HomeMy WebLinkAboutPermit Mechanical 2009-11-18
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'\OREGON
City Of Springfield
225 Fffth 51
Springfield, OR 97477
Phone: 541-726-3753
Email:.per~itcenler@ci.springfjeld.or.us
Residential Mechanical Authorization To Begin Work
69600-BMC-09-00185,
Approval Code: 069324 11/18/2009 2:47 pm
E-mailedTo:brandy@associatedheating.com
o New Construction
IRJ Addition/alteration/replacement
[X] 1 or 2 family dwelling 0 Mul~i-family D Commercial
o Accessory
~;\~w;'~4,;1(OB~SfrE.iNFbRMA riONAfio'ITOCA TIONI?~'B'~1'~!~
Jo~ Address: 3290 RALEIGHWOODAVE
I CityIStateIZIP:SPRINGFIELD, OR 97477
I Su'ite/bldQ,/apt.no.:
I Pr?iect Name:
I c.6", Stn,,"d;,.,';ons '0 job s;t.,
I Ta~ map/parcel no.: 1703221320600
Install ductless HIP
I "
Name: Ron Dobrowski
I Ph~ne: 541-747-2501
I E~ail;
Fax: .
I "lnTI"'-J:. CeB.lie. ;,o.:'1'0627'5W.-~;,;-~;!~,~:,;',,'\
I Bus;n.ss Nam'm~ffi~~W'!HAll! WIRf~-~
I Conta,,, AUTHORIZED UNDER TH~ ~...!.IIIUI,.'
I Add,"ss, PO Bcl,((JN!MtNlil:U Utc l::i 1\1l~lu,rVh .\
" ':"if,' 136 r,;-i/ ~EF.I!)O.
I Ci'o//State/zrp: EUGENE, OR 97440
I 'Phone: 5416832590 Fax: 5416070287
I Em~ail:
I Me~ro lie. no.: c.:ity lie. no.:
Upon ~eview and approval by your lo'cal jurisdiction, your permit will be e-malled or failed
withl.n one business day, with instructions on how to schedule your inspection.
NOT~: ThIs Authorization To Begin Work ellplres within 180 days If a permit Is not obtained.
The local building department may determine that an Authorization To Begin Work is null and
void if It does nol meet applicable land use I~Ws and local ordinances.
'~
,~\ .p
;-,.!\ n~ t>;)~
'0Y t?J'
I Description
I First Appliance Fee
I Subtotal
I State surcharge (12% of permit
total)
I Technology fee (5% of permit total)
I TOTAL PERMIT FEE
$79.00
$9.48
$3.95 I
$92.43 I
CC\ -[ LllO ~ It I \ 'D I O~
....'
1tTTENT10N: Oregon law reqtilreS yau-
follow rules adopted'bythe Oregon\t:ltiliIJ
Notification Center. Those rul" are aet;1adII
kl OAR 952;oQ1;(l(),10 through OAR 9524111-
0090. You may obtiln copies of the.rule8i1!r
calling the center. ,(Note:,ttletelephOllll
IlUQer 10r the'Oregan'Utlllty NotifIoat-
Genter 11.1 800 ~"'.aa44).
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Inspections Pbone: 541-726-3769
This-Authorization To Begin Work must be posted atthejo~ site until replaced by a Permit.
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01670
ISSUED: 11/18/2009
APPLIED: 11/18/2009
EXPIRES: 05/18/2010
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
54,1-726-3769 Inspection Line
SITE ADDRESS: 3290 RALEIGHWOOD AVE
ASSESSOR'S PARCEL NO.: 1703221320600
Springlield TYPE OF WORK: Heating System
TYPE, OF USE: New
Residential
PROJECT DESCRIPTION: Install ductless heat pnmp in residence.
Owner: DOBROWSKI RONALD J
Address: 3290 RALEIGHWOOD AVE
SPRINGFIELD OR 97477
Phone'Number: 541.747-2501
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor License
ASSOCIATED HEATING & AIR CONDITIO 106275
BUILDING INFORMATION I
Expiration Date
08/31/2010
Phone
541-683-2590
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:'
# of Bedrooms:
# of Stories:
Height.of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMEN: INFORMA TlON ,
REQUIRED PARKING
Street Improvements:
,. ",." .,.":::-:.::..,.,,~.,;,,~;,,j:'~:'."'i"
Frontyard Si.~'tiCE:, ,"" . ',A, Qi:!'.I:.llI.r.Dist: Total:
Side 1 Setba~ll.l" rr SHAll iXPIRE \F TMiI~rees Rqd: HandicaEped:
Si1e 2 SetbaJJ:\IS PERM THIS PERMMNODrive Rq"d: ATTENTION: Oregon 1!W.fflI.!l1~es you.t.O
Reuryard selt.WJIHORIZEO UNDESRAB^'NDONiD mf L.?f Coverage: follow rules adopted by the Oregon Utility
Solar SetbaclOOMMENCED OR 1,.. ", Notification Center. Those rules areselfOl'lb
All: 1B8 e~:, DCI"?? lnnAR~fi'-OO1.qQ.1Qthrou9hOAR952.oot.
, I PUBLIC IMPROVEMENTS'III"v, You may obtain copies Of me rules Dr
,. . 1 calling the center. (Note: \he telephone
, numfitl.ol3t1ufDJegon Utility NotifloatIoII
Do_u'3A>1.f!g;~3i-2344).
St~rm Sewer Available:
Special Instruction:
Notes:
"";'''.\
I Valuation Descriotion I
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
. Square Footage
or Bid Amount
Value
Date Calculated
. Page 1 of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01670
ISSUED: 11118/2009
APPLIED: 11/18/2009
EXPIRES: 05/18/2010
VALUE:
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fpps Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance '
Amount Paid
Date Paid
$9.48
$3.95
$79.00
11118/09
11/18/09
11/18/09
Receipt Number
1200900000000001268
1200900000000001268
1200900000000001268
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. will be made the following
work day.
I ~eou1rpd Tnsnections I
.Rongh Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
By signature, J state and agree, that I have carefiJliy e~~mtned the completed application and do hereby certify that all
information hereon is true and correct, and I furtIler c'ertify that any and all work performed shall be done in accordance with
. ..
the Ordinances of the City of Springlield and the~Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any stnictnre without permission of the Community Services Division, Building Safety.
J further certify that only contrllctors 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 ~re 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, lInd the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Page 2 of2
125 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
C0M2009-0 I 670
COM2009-0 1670
C0M2009.0 1670
Payments:
Type of Payment
ONLINE CHGS
cReceint 1
RECEIPT #:
Description
I st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
ONLINE PERMIT CHGS
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City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001268
Date: 11/18/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
KR
ONLINE ASSOCIAT Online
ED HEAT &
AIR
Payment Total:
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Page I of!
2:52:0IPM
Amount Due
79.00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43
11/1 8/2009