HomeMy WebLinkAboutPermit Mechanical 2009-1-20
'.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax .
541-726-3769 Inspection Liue'
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT,NO: COM2009-00084
ISSUED: 01/20/2009
APPLIED: 01/20/2009
EXPIRES: 07/20/2009
VALUE:
SITE ADDRESS: 5983 A ST
ASSESSOR'S PARCEL NO.: .1702343200513
Springfield TYPE OF WORK: Wood Stove
PROJECT DESCRIPTION: Install freestanding Wood Stove
Owner:
Address:
BLACHLY SCOTT M
5983 A.ST
SPRINGFIELD OR 97478
Contractor Type
Mechanical
Contractor
OWNER
# of U uits:
Primary Occupaucy Group:
Secondary Occupaucy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Coustruction
I
TYPE OF USE: Addition
Residential
J CONTRACTOR INFORMATION I
License
Expiration Date Phone
BUILDING INFORMA nON I
ula
MnTH'C'
I DEVELOPMENT INFORMiqiroNFfMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER T~qilliIDiDIlAlOO.NG
:,OMMENCED OR IS AEmlld9NED FOR
" ,NY 180 DAY PERIOD. Handicapped:
Compact:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS'
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
~o.,
Sidewalk Type:
AyrEIiYIU1~~i:RM\~W requires you to
foLow rules adopted by the Oregon Uti/it
,Notification Center. Those rules are set forfh
In OAR 952-001-0010 through OAR 952-001-
0090, You mav obtRin rrmiao nf tho _...__ '_
. I ' I """Ing me center. (Note: the telepho~e -,
Valuation Descrintion lumber for the Oregon Utility Notjficaii~n
Center IS 1-800-332,2344),
$ Per Sq ~t Squa,re Footage Value' Date Calculated
or multJpher or BId Amount
Page 1 012
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00084
ISSUED: 01120/2009
APPLIED: 01/20/2009
EXPIRES: 07/20/2009
VALUE:
225 Fifth Street, Springfield, OR .
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspectiou Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
$9.48
$3.95
$79.00
1/20/09
1/20/09
1/20/09
Receipt Number
2200900000000000068 '
2200900000000000068
2200900000000000068
Total Amount Paid
$92.43
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 RI'o1l1red Insnections I
III.' 111111111 , "'" ""
Wood Stove: After Installation.
By siguature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certily thaI 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 pertainiug to the work described herein, and
that NO OCCUPANCY will be made of auy 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 eusure that all required iuspections 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.
"
/ huloc;
Date
''';.:::'-:;::'' -::::-=;:;0>'':;::>-;;>
~-~~-E.~._""-~ ._
Owner or Contractors Signature
Paee 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00084
COM2009-00084
COM2009c00084
Payments:
Type of Payment
CreditCard
cReceiotJ
RECEIPT #:
Description
1 st Appliance
. + 5% Technology Fee.
+ 12% State Surcharge
Paid By
SCOTT BLACHLY
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000068
Date: 01120/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm
103860 In Person
Payment Total:
Page I of I
10:34:]9AM
Amount Due
79.00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43
1120/2009
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225 Firm STREET. SPRINGFIELD, OR 97477. PH:(54J)726-3753 . FAX: (541)726-3689
City Job Number, C,cj ~ 000 [; f
Job Location: , <.,--t/&"f tV tJ <;.. <J> I~r:>
Assessor's Map: 17oCA3 '?'" '3'<:?l. (]1J S; .$
a(L.
'iN7Y
Tax Lot:
Owner: S(OTT i?L.itt: i-f L';
,
Address: ~f? ~ tJ >'l .<:;T.
City: 5?I:::\">)
State: cJIl.,
Phone: q ~-r7'-f3 '
Zip: 7'7<../78
Preliminary Inspection for wood burning inserts is $66_04 (pl1or to insert).
Wood Stove/Pellet/Insert Pennit is $87.04 (includes applicable fees and surcharges).
Contractor Information
Contractor: ...-/J /;; t-J(2;'i' .-/
Address:
City:
Construction Contractor's Registration #:
Phone:
State:
Zip:
Expires:
By signing this permit/application, I agree to call"for an inspection(s) as required (726-3769).
I state that all information on this application! permit is correct and that I was provided with
the Wood Stove Safety information 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.
Signature: B _r"'" ~
Date:
1/20/01
I
) ;.-- ;;2 () -'__ C!"7
Date of Application:
/"
~
Checked for Delinquencies:
Checked for Historical Status:
~_.-
Shared Drive(I:)lBirilding FormsIWood Stove Permit 7-08.doc