HomeMy WebLinkAboutPermit Building 2010-3-12
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2010-00310
ISSUED: 03/12/2010
APPLIED: 03/1212010
EXPIRES: 09/1212010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 418 S 43RD PL
ASSESSOR'S PARCEL NO.: 1702323404321
Springfield TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Pellet insert
Owner: THOMPSON DONNIE & AMANDA
Address: 418 S 43RD PL
SPRINGFIELD OR 97478
Phone Number: 541-747-7800
I CONTRACTOR INFORMATION .
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION ~
# of Units:
Prim,;ry Occupancy Group:, R-3
Secondary Occupancy Group:
Primary Construction Type VB
Secondary Construction Type: n \f,'H feqU\t
# of Bedrooms: N1\O~: Ofegod \W \tie Of
~".e _d$ adopte'those JUles n/a
f1/IlIV'--: If. 0
otJ'9&Z.oo' ~ NFORMATlON
~. 'IOU tn~n\8f. ~ n 0\\1\\'1 tl
Front yard Setback: oa\l\fI9':-\tIe.Of8~O_332.~)ray Dist:'
Side I Setback: ~~ cent8f i& , # Street Trees Rqd:
Side 2 Setback: Paved Drive Rqd:
Rearyard Setback: % of Lot Coverage:
Solar Setbacks:
Lot Size:
Sq Ftlst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Spedallnstruction:
I PUBLIC IMPROVEMENTS I " ., ,:,.,oF'
. ,'" Side,\~..rki'~r"~O?>1- ,
, ,....". \C Illn"t
-,,,:: -- ,; ., '..' ~'USpo ~m~ :,
'--.p\\O~tt':. ~ \;~~\.\. ~$ \'t~ ~"~,, :':;
i~~~J~~~t" ~~~~~ ~~~~"O~
Notes:
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I 012
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Total Amount Paid
';d~:~:
Total Value of Project
Fees Paid.
Amount Paid
$9.48
$3.95
$79.00
$92.43
I Plan Reviews ~
Date Paid
3/12110
3/12/10
3/12/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-00310
ISSUED: 03/12/2010
APPLIED: 03/1212010
EXPIRES: 09/12/2010
VALUE:
Receipt Number
2201000000000000236
2201000000000000236
2201000000000000236
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, insp'ectio~s requested after 7:00 a.m. will be made the following
work day. '
Pellet Insert: After installation
LReouired InsDecWlw.i
By signature, I state and agree, that I have'carefully examined tbe completed application and do hereby certify that all
information hereon is true and correct, and I further certify tbat any and all work performed shall be done in accordance with
tbe Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
tbat 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 during construct'on.
Owner or Contractors Signatur
':'}l?'
: t: ::~ "
Pa2e 2 012
3/llllD
Date
,Mechanical Permit Application
DEF'ARTMENI USE9NlY
o
~... 'TI'1;:;- -'"'"'"" '''"_ """""-:.. ~ ':;'--r~" -.:~'::~~_ ' {J>."~-,:::
:' _'J)1;Y~_Qf'SI~J~l~tGYIEI..\:(>;~QREGQN :.-:~
Permit no.:
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
>-/2-(0
Date:
This permit is issued under OAR 918-440-0050, Permits expire if work is not started within 180 days of issuance or if work is
susllended for 180 days.
CAtEGORY; OF CONSTRUCTION
rtResidential D Government D Commercial
,lQBSITE INFORMATION AND lOCATION
City:
Phone:
E-mail:
This installation is being made on property owned by me or a
member of my immediate f,"nily, and is exempt from licensing
requirements under O~S 701.010.
Signature:
Cpt{fRAC:IPR INSTALLATION
Business name:
Address:
City:
Phone:
ZIP:
E-mail:
CCB license n
Print name:
Signature:
'.' '.'~-'
440.2545-J (I t/OS/COM)
n
I FEE SCHEDULE.
..
Residential, Qly. CllSt Total
fa; cost
First Anl)liance I $79.00 $ "i'l Pi
Wurnace/burner including ducts and nnts
Up to lOOk BTUnlr. $17.00 $
Over lOOk BTU/hr. $20.00 $
Heaters/stoves/vents
Unit heater $17.00 ~
Wood/pellet/gas stovelf1ue I $38.00
Repair/alter/add to heating appliance/ ---
refrigeration unit or cooling system! $58.00 $
absorption system
Evaporated cooler $13.00 $
Vent fan with one duct/appliance vent $9.00 $
Hood with exhaust and duct $13.00 $
Floor fumace including vent $58.00. $
Gas JliJling
One to four outlets I $7.00 $
Additional outlets (each) I $4.00 $
Air-handling units, including ducts
Up to 10,000 CFM ',J I $11.00 $
Over 10,000 CFM $20.00 $
Comllressor/ahsorlltion svstem/heat Dumn
Up to 3 hp/lOOk BTU $17.00 $
Up to 15 hp/500k BTU $29.00 $
Up to 30 hpll,OOO BTU $43.00 $
Up to 50 hpll ,750 BTU $57.00 $
Over 50 hp/l,750 BTU $95_00 $
Incinerators
Domestic incinerator I $20.00 $
COmiill!'rciali,,~, 'i,', ",. "i:,'. .".-'1:., "7-<:. .
Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc. S
, . , I.tem: .Cost Total
"Misli~lIaneous tees , ea. cost
Reinspection $58.00 $
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unclassed) $13.00 S
Each additional inspection: (I) $58.00 $
, >- - APPLICANT USE
(A) Enter subtotal of above lees (or enter set 7'J
minimum fee of S 79.00) $
(B) Investigative tee (equnl to [A])
(C) Enter 12% surcharge (.12 x [A+B]) $
(D) Seismic fee, 1% (.01 x [A])
(E) Technology Fec (5% of [A]) $3 ,~
TOTAL fccs and surchargcs (A through E): $ 971/$
225 Fifth ,Street
Sp~ingfield, Oregon 97477
541-726-3759 Phone
Sj:OV==LO;.i
~fi' .
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000236
Date: 03/12/2010
9:15:49AM
Job/Journal Number
COM20 I 0-003 1 0
COM20 I 0-00310
COM2010-00310
Payments:
Type of Payment
CreditCard
cRecciml
Description
I st Appliance
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
AMANDA THOMPSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
79.00
9.48
3,95
$92.43
Amount Paid
djb
$92.43
$92.43
033212 In Person
Payment Total:
, J,! ~ .,1
"
Page I of 1
3/12/20 I 0