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Home My WebLink AboutPermit Building 2003-12-12 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line . .' U 1 r OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2003-01250 ISSUED: ' 12/12/2003 APPLIED: 12/12/2003 EXPIRES: 06/12/2004 VALUE: SITE ADDRESS: 1020 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272201200 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install wood insert Owner: ARN BERGSTROM Address: 1020 DARLENE AVE SPRINGFIELD OR 97477 Contractor Type Mechanical Phone Numher: 541-344-9828 I CONTRACTOR INFORMATION I Contractor License EMERALD SWIMMING POOLS OF ORE IN 11294 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback:- Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction Expiration Date 10/22/2005 Phone 541-688-1090 # of Stories: Lot Size: R-3 Height of Structure Sq Ft 1st Floor: Type of tleat: Sq Ft 2nd Floor: VN Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Nnl\CE: "J' I J r:"O\Q~ If 'nl~.''f,I\!j~~s Surface Area: I DEVELtlIl\MEfNt'of.NEo~m~~PERM' II;) 1~\J I AU rrfJr"'~EO OR IS ABAfroONEO FOR REQUIRED PARKING o~QMNlin=nt>.,( PERIOD. Total: # sMllt W&rnqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: I PUBLIC IMPROVEl\1ENTSI:-J:Oregon law requires you, ~o - - ~ ,. "n "'regon Utility follow rules adoSldewalk 'lYpe: f , , ' C ntP'r Those rules are set 011 \Iotllicatlon e DownspoutslDralns:. 952-00 In OAR 952-001-0U 1 u ,,,' UU~II ~r" , 0090, You may obtain coPiS,S of the rules' II' 9 the center. (Note: ,he telephone ca ~n jor the Omgon Utility Notification num,Jer _. , .. :- lt~r is 1-0UU-~..J"," -I-V-' -. J' I Valuation DescriDtion I $ Per Sq Ft or multiplier Square Footage or Bid Amount- Value Datc Calculatcd Total Value of Projcct Paee 1 of2 . . CITY OF ~rK1NG_HJ!,LD . Building/Combination Permit PERMIT NO: COM2003-01250 ISSUED: 12/12/2003 APPLIED: 12/12/2003 EXPIRES: - 06/12/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~ Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Wood Stove Amount Paid Date Paid Reccipt Number $10.00 $4.50 $3.15 $15.00 $30.00 12112103 12112/03 12112103 12112/03 12112103 1200200000000002600 1200200000000002600 1200200000000002600 1200200000000002600 1200200000000002600 Total Amount Paid $62.65 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. Reouired In~neetion~ I 1 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 information hereon is true and correct, and 1 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, nnd that NO OCCUPANCY will be made of any structure without permission of the Community Scrvices Division, Building Safcty. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this projcct. 1 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 durin onstruction. gA--- 12/;'2-/0,2, . Date Paee 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ~":.~.":"'.~~.'..""e".,..".. ':. [ .~. . , , ,. ; ...,-,,- . Job/Journal Number COM2003-01250 COM2003-01250 COM2003-01250 COM2003-01250 COM2003-01250 Payments: Type of Payment Cash Change Job/Journal Number COM2003-01250 COM2003-01250 COM2003-01250 COM2003-01250 COM2003-01250 Payments: Type of Payment Cash Change Receipt #: 1200200000000002600 Description + 7% State Surcharge + 10% Administrative Fee Wood Stove Minimum/ Adj ustment Mechanical -Mechanical Issuance Fee- Paid By EMERALD POOL AND PATIO EMERALD POOL AND PATIO Received By djb djb Description + 7% State Surcharge + 10% Administrative Fee Wood Stove Minimum/Adjustment Mechanical -Mechanica11ssuance Fee- Paid By EMERALD POOL AND PATIO EMERALD POOL AND PATIO Received By djb djb Check Number Batch Number Authorization Number Check Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department Public Works Department Date: 12/12/2003 1:42:36PM , . Amount Paid Item Total: 3,15 4,50 30,00 15,00 10,00 $62.65 Amount Paid $65,00 . ($2.35) $62.65 Amount Paid 3,15 4,50 30,00 15,00 10,00 $62.65 Amount Paid $65,00 ($2,35) $62.65 . How Received In Person In Person Payment Total: Item Total: How Received In Person In Person Payment Total: ~ 12/12/03 FRI 10:0; FAX 541;263689 .,. ,. . .. P l"! ~a . . ,.' ~; 0: ., d, I'r" , lUSPCC~' '$45,00 (prior to inscrt) . N.Drenon law reqUIres you, ~~ ' ~ 'ood Stov ellet/ Dsert ermil is $62,65 (includes pefliiijPi~s'J~h'ce'Fee'lState Su.r.cb-al;g'er8!..~"(jMi~ Fee,) ~., ' g"llnW rules aaop to..:'. ":.Y_~ ;'.1"", afe set aort t), , .t tlon L;enl"', . ..~-- AD 8S2.QO' (j;);--, ",'," " , "c, ',.. ,'''',: '.. _ \Io\IICI1,._ ..oo'ot.l:lrolJg,hO>",., ':. " .., e J', r. ... ,,',' " " '........., ....,,2...{)Q, I, ,.. ,- , "tl " 1 "l!i>~ ,\:) .~: -, o,','tr,!c~o!, ~:Jr]:mat!~n ,..:::~"="'" ,: .,,, :", ::,:,-'--~nMZ~;;'ri'aY'oPw.\n::riOP'I:-eSQ1'~~OM ~,:t ~on;l::tn ~--~~' ParA tC~~~~Q~:~~~~t~~\~~~~ot\llcatlon ~. AddrNO l~~~ ~OlJ. 4Cf N. numu"'r.~~;ir,~~~-8reo..;<t?cg3..44k 7(/1 ~ [--:1 Cit: E ~ fMR.. -.) "'qte DR Zin 9740 '2.. ~: Construcl1on Contractors R~P~~li,~:C~.'h{\RE If1HE WOR~~P1fes 101z2/ns- (j)- JTI iOm:!t~ 1J~m~R lHIS PERMIl I:) I'lU . r:t!J.... t\ 0 OR IS ABANDONED I'Ul'I ~. By "gIllng th,s Pcm1itlapPli&,Q~hD,<bBl.\CJu an lllspcellOn(s) as requITed (726-3769). I slale lhat all H: information on this applicatiANY~1iM)iA~1cl1-r.!~t and th.nt i was provided with. the Wood Stove Safety ~; information for wood burning appliances and preliminary inspection standards as sct by the Orcgon Department ~: of Environmenlal Qualily or the Federal Environmental Protection Agency and I agree to provide the testing \J;J! approval number to Ille inspector at the time of inspection. I also understand that if I am requesting a ~. prcliminary inspeclion., the wall covering may be required to be removed, (Q '--:1/1// /en 5' ~; ,Sigllaturp v v I fA J?al ~ / ; ~f 6' Date of Application 0: Checked for Delinqucncics ~ Q Q. .~ ~. ~. Q, .~ ,.--.1 ~, ~ <: CITY OF SPRINGFiELD 16 OU I . 22'; nfTH STRr.n . srRJriCnr.J.[],OR 87477 . rl'J:("4J)72G,~,753 . rAX: (54])I2G,3G89 City Job ~umbe,. CO/IYI zo03-0 ( z... ') 0 /020 1)bV}e41€ Ave'. 1703. 27 Z.Z Tax Lot 0120-0 Job LocatiO!' Assessors Map 6ev~ S.WVVL Address _ [OLD \)("Dy-lev\e. AVe__ Cit;, S fy'" \v\~ f'i ~\ d . State 01<. Jf- (--,_ 00 Value ofSStovp;i)eJ1et Stove~~n- Owner -A V V\ Phone ../..$4/) 3'L~-=,1 ~ 28 '171./77 Zip (please circle appropriate appliance) . ... Oate~/IZ-)O S For Office Use 12..//2--/0") Iv v rhecked for Historical Statu, Shm~d Dri~e(T,)'Buildjn~ FurmsfWooC 510.1; PCllIutJ.O).tio..: