HomeMy WebLinkAboutPermit Mechanical 2003-10-14Building/Combination Permit
Status Issued
225 Fifth Street, Spring{ield, OR
541-726-3753 Phone
541-726-3676Fax
541 -7 26-37 69 Inspection Line
PERMIT NO: COM2003-0104IISSUED: 1011412003APPLIED: 1011412003EXPIRES: 0411412004
VALUE:
SITEADDRESS: 379S47THST
ASSESSOR'S PARCEL NO.: 1702324307100
PROJECT DESCRIPTION: Install pellet stove insert
Owner: EUGENE LACHANCE
Address: 379 S 47TH ST SPRINGFIELD OR 97478
Springfield TYPE OF WORI(: Pellet Stove
TYPE OF USE: New
Phone Number: 541-747-5928
Expiration Date
03t27t200s
Residential
Phone
541.-726-5723
Contractor Type
Mechanical
Contractor
AMBASSADOR PIPING INC
License
12t469
CONTRACTOR INFORMATION
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
# of Stories:
Height of Structure
nulnber
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
oh of Lot Coverage:
ty Notiti
1-800 432-2344\'
Lot Size:
Floor:
Floor:
Surface Area:
cation
REQUIRED PARKING
Total:
Handicapped:
Compact:
R-3
VN
i\i0TlcE: sidewark rvpe:
Ti,iS PER'4IT SHR:rDPHffiTTHE WOBK,,i.JiIiURIZED
UNDER THIS PERMIT IS NOIu,i:liliiiiIi\UIi] 0R lS ABAND0NED F0R
Ar! / 180 tiAY PERl0D.
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
Pase I of2
PUBLIC IMPROVEMENTS
Valuation Descrintion
Description Type of Construction Yalue Date Calculated
l, U l|,r-,rl\ U rN r UKryl,q!!!2Nl
Range
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law
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-01041ISSUED: 1011412003APPLIED: 1011412003
EXPIRESl. 0411412004
VALUE:
Fee Description
-Mechanical Issuance Fee-
+ l0o/o Administrative Fee
+ 7%o State Surcharge
Minimum/Adj ustment Mechanical
Pellet Stove/Insert
Total Amount Paid
Amount Paid
$10.00
$4.s0
$3.15
$1s.00
$30.00
$62.65
Date Paid
t0n4t03
t0n4t03
t0tr4t03
10fi4t03
t0lt4t03
Receipt Number
1200200000000002309
1200200000000002309
1200200000000002309
1200200000000002309
1200200000000002309
Plan Reviews
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.
I Pellet Insert: After installation
red 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.
/b-ly -23
Owner or Contractors Signature Date
Pzse 2 of 2
rees ralq I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Receipt #: 1200200000000002309 Date: 1011412003 9:30:51AM
Job/Journal Number Description Amount Paid
coM2003-01041
coM2003-01041
coM2003-01041
coM2003-01041
coM2003-01041
+ 1Yo State Surcharge
+ l0Yo Administrative Fee
Pellet Stove/Insert
Minimum/Adj ustment Mechanical
-Mechanical Issuance Fee-
3.15
4.50
30.00
15.00
10.00
Item Total:-------T6m5
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Check AMBASSADOR PIPING INC djb In Person
Payment Total:
s62.6s
$62.6s
225 fl[TH STREET . SPRING|IELD, OR 97477 o PII:(5'11)726-375|] o FAX: (541)726-3689
city Job Number Cc*q Zo<>3 '- ol C q I
s/Job
Assessors i7oz3zl3 'ax Lot OTroo
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Value of Wood stov@ st,,(please circle appropriate appliarice)
Preliminary Inspection is $45.00 (prior to insert)
\Yoorl Stove/Pellet/lnsert Permit is $62.65 (irrcludes Permit,Issuance l,'ce, State Surcharge & Admin f ee.)
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By signing this permit/application,s) as required (726-3769). I state that all
information on this application that I was provided with the Wood Stove Safety
infonnation 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
V{ORK
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ALL EXP \RE \I
S PERI
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Use
Checked for Delinquencies
Fo
Checked
Shared Drive('l':)/Building FormsiWood Stove Pemritl-03.doc
Date of Application
for Historical Status (---
CITY OF SPRINGFIELD, OREGON
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