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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 $92.43 1120/2009 =: o '..~ ~ .~ ~ .. ,.--4 ~, ~~ ~\~ <~ =: o ..~ l~ ~ ~ ~I~ ~ ~~ I~ ~ ~ ~ '~J ~j ~ .~ ~. .~ ~ rt.Il1 ~ o o ~ 225 Firm STREET. SPRINGFIELD, OR 97477. PH:(54J)726-3753 . FAX: (541)726-3689 City Job Number, C,cj ~ 000 [; f Job Location: , <.,--t/&"f tV tJ <;.. <J> I~r:> Assessor's Map: 17oCA3 '?'" '3'<:?l. (]1J S; .$ 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