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Home My WebLink AboutPermit Mechanical 2004-12-06Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01487ISSUED: 1210612004 APPLIEDz 1210612004 EXPIRES: 06/0612005 VALUE: v SITE ADDRESS: 873 25TH PL ASSESSOR'SPARCELNO.: 1703361108000 PROJECT DESCRIPTION: Instal gas heat stove Owner: BARBARA MORRIS Address: 873 N 25TH PL SPRINGFIELD OR 97477 Contractor TYpe Mechanical Contractor THIS PERMIT SHALT nuiHoiiiiio unrorn Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential Phone Number: 541-741-3641 License Expiration Date Phone T # of Units: Primary Occupancy Secondary Primary Construction Type Secondary Construction Type: # of Bedrooms: MMENC ABANED OR IS t)R-3 VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: loltow rule$ Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla Oregon h$rrc4ffi REQUIRED PARI(NG Total: Handicapped: Compact: rdtortl Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: $ Per Sq Ft or multiplier Square Footage or Bid Amount CONTRACTOR INFORMATION DEVELOPMENT INFORMATION Description Type of Construction Total Yalue of Project VaIue Date Calculated J Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-0L487ISSUED: 1210612004 APPLTED| 12t06t2004 EXPIRES: 06/0612005 VALUE: Amount Paid Date Paid Receipt Number 220040000000000r478 2200400000000001478 2200400000000001478 2200400000000001478 2200400000000001478 2200400000000001478 Fee Description -Mechanical Issuance Fee- + l0o/o Administrative Fee + 77o State Surcharge Gas Fireplace Gas Outlets 1-4 Minimum/Adj ustment Mechanical Total Amount Paid $10.00 $4.50 $3.15 $1s.00 $4.00 $26.00 t2t6t04 t2t6t04 t2t6t04 t2t6t04 tzt6t04 t2t6t04 $62.65 To Request an inspection call the24 hour recording at 726-3769. All inspection 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. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. leouired Insnections 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 times during construction. Arr*r"u 12-L r;,-/a-- DateOwner or Contractors Signature Pase2 of2 r ees ralo I 225 Fifth Street Spring"leld, Oregon 97 477 54i-726-3759 Phone _-.lity of Springfield Oflicial Receipt Development Services Department Public Works Department RECEIPT #: 2200400000000001478 Date: 1210612004 10:3e:51AM Job/Journal Number coM2004-01487 coM2004-01487 coM2004-01487 coM2004-01487 coM2004-01487 coM2004-01487 Description + 10%o Administrative Fee Gas Outlets l-4 Gas Fireplace Minimum/Adj ustment Mechanical -Mechanical Issuance Fee- + 7o/o State Surcharge Amount Due 4.50 4.00 15.00 26.00 10.00 3. l5 Item Total:$62.6s Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check BARBARA MORRIS djb r294 In Person $62.65 Payment totat: -58ffi t2l6/2004 Page I of I ryI m Construction Contractors Board 700 Summer St ltlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:!gry"gs1!g!4q Permit#: C-OYvtzsoct- O t u/ ['7 Address: 873 Z S+( (L Issued by:\6 Date: /Z-O6-Oy h Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: E- l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the strrcture is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instnrct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR & 38. I will be my own general conffactor. If I hire subcontractors, I will hire only subcontractors licensed with the Constlrrction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the confractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /A"/, o/ (Signature of permit applicant) @ate) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner. doc 06-0 I -04