HomeMy WebLinkAboutPermit Mechanical 2005-12-07Buitdin g/Co mbin atio n Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:7263753 Phone
541-726-3676Fax
541.:7 26-37 69 I ns pe ction Line
PERMIT NO: COM2005-01702
ISSUED:
APPLIED:
E)GIRES:
VALUE:
121071200s
12t07t2005
06t07t2006 tu
SITE ADDRESS: 3420 VIRGINIA AVE
ASSESSOR'S PARCEL NO.: 1702313401400
PROJECT DESCRIPTION: Pellet stove
Springfield TYPE OF
TYPEOF USE:
Pellet Stove
New Residential
Owner:
Address:
CYNTHIA WARD
3420 VIGINIA A\rE
SPRINGFIELD OR 97478
PhoneNumber: 541-343-6222
ARI(NG
Frontlard Setbaclc
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Notes:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
Vo ofLot Coverage:
\t
Sidewalk Type:
DownspoutVDrains
$ Per Sq Ft
or multiplier
Square Footage
or Bid AmountDescription Tvpe of Construction
lof2
Value Date Calculated
Contractor i.reeIContractor Type
Mechanical
# of Unib:
Primary Occupancy
Secondary
Type:
\e Energy Path:
Sprinkled nla
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Compact:
License
121469
Expiration Date
03t2712007
Phone
541-726-5723
$"i
L'I1Y I1,LiJTryIII\ I II\I(JI(1VIAII(-,T\ I
Valuation Description I
CITY OF SPRINGFIELD
Buildin g/Co mbinatio n Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Fax
541 :l 26-37 69 I nspe ction Line
PERMIT NO: COM2005-017 02ISSUED: 1210712005APPLIED: 1210712005E}(PIRES: 0610712006
VALUE:
, Fee Description
-Mechanical Issuance Fee-
+ l0o Administrative Fee
+ 77o State Surcharge
Minimum/Adjustment Mechanical
Pellet Stove/Insert
Total Amount
Amount Paid
Total Value of Project
Date Paid
t2t7t05
t2t7t05
t2t7t05
r2t7t05
t2t7t05
Receipt Number
1200500000000001786
1200500000000001786
1200500000000001786
1200500000000001786
1200500000000001786
$10.00
$4.50
$3.15
$15.00
$30.00
$62.6s
f,'ees Paid
Plan Reviews
To Request an inspection call the24 hour recording at 726a769. AII 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.
Freestanding Pellet Stove: After installation.
Ilenrrired Insneet
By signaturer l 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 SpringfieH and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCUPA|TCY will be made of any structure without permission of the Community Services Division,
Building Safety. I further certiS 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 stree( 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
Owner or Contractors Signature
2of2
Date
l2-^ -
225 Fifth Street
Si ring{'eld, Oregon 97477
541-726-3759 Phone
"'1y, of Springfield Official Receipt
-., evelopment Services Department
Public Worls Department
RECEIPT#: 1200500000000001786 Date: 1210712005 8:4e:30AM
Job/Journal Number
coM2005-01702
coM200s-01702
coM200s-01702
i coM2005-01702
coM2005-01702
Description
+ 7%o State Surcharge
+ l0% Adminishative Fee
Pellet Stove/Insert
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Amount Due
3.ls
4.50
30.00
15.00
10.00
Item Total:$62.65
Payments:
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Uheck Number
Check
,}
.{
AMBASSADORPIPINGINC DJB 9025 In Person $62.65
Payment Totat:
-$62.6-f
tl
,i
121712005 I of 1
AUmOnZatlon