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CITY OF SPRINGFIELD, OREGON
s~. P~RING~~~D' _ _ ..
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22') FIITIl STREET. SFRlNGFI1LD, OR g7477. FI! (,)4I)726-~7,)', . fA}( (')4])726-3689
/25""0
CIty Job Number COW'\'ZOO Y - 0
Job LocatIOn 2.5/ ~ ~"~"'I,4-L
/70"52 Sl{ l{
7 L-V'Ji
Ta, Lot
00 zo .1
As~e,.,sor's Map
Ownel
o Iltl" H 'R",~er 5f" ttvld
.25/'1" CPVI+~V1n"l\1 lillI/d.
Sp(ln~.t"~ld
LIp
"17477
M a ann P. Ro..+e.r
Fhone
7.210 - '1705
Address
()rf'a On
~
:'tate
CIty
Frellmmary Inspeebon for wood burnmg mserts IS $66 04 (pnor to Insert)
Wood Stove/Fellet/Insert Fermlt IS $87 04 (mcludes applle"ble fees and surel1.iJm\C
requires y"", ....
,-"",""'l'}regon laW~!1on Utlt~...
1-" ,~..... cloplt.... w, I are..... IV'
folloW rules ~nter. ,.hOse ru e~/>.R 952-001'
Not\I\~~~anoDmp'~gh at the rules bY
In Op..'f\' @'/J)_~!"n wl'l~e telephOne
Contractor Ted Huff -.Agt-Q~/)Io~_ l~ote:",w NotIfil'.lltlOl\
Addrc" -Po 1':"" .':U.::r ~Q call1Og ,~. thl! orego" ~). Fhone ..5.'/..1 - :2, 'J ~>''''o
l\UIDIl'" ",.. I \~UU
CIty E Ujt'.r>P. center 8:,rafe (')r"l'J"n Zip '17'10.2.
ConstructIOn Contrdctor'~ Reglstrat10n # 7.~ ~()In tApues ~/17 / ":1,,,, 9'
/
By sIgnIng thIs penmt/apphcal1on, I agree to cdll for an InSpectlOn(s) as requned (726-3769)
I state that all Intormal1on on thIs apphcal1on/penmt IS correct and that I was pro~_
the Wood Stove Safety Intormatlon t01 wood burmcttances an~~~ .twt
standards as set by the Oregon Depaliment of En I tl.f.A~6M~ ~
EnvnonmentaI Protecl1on Agency and I aglee to piT~ ~~tl' r n~'lhe
Inspector at the l1me of mspectlon I also understaA_1 !" 0Rl\& prehnllnary
InSpection, the wall coverIng may be reqUIred to b t-.Y PERIOO.
AtN 180
Sllgnature
~~
I
Ddte
S'/J~/4%'
i /
FOR OFFICE U:'E
Date of ApplICatIOn
~ /Z~ao c;j"
/
Checked for HI,loncal Slatus
v
Ched..ed for DelmquCnL.lc,)
Shared Dme(T )/Buddrng Fonn,lWood Sto\e Pennll7 08 doc
Status
Issued
225 Fifth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn LlOe
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO' COM2008-01250
ISSUED 08120/2008
APPLIED. 08/20/2008
EXPIRES: 0212012009
VALUE:
SITE ADDRESS 2515 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO 1703254400203
Spnngfield TYPE OF WORK Wood Stove
TYPE OF USE
New
ReSIdential
PROJECT DESCRIPTION Replace eXlstlOg IOsert
Owner
Address
RATER OLLIE H SR & M J
PO BOX 2514
EUGENE OR 97402
Contractor Type
MechdOlcal
Contractor
TED L HUFF JR
# of UOIts
Pnmary Occupancy Group R-3
Secondary Occupancy Group
Pnmary Construction Type VB
Secondary ConstructIOn Type
# of Bedrooms
Frontyard Set hack
Side I Setback
S.de 2 Setback
Rearyard Setbdck
Solar Setbacks
Street Improvements
Storm Sewer AVdllable
Special InstructIOn
Notes
DescriptIon
Type of ConstructIOn
Phone Number 541-726-7705
~!:~.: r;:
l (,..Dl'FRACTOR ,INFORMATION I
fallow" "u" uregon law ~
NOllflC rules adoPted by th YOu flxPlratlOn Date
In OAR, ~'g!; :e.nter. Those....l 6~~~n Utility 05115/2009
~IJFmmi~;~"'Wls. ~l>I R-95'2'.OO?
, -/,( ~ 1/11:1 centel (N \-71/Jf1:e rules b .
nUmbW cfP5Iba~~gonO~~,~e telePhone V Lot SIZe
fflll~lr51"8~2_~~.?flf/caUon Sq Ft 1st Floor
Type of Heat ........). Sq Ft 2nd Floor
Water Type Sq Ft Basement
Rdnge Type Sq Ft Gal agelCal port
Energy Path- Sq Ft Other
Spnnkled Buddmg n/a Occupant Load
Phone
541-338-7550
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total
Handlcdpped
Compact
OverldY DlSt
# Street Trees Rqd
NOrrc'f',d Dnve Rqd
THIS p'f.t1hot Coverage
AUT,..,n~~~'T SHAll ~IRr: ,.. ....,_.
rro~~~lNIi~ ERMiT'",sVUHK
h,., ;W~D:IJ"'W~NEIJ;_~ffype
Downspouts/DI alOs
I V aluahon Descr~Dhon I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Date Calculated
Value
Paee I of 2
-ii2~
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-01250
ISSUED. 08/20/2008
APPLIED: 08/20/2008
EXPIRES 02/20/2009
VALUE:
225 Fifth Street, Sprmgtield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769Inspectoon Lme
Total Value of Project
Fees P.BuI I
Fee Description
-Mechamcallssuance Fee--
+ 10% Admmlstratlve Fee
+ 12% State Surcharge
+ 5% Technology Fee
MlmmumlAdJustment Mechamcal
Wood StovelInsert
Amount PaId
Date Paid
Receipt Number
$2100
$520
$624
$260
$1900
$33 00
8120/08
8/20/08
8/20/08
8120/08
8120/08
8120/08
2200800000000001263
2200800000000001263
2200800000000001263
2200800000000001263
2200800000000001263
2200800000000001263
Total Amount Paid
$87 04
Plan Reviews I
To Reque~t an lIIspectlOn call the 24 hour recordlllg at 726-3769. All inspectIOns requested before 7'00
a.m wtll be made the same worklllg day, inspectIOns requested after 7:00 a.m. Will be made the followlIIg
work day
I Renuirerl InsnedlOn,s I
Wood Burnmg Insert After mstallatlOn
By signature, 1 state and agree, that I have carefully exammed the completed apphcatoon and do hereby certofy that all
mformatoon hereon IS true and correct, and I further certofy that any and all work performed shall be done III accordance with
the Ordmances of the City of Spnngtield and the Laws of the State of Oregon pertammg to the work descnhed herem, and
that NO OCCUPANCY Will be made of an} structure wIthout permISSIOn of the Commumty Services DIvIsIOn, BUlldmg Safety
I further certlty that only contractOl s and employees who are 10 comphance With ORS 701 005 wIll be used on thiS project
I further agree to ensure that all reqUired mspecllOns are requested at the proper tome, that each address IS readable from the
street, that the permit card IS located at the fl ont 01 the property, and the approved set of plans wIll remam on the sIte at all
times dUring constructIOn
w. . ~./~
Owner o:?o::'ctors SIgnature
fh,y/J%
Date
Paee 2 of2
225 FIfth Strcct
Sprmgfield, Oregon 97477
541-726-3759 Phone
~~
CIty of Spnngfield Officl3l ReceIpt
Development ServIces Departmcnt
Public Works Department
Job/Journal Number
COM2008-0 1250
COM2008-01250
COM2008-0 1250
COM2008-0 1250
COM2008-0 1250
COM2008-0 1250
Payments
Type of Payment
Check
cRLcemtl
RECEIPT #.
2200800000000001263
Date' 08/20/2008
DescriptIOn
Wood Stovellnsen
MInimum/AdJustment Mechamcal
-MechamcalIssuance Fee-
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmInIStrative Fee
PaId By
MARJORIE RATER
Item Total
~heck Number AuthOrization
Received By Batch Number Number How ReceIVed
dJb 6392 In Person
Payment Total
Page 1 of I
8 15 09AM
Amount Due
3300
1900
2100
260
624
520
$87 04
Amount Paid
$87 04
$87 04
8/20/2008