HomeMy WebLinkAboutPermit Mechanical 2009-3-13
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225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689
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City Job Number COW\ zc:>O ~
Job Location: '-lilo L $, SfZ.'...r...r.'-eld (')/Z
1703Zb3"4
Ci '1 c/77
.
05<;00
Assessor's Map:
, Tax Lot:
Owner: J~ L e,~ P J+u I S (?-'-/
Address: il 'I C) L -5: t-
City: S?/.. ,',u'Y~:.Qlcl
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Phone: S 'f! - 5 S t'-S '3 'I ')
State: Q rZ"
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Zip: 01'7'/77
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Preliminary inspection for wood burning inserts is ~e-4-w;:ior to insert).
Wood Stove/Pellet/Insert Permit is $87.04 (inc1w:leS applicable fees and surcharges).
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Contractor Information
Contractor: 0 IV e e..
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Address: ._... .onllireS'VOU to
, :rrENTION: U"'\olu", ''''''-<,"r, egon U\lIIlY
CIty: A. _ ~An'prl bv111State. i '-"'n '
fnilOW fUlCo;J ....-~~ rules Q.lv .:l"" .-.
Construction Contractor's ReJ(1strationrl~h came'. Those _~ f"\~Q QS2'001-
I~O\IH'-'Q' ' ~i bOlU ""U~"-''- - \ bY
, OAR 952-uu - , ies of the ru es
m _ .. "''':'''' l1}1tam cop l_,.--!........'~o ,I .
vu~~\ii~9 the center. \Iw'uiil\ty ~.lotiiication ,. .
By signing this permit/ap~on\qraS!e<J;~o~;~1Qr2JjR~spection(s) as required (726-3769).
I state that all information on thisCRWliU\ion/permit is correct and that I was provided with
the Wood Stove Safety information for wood burning appliances and prelimimiry 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. "
Phone:
Zip:
Expires: "
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~WI '\ 8~h?cked for Historical Status:
Date of Application:
Checked for Delinquencies:
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Shared Drive(T:)IBuilding FonnsIWood Sttive Pennit 7-08.doc
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009~00348
ISSUED: 03/13/2009
APPLIED: 03/1312009
EXPIRES: 09/13/2009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 440 L St
ASSESSOR'S PARCEL NO.: 1703263405900
Springlield' TYPE OF WORK: Wood .Stove
PROJECT DESCRIPTION: .Install freestanding wood stove
TYPE OF USE: New
Residential
Owner: BO PAULSON
Address: 440 L ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
.Contractor Type
Mechanical
Contractor
OWNER
License
, I BUILDING INFORMATION I
# of Units:
Primary Occnpancy Gronp:
Secondary Occnpancy Gronp:
Primary Constrnction Type
Secondary Constrnction Type:
# of Bedrooms:
# of Stories:
R-3 Height of Strnctnre
Type of Heat:
VB ~~\n8'tYI'~quireS youto
ATTENTION: Or Rl',ngeY-NpeDregon Utility
follow rules adol,!.\n~rgy~~tlilJS are set forth
'f' tion Cent8'i, "~ . ~ 'cR952-001-
Notllca 01.~rjlJ.!I\<;,dl~i1ililing, I by n/a
,_'ro'l'l'152-0 - " __,~o nf \l1e ru es
. .0090. \'lvDEYELOP~ENEf. IN'Ff},RMAffbN I
ca\\in':;:. " , it:,' bn U~\/,[, "J'~" -
number lor the. o~e~00_332-2344).
Center 19verlay Dist: .
# Street Trees Rqd:
Paved 'Drive Rqd:
% of Lot Coverage:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Phone Nnmber: 541-556-3345
Expiration Date Phone
Lot Size:
Sq Ft I stFloor:
Sq Ft 2nd Floor:
Sq Ft Bas'ement:
Sq Ft Garage/Carport
, Sq Ft Other:
Occnpani Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
iWc 'R~ponts/Drains:
NOi\CE: NlIi SW',\..\.. fJC.pm~~~NlIi IS ~O't
~~:;~2EO UNRO~; ;~~~OONEO fO~ .
~fr"('j;:l'lO
v ..-..: --\\1....
A ~'\llQaq~/ ~es~riotion I
Street Improvements:
Sto'rm Sewer'Available:
Special Instrnction:
Notes:
Description
$ Per SqFt
or mnltiplier
Sqnare Footage
or Bid Amonnt
Type of Construction
Paee I of2
Value 'I
Date Calcnlated
CITY OF SI'RINGFIELD
"
Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-00348
ISSUED: 03/1312009
APPLIED: 03~1312009
EXPIRES: 09h312009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726"3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
Fees Paid 1
,
Fee Description
+ 12% State Snrcharge '
+ 5% Technology Fee
I st Appliance
Amount Paid
Date Paid
$9.48
$3;95
$79.00
3/13/09
3/13/09
3/13/09
Receipt,Number
1200900000006000191
1200900000000000191
1200900000000000191
Total Amonnt Paid
$92.43
I Plan Reviews .1
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 Reouired Insnect!on~ .
Wood Stove: After Installation.
By signatnre, I state and agree, that I have carefnlly examined the completed application and do herehy certify that all
information hereon is trne and correct, and I further certify that any and all work performed shall b~ done in accordance with
the Ordinauces of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any strnctnre withont permission ofthc Commnnity ServiceS Division, Building Safety.
I fnrther certify that only contractors and eniployees who are in compliance with ORS 701.005 will b'e nsed on this project.
I further agree to ensure that all 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. j~
'--;' /~ /J -'
c.'.2;jF--/Zaf.(~- 3- /3--01
L.-
Owner or Cont~actors Signature Date
Pilee 2 01'2
225 FifthJ)treet
, ,- ,;-
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #: 1200900000000000191 Date: 03/13/2009 2:33:38PM
Job/Journal Number Description Amount Due
COM2009-00348 I st Appliance 79.00
COM2009-00348 + 5% Technology Fee 3.95
, COM2009-00348 +.12% State Surcharge 9.48
Item Total: $92.43
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Cash 80 PAULSON djb In Person $100.00
Change 80 PAULSON djb In Person ($7,57)
Payment Total: $92.43
Job/Journal Number Description Amount Due
COM2009c00348 I st Appliance 79.00
COM2009-00348 + 5% Technology Fee 3.95
COM2009-00348 + 12% State Surcharge 9.48
Item Total: $92.43
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Cash 80 PAULSON djb In Person $100,00
Change BO PAULSON djb In Person ($7,57)
Payment Total: $92.43
cReccintl
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