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Home My WebLink AboutPermit Mechanical 2003-04-21City of Springfield Mechanical Permit Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: MEC2003-00026 4t2u2003 4121t2003 10t2u2003 fu- SITE ADDRESS: ASSESSOR'S PARCEL NO.: 2350 1OTHPL 1703261203400 Springfield TYPE OF WORK: TYPE OF USE: New Residential PROJECT DESCRIPTION: Install pellet stove OWNER/APPLICANT: YOTJNG RAYMOND A TE 2350 N IOTH ST SPRINGFIELD OP.97477 Description + l0% Administrative Fee + 7Yo State Surcharge -Issuance Fee- Minimum/Adiustments - Mech Pellet Stove/Insert MECHANICAL CONTRACTOR: PELLETWERKS 150 N MCKI EUGENE CCB #12120/2004 t03l 541-607-2903 Amount Paid 4.s0 3. l5 10.00 15.00 30.00 037 037 037 I I 20020000000000 1037 To Request an inspection call the 24 hour inspections requested before 7:00 a.m. will be made the same working day, inspections req will be made the following working day. Required Inspections: 1 Freestanding Pellet Stove: After installation. By Signature, I state and agree, that I have carefully do hereby certifu that all information hereon is true and correct, and I further shall be done in accordance with the Ordinances of the City of Springfield and of Oregon pertaining to the work described herein. I further certifu that only contractors in compliance with ORS 701.055 will be used on this project. I further agree to ensure inspections are requested at the proper time, that each address is readable from the street, and approved set of plans, if applicable, will the site at all construction \{t1\t Contractors Page I of I Date atmf,*D 4/2U2003 l0:53:58AM City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97477 54L-726-3759 Phone Receipt #: 120020000000000 1 037 Date: 0412112003 L.-e ltems: Job/Journal Number Description Amount Paid MEC2003-00026 MEC2003-00026 MEC2003-00026 MEC2003-00026 MEC2003-00026 Pellet Stove/Insert Minimum/Adj ushnents - Mech -Issuance Fee- + 7%o State Surcharge + l0%o Administrative Fee Payments: 30.00 15.00 10.00 3. l5 4.s0 Line ltem Total:$62.65 Type of Payment Paid By Received By Check Number Conlirm No How Received Amount Paid Cash Change RAYMOND YOUNG RAYMOND YOUNG djb djb In Person In Person 63.00 (0.3s) Total:$62.6s Page I of2 cRcceipt.rpt 4/2U2003 l0:53:58AM City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97 477 54L-726-3759 Phone Receipt #: 120020000000000 1 037 Date: 0412112003 Job/Journal Number Description Amount Paid MEC2003-00026 MEC2003-00026 MEC2003-00026 MEC2003-00026 MEC2003-00026 Pellet Stove/Insert Minimum/Adjustments - Mech -Issuance Fee- + 7%o State Surcharge + l0o/o Administrative Fee Payments: 30.00 15.00 10.00 3. l5 4.50 Line Item Total:$62.6s Type of Payment Paid By Received By Check Number Conlirm No How Received Amount Paid Cash Change RAYMOND YOUNG RAYMOND YOUNG djb djb In Person In Person 63.00 (0.35) Total:$62.6s Page 2 of?cReceipt.rpt ffir*, Construction Contracr s Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Statement: lnformation Notice to Property Owners About Construction 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 be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: pi f . I own, reside in, or will reside in the completed structure. ff,I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. ORk38. I will be my own general contractor If I hire subcontractors, I will hire only subcontractors licensed with the Construction 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 notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information N,Owners about Construction Responsibilities on the reverse side of this form. Ir (Signature of Permit #: {YlELZc; o<-{}Z6 Address: Z3SO /Or\ ?t Issued by:}G Date Z.o prop-own.doc 05122100 (lYhite copy to issuing agency permitfile, pink copy to applicant.) o ) 225 FIFIH STREET . SPRINGFIELD,OR 97477 r PI{:(541)726-3753 . FAX: (541)726-3689 city Job Number WtAcZoAS -O OD Z b +h Job Assessors ttt^, t 7 O3Zb I Z^ tax Lot O 3!o<> Owner Pavrnon -l A ,Vo* 5(,F( ,A\\Jr,p{. *a. cs; Q. 3o.ti#,1 f,F{l,l\)-q Aj.# \, '. / Address e?5D t DFh St Phone City \,-,.- "4. l)e:E z,p q2472 (please circle appropriate appliance) State"r"'/l Value of Wood Preliminara Inspection is $45.0S Wood Stove/Pellet/Insert $62.6s Permit,lssuance F'ee, State Sureharge & Admin Fee.) F.{HA\l r, p{.{-l' c),, G},at J'i cltr: e'ltEl!r{, fJ.: $''*" V),r,'trtl,q+ Q; A\J#"w FF{l/n\,A\Jt 'i L Address /so € e&G Construction Contractors By signing this information on this information for of Environmental approval number preliminary Y LLC OlL for an inspection(s) and that I was preliminary inspection Protection of inspection. I also be required to be For Office Use () (726-3'769). I state that all Wood Stove Safety as set by the Oregon Department I agree to provide the testing if I am requesting a Date ?'l < L ttoi Z Z oI \ OQ Sqc ._q -7----7 Date of Application Checked for Delinquencies oL(Ztc)3 Checked Shared Drive(T:/Building FormsiWmd Stove Permitl-03-doc for Historical Status- CITY OF.SPRINGFMLD, OREGON C o ntr scto r I nfonnution y1or.- 6 E2 ^1'3 7 5