HomeMy WebLinkAboutPermit Mechanical 2009-8-12
CITY OF SPRINGFIELD
Building/CQmbination Permit
PERMIT NO: COM2009-01168
ISSUED: 08/12/2009
APPLIED: 08/12/2009
EXPIRES: 02/12/2010
VALUE:
$I!RIN'"'e'iEl;;Q! ","~k" '
_.."~, ,..-",..,.,~j~",\.",,,.,,,,,,~.,,j '#!:lJ'W(1!iit7'n.
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726~3769 Inspection Line
SITE ADDRESS: 2763 33RD ST
ASSESSOR'S PARCEL NO.: 1702193100302
Springlield TYPE OF WORK: Wo~d Stove
PROJECT DESCRIPTION: Install wood insert
TYPE OF USE: New
Residential
Owner: DEROSIER SUZANNE MARIE
Address: 2763 N 33RD ST .
SPRINGFIELD OR 97477
Contractor Type
Mechanical
I CONTRACTOR INFO~MATlON.'
ATTENTION: uregolll'''. '~ore on Utility
Contract~5110w rules adopted by tl1~\es a~e L4jcense
AMBASS;,\:I?,QRJ"IPINGiI~9, ~~~~:. ,I"h (JAR 91:2'1469-
, OAK"" .-"" ,~~, - . '" __",m, uy
In 0 y~l, BUlhDINGIINFORMATION,I, .
OO~a\iing ihe center. ~~~~';Ji;\i;y Notiiicati;n
limber lor tlll,?~.St~';!~s. 0,2-2344).
Jf-3 centeHelght.of'SfruCture
Type of Heat:
Water Type:
Range Type:
Energy Path:
, Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gronp:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
VB
I DEVELOPMENT INFORMATION'
Phone Number: 541-741-4338
Expiration Date
03/27/2011
Phone
541-726-5723
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2hd Floor:
Sq Ft B:asement:
Sq Ft Garage/Carport
Sq Ft Other:
Occup~nt Load:
REQUIRED PARKING
Overlay Dist: ' Total:
# Street Trees Rqd: ' ijandicapped:
p.~t:9{1?m::~ Rqd: EXPIRE IF THE \NOpCompact:
o/:lofbot,eovera-'eHflLL IS nERMIT IS NOT
MI0 1 ~'''''' 1;" R T\1 r
1I~~~.~R,~~E~ U~~~: ^Q~Mf)ONED FOR, .'
I PUBLlCIIMPRQYJ::NIJj:J'1j,T:S,I)D.
t\,'ol j ''"'.....-
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
, Sidewalk Type:
Downspouts/Drains:
Notes:
I , Valuation Descrintion I
Description
Type of Construction
, $ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page 1 of2
Value
Date Calculated
-4!;~illill::iiI) ',""", '" ,',:
Wi:11Ilf '
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Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
$9.48
$3.95
$79.00
Total Amount Paid
, $92.43
Total Value of Project
Fe~s P~id I
Date Paid
I Plan Reviews I
8/12/09
8/12/09
81l2l09
CITY OF SPRINGFIELD
Building/Combination Permit
,
PERMIT NO: COM2009-01168 .
ISSUED: 08/12/2009'
APPLIED: 08/12/2009
EXPIRES: 02/12/2010
VALUE: .'
Receipt Number
,
1200900000000000908
1200900000000000908
1200900000000000908
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.
.1 Refl"i -ed Insoections I
.,I,li1,111l,,11 .m f"
Wood Burning Insert: After installation.
By signaturc, 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,be done in accordance with
the Ordinances 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 structure withont permission of the Commuoity 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 ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the pcrmit card is located atthe front of the property, and the approved set of plaos will remain on the site at all
timesdu7tt;;ld~~~ D-/Z--OC)'
~v
Owner or Contractors Signature
Pal!e 2 of2
Date
225 ~ifth>Street
Springfield, Oregon 97477
541-726-3759 Phone.
Job/Journal Number
COM2009-0 1168
COM2009-0 1168
COM2009-0 1168
Payments:
Type of Payment
CreditCard
cReceil1tl
RECEIPT #:
Description
, 1st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
MATTHEW CLEMENT
~n:a~;Ln.
Wic.'.;
. City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000908
Date: 08/12/2009
Item Total:
l:heck Number Authorizatio-n
Received By Batch Number Number How'Received
djb
05502b In Person
,
payment Total:
Page I of 1
8:52:26AM
Amount Due
79,00
3,95
9,48
$92.43
Amount Paid
$92,43
$92.43
.....-.. -
,1
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8/12/2009