HomeMy WebLinkAboutPermit Mechanical 2009-10-22
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01554
ISSUED: 10/22/2009
APPLIED: 10/22/2009
EXPIRES: 04/22/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1066 L ST
ASSESSOR'S PARCEL NO,: 1703264406301
Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Install freestimding pellet stove
Owner: APPEL CALEB
Address: 1066 L ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION i
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
# of.Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
ATT C:B'l!JI'lJBIflIf..,JNfO~~ TI\lN II
fOlio.. . u:"'~ ~Clo i db I. . " -- 'You to
NotificatiO'lll9flst.frj;Th y the Oregon Utility
R_{n OAR 952Hlf1gta(of~t~~.:1:'.Ies are set forth
'u090. You 1j'lftYe<lb1H1fp ~!JII OAR 952-001_
calling th troples of Ihe rules b
VB number fo~~~ote:. ~he telephone Y
, K"I'l;....''YtI''n UtIlity N I'fi
Ce'l!Il~/~1~2_23~: cation
Sprinkled Building: n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport,
Sq Ft Other:
Occupant Load:
I. DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
IPU~LIC IMPROVEMENTS I
NOTICE: ' ,', .". c"'SidewalkType:
THIS PERMIT SHALL EXPIRE IF ilihlin'l/,Q~Drains:
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS' ABANDONED FOR
ANY 180 DAY PERIOD,
Notes:
I Valuation DescriDtion I
it{\.....~.
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amonnt
Value
Date Calculated
Paee 1 of 2
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01554
ISSUED: 10/22/2009
APPLIED: 10/22/2009
EXPIRES: 04/22/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
F~e~ P~id I
Fee Description
+ 12% State Surcharge
+ 5% Technology'!'ee
1st Appliance
Amount Paid
Date Paid
Receipt Number
$9,48
$3.95
$79,00
10/22/09
10/22/09
10/22/09
2200900000000001211 '
2200900000000001211
2200900000000001211
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, wilf be made the following.
work day.
I Rellllired Insoeet'rns ~
III I 1 r.,.huI.Y
!'reestanding Pellet Stove: After installation,
By siguature, 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 without permission of the Community Services Division, Building Safety.
I further certify that only coutractors 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 permit card is located,at the front ofthe property, and the approved set of plans will remain on the site at all '.
times during construction. >
~A~.L
\'O-lL-D~
Owner or Contractors Signature
Date
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
A."._ "c.u;g~I...IIU>...'.,.4iJj.. ."...
iL,. ·
..".,..,'.....................,.,
City of Spr~ngfield Official Receipt
Development Services Department.
Public Works Department'
RECEIPT #: 2200900000000001211 Date: 10/22/2009 1:22:0SPM
Job/Journal Number Description Amount Due
COM2009-01554 1st Appliance 79,00'
COM2009.0 1554 + 5% Technology Fee 3,95
COM2009-01554 + 12% State Surcharge 9.48
Item Total: $92,43
Payments: t:heck Number Authorization
Type of Payment Paid By Received By Batch Number Number How "Received Amount Paid:
Cash CALEB APPEL djb In Person $100,00
Change CALEB APPEL djb In Person ($7,57)
Payment Total: $92,43:
Job/Journal Number Description Amount Due
COM2009-01554 1 st Appliance 79,00;
COM2009-0 1554 + 5% Technology Fee 3,95
COM2009-01554 + 12% Stare Surcharge 9.48
Item Total: $92.43
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Receive~ Amount Paid
Cash CALEB APPEL djb In Person $100,00
Change CALEB APPEL djb " In Person ($7,57)
Payment Total: $92.43
cReceint 1
, Page 1 of 1
10/22/2009
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By signing thi~ perrm.'t/.application, I agree to call for ~n inspection..(. S)3.~'ir~&lriitea:<..t~"'~6. 9).
I state that all mforma~on on thIS apphcatIon/per~t IS corre~t ~pd)hatI w, ~~~~
the Wood Stove Safety mformatIon for wood burmng apphances a~d '\'~~c~~'i1
standards as set by the Oregon Department of En~tal.li~ \'tl~O~;;,:,
Environmental Protection Agency .and I agree to ' ~ ~~ ~ra ti1?er to the
inspector at the time of inspection. I also unders ~q ~ ng a preliminary
inspection, the wan covering may be required ,to b~1ld '&w:.'f-'U \,t.?\O'U.
, " . . ,c,Q\It\,,\'O\) 'U~ __ '
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Signature: ~ .~
225 Firm STREET - SPRINGFIELD, OR 97477- PH;(541)726-3753 - FAX: (541)726-3689
City Job Number
Job Location:
COwtZdO'7 -01 SSL(
/Obb L s.. +-
'703. Zb4Lf
Tax Lot:
Assessor's Map:
Owner: r. () i....\-, ~ \'1' p\
AddTess: \ 0\..0\0 1_ <..h-u>-I-
City: _ ~1"\n",Q:.Jd.
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o.uiles'I \j\i\i\'i
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Preliminary Inspection for wood ~g it=,rtS is--I$66.~Jl~!~~~\'
Wood Stove/Pellet/Insert Pennit is $87;01.~q'1cludes'l~~R.li~f~\il . ~'i
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Phone:
State: OR
Contractor:
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AddTess:
Phone:
City:
Construction Contractor's Registration #:
State:
Zip:
Expires:
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Date:
ob~O(
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Zip: ot7'-l1l
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Date of Application;
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Checked for Delinquencies:
Checked for Historical Status:
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Shared Drive(T:)lBuilding FonnsIWood StoVe Permit 7-08.doc
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