HomeMy WebLinkAboutPermit Mechanical 2007-01-16LD
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2007 -00067ISSUED: 0111612007
APPLIED: 01/1612007
EXPIRESz 0711612007
VALUE:
SITE ADDRESS: 566 38TH PL
ASSESSOR'SPARCELNO.: 1702311307800
PROJECT DESCRIPTION: Wood insert
Springfield TYPE OF WORK: Wood Stove
TYPE OF USE: New
Owner:
Address:
Contractor Type
Mechanical
STREETER DANNY L
566 38TH PL
SPRINGFIELD OR 97478
Contractor
CHRIS B WINSLOW
License
s2381
Expiration Date
01/10/2008
Residential
Phone
541-895-3593
CONTRACTOR INFORMATION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
R-3
VB
# 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:
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:nla
Sidewalk Type:
Downspouts/Drains:
REQUIRED PARKING
Total:
Handicapped:
Compact:
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
PUBLIC IMPROVEMENTS
Description Type of Construction
Pase I of2
Value Date Calculated
BUILI"ING TNTUKlvrryJ
N.
\$
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Valuation Description I
ITY
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 [nspection Line
Building/Combination Permit
PERMIT NO: COM2007 -00067
ISSUED: 0111612007
APPLIEDz 0111612007
EXPIRESz 0711612007
VALUE:
Fee Description
-Mechanical Issuance Fee-
+ l0oh Administrative Fee
+ 57o Technology Fee
+ 87o State Surcharge
Inspection - Preliminary
Minimum/Adjustment Mechanical
Wood Stove/Insert
Amount Paid
Total Value of Project
Date Paid Receipt Number
1200700000000000035
1200700000000000035
1 200700000000000035
1200700000000000035
1200700000000000035
I 200700000000000035
1200700000000000035
$10.00
$4.50
$4.50
$3.60
$45.00
$15.00
$30.00
ut6t07
ut6t07
yt6t07
Ut6t07
ut6t07
ut6/07
ut6l07
Total Amount Paid $l12.60
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
Wood Burning Insert: After installation.
Preliminary Inspection: Prior to the installation of solid fuel appliance which will be vented through an existing
chimney.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCy will be made of any structure without permission of the Community Services Division, Building Safety
I further certify that only contractors and employees who are in compliance with ORS 70f .005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times construction.
/-/b4a
Owner or Contractors Signature
Paee2 of 2
Date
i
Keoulred lnsDectlons I
-r eclriu(l_l
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
C' of Springfield Official Receipt
L-,elopment Services Department
Public Works Department
RECEIPT #: 1200700000000000035 Date: 0111612007 e:35:48AM
Job/Journal Number
coM2007-00067
coM2007-00067
coM2007-00067
coM2007-00067
coM2007-00067
coM2007-00067
coM2007-00067
Description
Wood Stove/Insert
Minimum/Adj ustment Mechanical
Inspection - Preliminary
+ 5olo Technology Fee
+ 8% State Surcharge
+ 10Yo Administrative Fee
-Mechanical Issuance Fee-
Amount Due
30.00
I 5.00
45.00
4.50
3.60
4.50
r 0.00
Item Total:$r 12.60
Payments:
Type of Payment Paid By
Check Number
Received By Batch Number
Arithorization
Number How Received Amount Paid
Check YE OLD TOWN SWEEP djb I 8556 In Person
Payment total:
-5Ti766-
$l12.60
cReceint I Page I of I U16/2007
*FB*il*lm*r-$
225 FIilH STREET . SPRINGFIELD,OR 97477 o PH:(541)726-3753 o FAX: (541)726-3689
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Address
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Value of Wood Stove/Pellet 3 3oo (please circle appropriate appliance)
Prelimin*r-v Inspection is $45.i10 (prior to insert)
Wooel Stove/Fellet/lnsed Permit is $62.65 (inclndes Perrnit, lssnance i'ee, State Surcharge & Arlmin !:ee.)
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Construction Contractors Registration {z
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 /pernit is correct and that I was provided with the Wood Stove Safety
infonnation for wood burning appliances and prelirninary inspection standards as set by the Oregon Department
of Environmental Quality or the Federal Environmental Piotection 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 .
/uz^Date *oa
For Office Use
Date of Application /-t6- D7
Checked for Delinque n"i", / Checked for Historica lstutu, V
Shared Drive(T:),'Building Fomrsr'Wood Stove Pemtitl-03.doc