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Home My WebLink AboutPermit Mechanical 2004-06-15Building/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: COM2004-00705ISSUED: 0611512004APPLIED: 06/1512004EXPIRES: 1211512004 VALUE: SITE ADDRESS: 2378 19TH ST ASSESSOR'S PARCEL NO.: 1703252113300 PROJECT DESCRIPTION: Install pellet insert Owner: ARCHER TAMMy Address: 237819TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORI( Pellet Stove TYPE OF USE: New Residential Contractor Type Mechanical Contractor MIDGLEY'S License 019364 Expiration Date lut3l2004 Phone 343-1131 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Dist: # Street Trees Rqd: Paved Drive Rqd: Vo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: vt[ R-3 I| Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: td $ Per Sq Ft or multiplier REQUIRED PARI(NG Total: Handicapped: Compact: $$ $s Square Footage or Bid Amount PUBLIC IMPROVEMENTS Descrintion Tvpe of Construction Total Value of Project Value Date Calculated I'UILUII\ (r I1\.r (r.r(.lYlA I l(rN I p Sidewalk 225Fitth Street Springfield; Oregon 97 477 541-'i26-3759 Phone Ct'+y of Springfield Official Receipt ',elopment Services Department Public Works Department RECEIPT #: 1200400000000000903 Date: 0611512004 10:07:28AM Job/Journal Number coM2004-0070s coM2004-0070s coM2004-0070s coM2004-00705 coM2004-00705 Description + 7o/o State Surcharge + l0% Administrative Fee Pellet Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Amount Due 3.15 4.50 30.00 1s.00 10.00 Item Total:$62.65 Payments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check MIDGLEYS djb 8r43 In Person Payment Total: $62.6s -$6-r-6-t 6/ts/2004 Page 1 of I a*m!uL' Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-72646768ax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00705ISSUED: 0611512004APPLIED: 0611512004EXPIRES: 1211512004 VALUE: Fee Description -Mechanical Issuance Fee- + 10Yo Administrative Fee + 1oh State Surcharge Minimur/Adj ustment Mechanical Pellet Stove/Insert Total Amount Paid Amount Paid $10.00 $4.s0 $3.1s $15.00 $30.00 $62.65 Date Paid 6fi5t04 6ns.t04 6nsl04 6n5t04 6n5t04 Receipt Number 1200400000000000903 1200400000000000903 1200400000000000903 1200400000000000903 1200400000000000903 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. Pellet Insert: After installation ffi 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 Springlield 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 alt 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. Contractors Date Pase2 of? U! Bees Prid I