HomeMy WebLinkAboutPermit Mechanical 2009-6-10
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22511ffil STREET 0 SPRINGI1ELD, OR 97477 0 PH:(541)726-3753 . FAX: (541)726-3689
City Job Number
Job Location:
, Assessor's Map:
COtv' 200 '1- 00&'30
/"OOb ~ci3BLk: ci 5'10IvirAE4j
/ Boz o:Ssl{ Tax Lot:
o/'t 9 TLJ '78'
() Olb 7
Owner: ~ II/Uz.=tV ~ F 5771(/4
Address: r: ()() h {JcBBLf::: c.,
City: Sf' I'?i <V Ir FI13lJ.1
Phone:
:j '1 S -CJ 'itS:-'l / '1('{ -~bS
, (U;;LL)
Zip: 9 7"1 7 'if '
Slate:
CJi?-
Preliminary Inspection for wood Imming inserts is $66.04 (prior to insert).
Wood Stove/Pellet/Insert Permit is ~4 (includes applicable fees and surcharges).
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Contractor Information 10\\~\N :~o~ cente\~~~~~Ug\\ Ol'-R 9~~~s '0'1
Contractor: ~/,'/ /V,.c 01 ~^o~~R 95'2.00\,'~2\"in eopie~~~ ;~\~o\\One
.. '{aU ll'~' - (NO'''' ,..- 'realiOn
Address: 0090,. Ph\1N:eentel. _^, I\iliW Not' \
e811"g the L1'''\'!"' 33'2''2:;'1'')'
City: Slate: _"",hellol 1', ,ZiIl:,800-
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Construction Contractor's Registration #: 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 'y,.
Environmental Protection Agency and I agree to provide the testing approv~"\'~tri~~R the
inspector at the time of inspection. I also understand that if I am re't~~1lh~~~~ary
inspection, the wall covering may be required \\i6~\1fefuoVff5\'\f>."-\. ,\,\\5 ~t.I'" D tOI"
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Signature: .,A A ff~ c.C)~,\\ClDf>.'i Date: G-/0-09
_ ) It' . 1-\\'-'\ j'
Date of Application:
~J0
v-
,
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Checked for Delinquencies:
Checked for Historical Status:
Shared Orive(T:YBuilding Form;;tWood Stove Permit 7-08.doc
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Status
Issued
CITY' OF SPRINGFIELD
Building/C6mbination Permit
PERMIT NO: COM2009:00830
ISSUED: 06/10/2009
APPLIED: 06/10/2009
EXPIRES: 12/10/2009
VALVE: '
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541.726-3769 Inspection Line'
SITE ADDRESS: 6006 PEBBLE CT
ASSESSOR'S PARCEL NO,: 1802033400167
Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install pellet stove
Owner: DARREN OFSTHUN, .
Address: 6006 PEBBLE CRT
SPRINGFIELD OR 97478
Phone Number: 54J-914-3565
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
VB
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
"
Sq Ft t'st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft C;arage/Carport
Sq Ft Other:
Occupht Load:
,
# of Units:
Primary Occupancy Group:
Second3l'y Occnpancy Group:
Primary Construction Type
Secondary Constrnction Type:
# of Bedrooms:
R-3
nla
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Sctbacks:
I DEVELOPMENT INFORMATION I
, , s you to
n laW reqUIre T
ATTENTION: OrrmerlaytDisf:iregon Uti Ity
les adol1',~u~. " , - ,er. set forth
fo\\oW tU ent8~Sff~5!a-r~es;~"i1: 52^00I'.
Nolltlcatlon C 01 ifavedlDrive1Rqd~ 9 les by
in OAR 952^0 y^oo/~'&.f;Lot,:Goveg~~: r~one
0090 You ma U (Note' the te,ep ,
ool'linG the cent!r, __~ 1';iliIV Notiiicatlon
numbc'(rp:U~LIS:liMRR0viJViENTS ,
REQUIRED PARKING
" Total:
Handicapped:
Compact:
Street Improvem.cnts:
Storm Sewer Available:
Special Instrnction:
"'0\\"
r 1\'It. v' 0:\-'
. 'f,.'?I\\t. I II IS ~
~O\\C~~MI\ S\'If>.L~\\\\'IIS '?~~~\) rO\\
.,-\.IIS '?~~n I \~\) . ,0 [>~\)
~~~~~Ct.~ ~~~~tion DescriDtion, I
:'i \ 'Oil \)
T f C f>.~t t' $ Per Sq Ft Sqnare Footage
ype 0 ODS rue Ion . . .
, or mnltlpller or BId Amonnt
Sidewalk Type: '
Down~pouts!Drains:
Notes:
Description
Valne
Date Calculated
Paee 1 of 2
~RINQEII,IU:)~
-" '" "
CITY OF SPRI~lJ"1ELD
Status
Issued
I,
Building/Combination Permit
PERMIT NO: COM2009-00830
ISSUED: 06/10/2009
APPLIED: 06/10/2009
EXPIRES: 12/10/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541- 726-3769 Inspection Line
Total Value of Project
Fees paidJ
. Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
Receipt Nnmber
$9.48
$3.95
$79.00
6/10/09
6/10/09
6/1 0/09
2200900000000000643
2200900000000000643
2200900000000000643
, ,
Total Amount Paid'
$92.43
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. wm be made the following
I,
work day.
I Reouired Insnections I
Freestanding Pellet Stove: After installation.
I'
I'
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 he done in accordance with
the Ordinances of the City of Springl1eld 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 wi!' he used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each ~ddress 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.
4JPM JIJ/~
t-( 0- CJ~:
Owner or Contractors Signature
Date
Page 2 01'2
225 Fifth Street
Springfield, eregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00830
COM2009-00830
COM2009-00830
Payments:
Type of Payment
CreditCard
cReccintl
RECEIPT #:
Description
I sl Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DARREN OFSTHUN
~..J:Q~:;.~.- ".
IlL.,.
-- .....<".,,-,,""'.......--.., " "
City of Spri!lgfield Official Receipt
Developmerlt Services Department
Publie Works Department
2200900000000000643
Date: 06/10/2009
8:28:02AM
Item Total:
Check Number Authorization
Received By Batch Number Number Uow Received
Amount Due
79,00
3,95
9.48
$92.43
Amount Paid
djb
017972 In Person
Payment Total:
$92.43
$92.43
Page I of I
6/10/2009