HomeMy WebLinkAboutPermit Mechanical 2010-1-22
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Residential Mechanical Authorization To Begin Work
69600-BMC-10-00016
Approval Code: 05512C 1/22/2010 12:52 pm
E-mailedTo:ambassadorpiping@hotmail.com
SPRINGFIELD
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City Of Springfield
225 Fifth 5t
Springfield. OR 97477
Phone: 541.726.3753
Email: permilcenter@cLspringfield.or.us
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I 0 New Construction
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IR] Addition/alteration/replacement
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I Description I Qty. I Ea.
l~in!m-un:fFee~I~:: ,~il;.~<f.:;"<''':
I First Appliance Fee l
IMec;han!~al Permit'Fe'es.~:E"",{_!+;~( -- "7't' '"
I Subtotal
I State surcharge (12% of permit
total)
I Technology fee (5% of permillotal)
[ TOTAL PERMIT FEE
, - .' 3!-~~,': :1
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';",~~<CATEGOR'("QE:CONSTRU?TIO/ll~,;i>..,Z.~' ",>,;fg':;;";
1 or 2 family dwelling 0 Multi-family 0 Commercial 0 Accessory
Total I
II
$79,00 I
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$79,00 1
$HBI
$3,95 I
$92.43 I
Job Address: 3806 E ST
City/StatefZIP: SPRINGFIELD, OR 97478
Suite/bldg.lapt.no.:
Project Name: Rife
I Cr~ss Streetfdireetions to job site:
Tax map/parcel no.: 1702311300800
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Install of Pellellnsert
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<;i,:!~ >~ .~~..~'~\~:,S_lrE:.CONTACT;({t~; ;~'~4.~--.;\.".~:;'.; '.;7\::: ~: i
Name: Mike Rife
Phone: 541-747-6643
Fax:
Email:
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CCB lie. no.: 121469
Business Name: AMBASSADOR PIPING lNC
Contact:
Address: PO BOX 70737
City/State/ZIP: EUGENE, OR 97401
Phone: 5417265723
Fax: 5417265174
Email:
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Metro lie. no.:
City Iic. no.:
Upon review and approval by your local jurladiction, your permit will be e-mallod or faxod
within one business day, with Instructions on how to schedulo your inspecllon.
NOTE: This Authorization To Begin Work oxpires'within 160 days if a permIt Is not obtaIned.
The local building department may dotermine that an Authorization To Begin Work Is
void if it does not moot applicable land uso laws and local ordinances.
Inspections Phone: 541,726.3769
This Authorization To Begin Work must be posted at the job site until replaced by a Permit
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Status
Issued
CITY OF SPRINGFIELD'
. Building/Combination Permit
PERMIT NO: COM20IO-00096
JSSVED: 01122/2010
APPLIED: 01122/2010
EXPIRES: 07/22/2010
VALVE:
225 Fifth Street, Springfield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3806 E ST
ASSESSOR'S PARCEL NO,: 1702311300800
, Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Resideutial
PROJECT DESCRIPTION: Pellet insert 'installation
Owner: RIFE MICHAEL L & KATHERINE J
Address: 3806 E ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor
AMBASSADOR PIP]NG INC
License
121469
Expiration Date
03/27/2011
Phone
541-726-5723
B~ILDlNG INFORMATION'
# of Uuits:
Primary Occupancy Group:
Secoudary Occupancy Group:
Primary Construction Type
Secoudary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
R~hge Type:
Eiiergy'Patb:
Sprinkled Building:
Lot Size:
Sq Ft ] st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupanl Load:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Sethack:
Side] Setback:
Side 2 Setback:
Rearyard Set hack:
Solar Setbacks:
Overlay Dist:
# Slreet Trees Rqd:
Paved,Drive Rqd:
% of Lot Coverage:
~!.~.~
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street .Improvements:
Storm Sewer A vailahle:
Special Instruction:
uires you to
~_-'lM J"w req ',dr'"''
I PUBLIC IMPROVg' - ,,\ 'v~'~dopted by theu\Ue~":r~'~et iorlh
. nll'l!. Th.?se r 001-
Notificat on Ce I~~".OAR 952.
In OAR 952-001-. oQies' of the rules by
0090, You ma~i!hRBu!AfIlil\elephO~e
calling the center, -~n Utility NotificatiOn
lIumber tor the. O!1~00_332-2344).
Center IS
Notes: NOTICE:
THIS PERMIT C'u~..
flU I HORIZED U" .:~ ~/\rl/1t'l" TJ~c V H
COMMENCED 0 NRDER THIS PERM/Y r~aY~~ion Descrintion I
ANY 18 IS ABANDONED F - :;::. I ,
.. a DAY PERIDn . 9~er Sq'Ft : Square Footage
DeSCriptIOn Type Of ebllstructlOn I . I' B'd A
. or OlU tip ler or I mount
Value
Dale Calculated
Paee ] orz
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00096
ISSUED: 0112212010
APPLIED: 01122/2010
EXPIRES: 07/22/20]0
VALUE:
225 Fifth Street, Spriugfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54]-726-3769 Inspection Line
Total Value of Project
Fees Paid I
.'
Fee Description
+ ] 2% State Surcharge
+ 5% Technology Fee
]st Appliance
Amount Paid
Date Paid
Receipt Numher
$9.48
$3.95
$79,00
1/22/10
1122/] 0
1122/10
220]000000000000062
220]000000000000062
220]000000000000062
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.
R,~olJired Insnections I
Pellet Insert: After installatiou '
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By signature, I state and agree, that I have carefully examiued 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 Springlield and the Laws of the State of Oregon pertainiug to the work described herein, and
that NO OCCUPANCY will be made ofany structure without permission of the Commuuity Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used ou this'projecl.
I further agree to ensure that all required iuspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the frout of the property, and the approved set of plans will remaiu on the site at all
times during construction.
Owner or Contractors Signature
Date
"j '.
Paee 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM20 I 0-00096
COM20 I 0-00096
, COM20 I 0-00096
Payments:
Type of Payment
ONLINE GIGS
cRcccinll
RECEIPT #:
Description
1st Appliance
+ 12% State Surcharge
+ 5% Technology Fee,
Paid By
ONLINE PERMIT CHGS
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City of Springficld Official Receipt
Development Services Departmcnt
Public Works Departmcnt
2201000000000000062
Date: 01/22/2010
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
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ONLINE ambassado Online
Payment Total:
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Page I of I
] :50: 17PM '
Amount Due
79,00
9.48
3,95
$92,43
Amount Paid
$92.43
$92.43
1/22/20 I 0