HomeMy WebLinkAboutPermit Mechanical 2009-11-18
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....- Checked for Delinquencies:
SPRINGFIELD ,",," ,
11
225 FIlTIl STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689
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1702 ~5 2-<.
Tax Lot:
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Phone:
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Zip: Cj141Y; "
State:
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Preliminary Inspection for wood burning inserts is ~,(prior to insert).
Wood Stove/Pellet/Insert Pennit is $87.04..(inclUi1eS applicable fees and sUrcharges).
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Contractor Information
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Construction Contractor's Registration #: nt:?~ ,_ '1~\Jt. .Q,~~'v
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By signing this pennit/ apPlicationC,J'ltt~~ ~~all 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
Environmental Protection Agency and I agree to provide the testing approval number to the
inspector at the time of inspection. I also I;IDderstand that if I am requesting a preliminary
inspection, the wall covering may be reqUired to be removed. 'loll \0
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Shared Drive(T:)fBuilding FormslWood Stove Permit 7-08.doc
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01664
ISSUED: 11/18/2009
APPLIED: 11118/2009
EXPIRES: 05/18/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6828 D CT
ASSESSOR'S PARCEL NO.: 1702352313600
Springfield TYPE OF WORK: Wood Stove
PROJECT DESCRIPTION: Wood insert
TYPE OF USE: New
Residential
Owner: MARCHANT LlNDSA Y N
Address: 6828 D ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION.
Contractor Type
Mechanical
License
Contractor
OWNER
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
R-3 Height of Structure
Type of Heat:
VB Water Type:
Range Type: 'IOU \0
Ene~tl<%"eS l \l~i\i\"f
.,,"<'InN' o\e9~~~'\~"'e~€i\ol\!' n/a
I"'o:\~~' ;u\e~L-.i5B\(Eu~)PMf~rol'oN'~IIWON ·
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l-lOli\iCa~~2"OO~"OV I \~cO\lies 0 \~\8pnoll.
in O~oR '{oil l1\a'i O~~v~\8~t\~ tl~~
009.. 1M cen&r~~):
ca~~~l 10f 1M il ~ Rqd:
(\11 cen\el % of Lot Coverage,
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I PUBLIC IMPROVEMENTS I
Expiration Date Phone
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type: i yaQt\\<.
NOi\Ct: S\\~tt"tl1.~~1 \S ~O't
1\-11S ?ERl'J\~ \}t'4DE~ 1\-1\5 ~()~~O fOt\
l\\Jl\-10R11E D 01\ \S f\\)~~
'0\1J\\IJ\EN~~" oI=RIOD.
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
. ..,." VI'.
I \'\1 '-I
Valuation Descriotion
Description
Type of Construction
$ Per Sq Ft
or multiplier .
Square Footage
or Bid Amount
Page 1 of2
Value
Date Calculated
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-01664
ISSUED: 11/18/2009
APPLIED: 11/18/2009
EXPIRES: 05/18/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcbarge
+ 5% Technology Fee
1st Appliance
Amount Paid .-
Date Paid
Receipt Number
$9.48
$3.95
$79.00
11/18/09
11/18/09
11/18/09
1200900000000001263
1200900000000001263
1200900000000001263
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 Reouirpd Insnections I
Wood Burning Insert: After installation.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
inf~rmation 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 Springlield 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 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 of.the property, and the approved set of plans will remain on the site at all
times :PAc:;;n, 11/puflMf)
ow~~ntractors ~ature
Ii -Ict-m
Date
Page 2 of 2
225 Fiith Str,eet
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1664
COM2009-0 1664
COM2009-0 1664
Payments:
Type of Payment
Cred itCard
cReceiotl'
R~CEIPT #:
Description
I 5t Appliance
+ 5%Technology Fee
+ 12% State Surcharge
Paid By
L1NDSA Y MARCHANT
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City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001263
Date: 11/18/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 03284c In Person
Payment Total:
Page I of I
9:25:09AM
Amount Due
79.00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43
11/18/2009