuIts.asp 9/612002