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Home My WebLink AboutPermit Mechanical 2004-12-20 r';' r ; CITy:.qr ~P~NGFI~LD . Building/Combination Permit PERMIT NO: COM2004-01562 ISSUED: 12/2012004 APPLIED: 12/20/2004 EXPIRES: 06/20/2005 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5029 Forsythia Dr ASSESSOR'S PARCEL NO.: 1802042202500 Springfield ,'TYPE OF WORK: Pellet Stove PROJECT DESCRIPTION: Pellet stove TYP~ OF USE: New Residential Owner: LARRY BUSH Address: 5029 FORSYTHIA DR SPRINGFIELD OR 97478 Phone Number: 541-736-3946 I CONTRACTOR INFO~ATION , Contractor Type Mechanical Contractor MARSHALLS INC License 25790 Expiration Date 12/23/2005 Phone 541-747-7445 VN BUILDING ll"u<uRMATION I # of Stories: ,\-\or. \NG~~.ot Size: Height of Structu~~\~t \r *\, \<2> ~~ Ft 1st Floor: "1~JJie.of~~l\\..\.. ,\-\0\<2> ~t~ \) ~G~ Sq Ft 2nd Floor: ~\J t\~r.Nf l\~:~\)r.~ ~\)G~t: Sq Ft Basement: ,\\\<2> ~~fLt I't?b~ \<2> ~\)~ Sq Ft Garage/Carport ~\)'~~r:~~~. ~\\\G\). Sq Ft Other: ~G$p"ri ~~u'ill:ting: n/a Occupant Load: u\~,( ,\\) I DEVELOPMENT INFORMATION' REQUIRED PARKING Overlay Dist: ' ., \Cifotal: . uQ'v # Street Trees Rqd: o.,u\1eS ., \)\\X\t)andicapped: Paved Drive Rqd: ~ \a\tJ to OteQ;O~ !\ \~pact: % of Lot Covera~:OteQ;Od 'O~ \'ne ~ S ate S~2.()0'\. ' . ~"~~:~~s ~do~:e ~'nose t~~ O~~': fU\eS '0'1 _~IY i, ~I..t!: o\\"a' 0\ ir '~O'\V I PUBLIC IM'N<, )'~\UIJ!. 'afO'\. co~\eS e \e\e~, 'j}O'(\ ~u ~~ 9~'" ~ o'O\a.\~~~~'~~~o\\\\Cal $\ 0 Q.'(OU ~3: ce(\\et. 0(\ U'$~ ;,~lrr). ()09 ~X\(\9 \'ne \'ne O~~a~ffl)rams: C3: et \ot \S Vij (\U~'O Cen\et # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description Type of Construction $ PerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated . TotalValue ()f Project Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01562 ISSUED: 12/20/2004 APPLIED: 12/20/2004 EXPIRES: 06/20/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line L Fees Paid J Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Amount Paid Date Paid $10.00 $4.50 $3.15 $15.00 $30.00 12/20/04 12/20/04 12/20/04 12/20/04 12/20/04 Receipt Number 1200400000000001764 1200400000000001764 1200400000000001764 1200400000000001764 1200400000000001764 Total Amount Paid $62.65 I Plan Reviews, 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. I Reouired Insoections . Freestanding Pellet Stove: 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 I 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, 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 ~cs~ ~ -- Owner or Contractors Signature :ClLL J?--OO- ocf , I Date Pa2e 2 of2 225 Fifth Street Springfield, Oregon 97477 541~726-~759 Phone T.:;~~ii':',:;.''' ',I,: Mr' "It'''' 'p~ ! " " ,. ".. ," ~, ,,': '. ,) ""'''.''1'';',,,;:,''''''L'''.:~<..~'''''''~'' .' "'" C'ity of Springfield Official Receipt lelopment Service~ Department Public Works Department RECEIPT #: 1200400000000001764 Date: 12/20/2004 11:14:14AM Job/Journal Number COM2004-0 1562 COM2004-0 1562 COM2004-0 1562 CO M2004-0 1562 ~OM2004-0 1562 Description 'Miniinu~Adjustinent Mechanical "':'Me'chanicallssuance Fee~ + 7% State Surcharge + 10% Administrative Fee Pellet Stove/Insert Payments: Type of Payment Check Paid By MARS HALLS INC Item Total: Check Number Authorization Received By Batch Number' Number How Received Amount Due 15,00 10,00 3,15 4,50 30.00 $62.65 Amount Paid djb 18356 In Person Payment Total: $62,65 $62.65 '_.J 12/20/2004 Page 1 of I