HomeMy WebLinkAboutPermit Mechanical 2009-9-4
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i5PRlNGFlELD
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225 FIfTH STREET'. SPRlNGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)726,3689
-
City Job Number : a q -/ J I Z;
Job Location: Ii c::: "2... OL;.\{ (/V'..;J \ L.-
Assessor's Map: \ '1~tz.v,4 \
Tax Lot: /.::;." ~
~(!5'0{o)'
~wner::S1-(~ \f\ \P.\! <i--~\nno: DA y(~ +-
Addres~ \ \...,;:J C\ \ 'i V\/\\()I!" 0("QP~-
City:, \klll\ G~\ pI r.l State: O'lCCJr\V\.
Phone:
q ffi ,7\ ~ :s =f'
Zip: g =ill-=? 7
Preliminary Inspection for wood burning inserts is $67.86 (prior to insert).
Wood Stove/Pellet/Insert.Permit is $92.43 (includes applicable fees and sur<;harges).
.--..----
" .
:\) '. ~ontractor Infonnation . \ \
contractor:\\\'{ ':)\\.j\JP:;::)<2 .'(\J\ (I r ~ ~ Q r~ \\U:' S;~+-
Address:'~ ~ 'I... . d. \n3 .'~1'4 Phone\ 51..\\) 0" \ \) -.")loJ.. ~
City: f\.~ADV\.P . '. :;]:"'J,' <;<'''. IState:O\"(lJ",r\ EXPI.'resZ.ili,.: '~1~. ,,';.:"/:1. '?O..tJ
Construction ~ontra~tor's Registrati~t1. #: _,){ ,'-,) \LJ .' _ --.J 21 e:-
... . · \.tV\! I
By signing this permit/application, I agree to cal! for an inspection(s) as required (726.3769).
I state that all information on this application/perinit 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 Fe4eral
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
mspectlOn, the wall covermg maY/b. ~"~tDate': .
Signature: CY / 3 ) '[) '/
Date of Application:
q/y!o ~
Checked for Delinquencies:
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'. . \9''\
Checked. for Historical Status:
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CITY OF SPRINGFIELD
,
,
Status
Iss u ed
Building/Cqmbination Permit
PERMIT NO: COM2009-01318
ISSUED: 09/04/2009
APPLIED: 09/04/2009
EXPIRES: 03/04/2010
VALUE:
225 Fifth Street, Springfield, .oR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1152 .oLYMPIC ST
ASSESS.oR'S PARCEL N.o.: 1703264108600
,
Springfield TYPE .oF W.oRK: Mechanical .only.
TYPE .oF USE: New.
Residential
PR.oJECT DESCRIPTI.oN: W.o.oD ST.oVE
.owner:
Address:
DUPRET STANLEY J & D.oNNA L
1152 .oLYMPIC ST . ou to
SPRINGFIELD .oR 97477 ATIENTION: Oregon law reqoulres Y Utility
" .. ..__ .......l........tarl h\f the reqon
1...,'.',--;:' ~:;--_-.:: r.........t~1" Th[)~e rules are S81lUIllI
~'I'~C.oNTRMA VK iNFORMA:FI0NOI-001- Ii
~~90 You may obtain copies \)1 lIl" 'Ules by :i
caliing the center. (Note:.lnic'ellsehon~xpiratihn Date
nllmber for the Oregon UY~1i~(M~lllcatlon 06/1512011
'.__T....r.~ '-"1'" ......... -- .
BUILDING INF~RMATI.oN I
Contractor
TED HUFF
Phone
Contractor Type
Mechanical
# of Units:
Primary .occupancy Group:
Secondary .occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms: '
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
# of Stories: Lot Size: .
R-3 Height of Structure Sq Ft I'st Floor:
Type of Heat: Sq Ft 2,nd FloOl':
VB Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
~nergy Path: Sq Ft .other:
NOTICEsj:lrink!edAB~ildjltll:RE IF TH\!,/MORK Occup~nt Load:
TUIC D~Rl\nIT SH, ,LL "EAI I . ,,_~,
--~...-,." ''''J'''''' '.ll~VI
IIIDE-YEl!.OP.MENN'NFO~AT.IO~"1 R
. COMIVltl~l,tU un ,oJ fwn'w-"-- REQUIRED PARKING
ANY 18rO~~;ia~lillmD, Total:
# Street Trees Rqd: HandiCapped:
Paved Drive Rqd: :' Compact:
% of Lot Coverage:
I ~UBL1C IMPR.oVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
,
DownspoutsfDrains:
Notes:
IV~luatio~ De~cri'Dtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of2
Status
Iss u ed
CITY: OF SPRIr~t..l' lELD
Building/Combination Permit
PERMIT NO: COM2009-01318
ISSUED: 09/04/2009
APPLIED: 09/04/2009
EXPIRES: 03/04/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees. Paicl 1
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
$9.48
$3,95
$79,00
9/4/09
9/4/09
9/4/09
Receipt Number
I'
220Q900000000001010
2200900000000001010
2200900000000001010
Total Amount Paid
$92.43
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. will~be made the following
work day.
~,e9~ire~ I~~'1ett,iq~,s ,I
Wood Stove: After Installation.
Rough Mechanical: Prior to Cover
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 shallibe 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 without permission of the Community Servites Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701,005, will:be used on ihis project,
I further agree to ensure that all required inspections are requested at the proper time, that each aadress is readable from the
street, that the permit card is ~d'at the front of the property, and the approved set of plans will remain on the site at all
'm.. ,.ri., 00'''00'''''' '1 fr / e p
Date
Page 2 of 2
225 Fifth Street '.
Spril!gfield,Oregon.97477
.541-7'26-3759 Phone
Job/Journal Number
C0M2009-01318
COM2009-01318
COM2009-01318. .',
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
Description
,1st.'Appliance
. :+ 5% Technology Fee
': ;+ 12% State Surcharge
Paid By
STANLEY DUPRET
".{
2200900000000001010
Received By
Check Number
Batch Number
CJC
Page I of I
City of Springfield Official Receipt
1-
Development Services Department
Public Works Department
I
Date: 09/04/2009
2:50:5IPM
Item Total:
Authorization
Number
Amount Due
79.00
3.95
9.48
$92.43
I~
How Received
Amount Paid
00465Z In P,erson
Payment Total:
$92.43
$92.43
I'
9/4/2009