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HomeMy WebLinkAboutPermit Building 2004-8-25 \ -. e=-CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01055 ISSUED: 08/25/2004 APPLIED: 08/25/2004 EXPIRES: 02/25/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2389 DUBENS LN ASSESSOR'S PARCEL NO.: 1703361105800 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Install pellet stove Owner: MONTGOMERY GARY D & JOYCE M Address: 2389 DUB ENS LN SPRINGFIELD OR 97477 Phone Number: 541-689-5028 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor BRIAN JOSEPH FERNANDEZ License 71191 Expiration Date 06/21/2006 Phone 541-689-5028 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 # of Stories: Heigbt of Structure Type of Heat: Water Type: Range Type: Energy Patb: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Occupant Load: Vlbr nla I DEVELOPl\<'''l'. mruNvlATlON I Frontyard Setback: Side 1 Setback: Side 2 Setback: , Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: IV U II C E : I PUBLIC IMPROVEMENTS' THIS Pr:rW,T S ' Street Iml!rov'ements:I HALL EXPIRE 110 rHOR/7F.f} , IF THE WOR Storm S~er."vailable:)NDER THIS PER K specla~'insnWctiil~ED OR IS ABANDO MIT IS NOT NY 180 DAY PERIOD NED FOR Notes: . Sidewalk Type: Description Type of Construction Downspontsmrains: \I I -. 'l\...I,.V;l...~V"Ic:...Jjc;qujre::>yuuto ,ollu,,' rultis adopted by the Oregon Utility '!o"i;c~'i;n Center. Those rules are set forth ~ <?~f! ,:752-001-001 0 through OAR 952-001- -~"'~. ......, .n_" . "ULGIII l,;ufJleti or tile rUles Dy I Valuation De~brYiiiori'(llter. (Note:.the tel~phone -.. .--. .u, "'~ Oregon Utility Notification $ Per Sq Ft Square'Footage10-332-23.V\ or multiplier or Bid Amount a ue Date Calculated Total Value of Project Paeelof2 r" "I"~,I.,:\lC,rL lO," ~', .. . .-- .,..'~h.:.:t, : ~'I" i , -. ol' I '"', .'. . I," ,i . . CITY OF SPKll~u"lJ'.LD Building/Combination Permit PERMIT NO: COM2004-01055 ISSUED: 08/25/2004 APPLIED: 08/25/2004 EXPIRES: 02125/2005 VALUE: Statlls Isslled 225 FifI h SII'('CI. Springfield, OR :'<11-726-3753 Phone ,41-726-J('7(' Fas 541-72(l-.17(llJ IIl~pcction Line I Fees Paid I )-"('1' Dt'Sfrilllinn -.\h'Chanit'allsslI:lI1CC Fcc- \- IW:I., t\c1l1linislrativc Fcc _I- 7'Xl Slah' SlIrdl:lrgc "linillllll11/Ad,illslmcnt .Mechanical P.'lIet Slo\'cllns<.'rt Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $15.00 $30.00 8/25/04 8/25104 8/25/04 8/25/04 8/25/04 120040001111000001262 121111400000000001262 12110400000000001262 120040001111000001262 121111400000000001262 Tntal Amount Paid $62.65 I Plan Reviews I Tn Reqllest all inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will he Illade the same working day, inspections requested after 7:00 a.m. will be Illade the following work day. , Re('l'red InSllections I I III.. I r Pellet I nSl'rt: After installation B)' signalnre. I slalc 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 thc Ordinanc('s of the City of Springfield and the Laws of the State of Oregon pertaining to the work dcscribed berein, and that 1\0 OCCCI'.\:S:CY will he made of any structure without permission of the Community Services Division, Building Safety. t I'nrther ('('I'I if)' lhal only contractors and employees who arc in compliance with ORS 701.005 will he used on tbis project. 1 furthu agn.'c 10 l'nsure thut all required inspections are requested at the proper time, that each address is readable from the 'tl'ect.lhat thc I'(.l'tnil card is located at the front oftbe property, and the approved set of plans will remain on tbe site at all firlll'S Irin:,: rUIl...trucfion. ., __~ '711- ~~ o,,"nl'I'O Conlraclors Signature () I g / ;}S-~f-' Date Paee 2 of 2 225 Fifth Street . , Sprill.;;flel~, Oregon 97477 541-'hfi-3759 Phone Jnh/.lonrnal f','ullIht'r COM2004-0 I 055 COO'12004-01055 COil12004-01055 COi\'12004-01055' COi\'12004-0 I 05S 1';:IYIlH'l1tS: Type nf l)aYIlIl'lIf Check ~/25/2(}04 . RECEIPT #: ~~Rl!!l!!"~___.."". wr' . ~.-. i ... 1 '. ~'.'.."~""" '.- -, - aY of Springfield Official Receipt Wvelopment Services Department Public Works Department 1200400000000001262 Date: 08/25/2004 Description + 7% State Surcharge + 10% Administrative Fee Pellet StovelInsert Minimum! Adjustment Mechanical -Mechanical Issuance Fee- P:d" By JOYCE MONTGOMERY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2029 In Person Payment Total: Page 1 of 1 9:03:3IAM Amount Due 3.15 4.50 30,00 15.00 10.00 $62.65 Amount Paid $62,65 $62.65