HomeMy WebLinkAboutPermit Building 2007-12-28 (2)
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225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SCANNED
8ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-0I872
ISSUED: 12/28/2007
APPLIED: 12/18/2007
EXPIRES: 06/28/2008
VALUE: $ 1,,050.00
Status
Issued
SITE ADDRESS: 5150 F:ORSYTHIA DR
ASSESSOR'S PARCEL NO.: 1802042101600
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION:
Owner: QUESADA JOE L & MARGARITA
Address: 5150 FORSYTHIA DR
SPRINGFIELD OR 97478
I CONTRACTOR INFORMA TION ,
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft Is! Floor:
Sq Ft 2nd Floor:
Sq Ft Bnsement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION ,
Frontyard Setback:
Side I Sethack:
Side 2 Sethack:
Rearyard Sethack:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
Street Improvements:
Sidewalk Type:
DownspoutslDrains:
Storm Sewer Availahle:
Special Instruction:
Description
ATTENTION: Oreg,)n law requIres you.t,o
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
UDfl:::{, ,,,,,:,,..;-. ;;:;.: 881 'Y.'.^""-"3h-I"I~1'l O<;?;ll!11.
THIS PERMIT SHALL EXPIR.l !l"J:J;,'_ll:lI""J;"i-'- .. I 0090. You may obtflin copies of the rules by
t1 'v HI ual'lon I'JescrmtlOn Ir the center (Note' the telephone
AUTHORIZED UNDER THIS P~t\IVIII I" I~U I ~m'~~r for the or~gon uiility Notification
COMM~~~Mr~ttWAND~ ~.l!l~t Squa.'e Foot_ge CentevilIu1,.a00-332-M1~C.lculated
ANY 180 DAY PERIOD. or multJpher or B,d Amount
Notes:
Paee I of 2
.
.ITY OF ~rtUj~\Jl' IJ'..LU
Building/Combination Permit
PERMIT NO: COM2007-01872
ISSUED: 12/28/2007
APPLIED: 12/18/2007
EXPIRES: 06/;!8/2008
VALUE: $ 1.,050.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
l.F"". P"irll
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
. + 8% State Surcharge
MinimumlAdjustment Mechanical
Wood Stovellnsert
Amount Paid
Date Paid
Receipt Numher
$20.00
$5.00
$2.50
$4.00
$17.00
$33.00
12118/07
12118/07
12/18107
12/18/07
12118107
12/18/07
1200700000000001507
1200700000000001507
1200700000000001507
1200100000000001507
1200700000000001507
1200700000000001507
Total Amount Paid
$81.50
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.
1 R..n"i"('ld' n.neelion. ,
~I'U
Wood Stove: After Installation.
By signature, I state and agree, that I have carefully examined the completed application and do h,,,ehy certify that all
information h'ereon 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 nddress is readable from the
street, that th e ~,i:.lr.d is I ated a nt of the property, and the approved set of plans will remain on the site at all
rim"'~;;l"" ~ I ~~q t,7
owfer or contractor~ . Date / / .
Paee 2 of2
225 Fifth Street
Sp~ingfieI.d, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0 1872
COM2007-0 1872
COM2007-0 1872
COM2007-0 1872
COM2007-0 1872
COM2007-01872
Payments:
Type of Payment
Cash
cReceintl
RECEIPT #:
eT..,o
Wic.....~
'., ,
.~, " .~.__,.. ,.. _,' _. .1" ,-
Ci_Springfield Official Receipt
De.pment Services Department
Public Works Department
1200700000000001507
Date: 12/18/2007
Description
Wood Stove/lnsert
Minimum/Adjustment Mechanical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
-Mechanical Issuance Fee-
Paid By
RICHARD QUESADA
Item Total:
Lheck Number Authorization
Received By Batch Number Number How Rf~ceived
dim In Person
Payment Total:
Page I of 1
1:47:34PM
Amount Due
33.00
17,00
2.50
4,00
5,00
20,00
$81.5U
Amount Paid
$81.50
$81.5U
12/18/2007
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225 FlITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Number
Job Location:
Assessor's Map:
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Tax Lot:
Owner:
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Address:
City:
State:
Phone:
On~"V1
Preliminary Inspection for wood burning inserts is $61.50 (prior to insert).
Wood Stove/Pellet/Insert Permit is $81.50 (includes applicable fees and surcharges).
Contractor Information
L)\,{ / A ) r=,,(
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Contractor:
Address:
City:
Construction Contractor's Registration #:
Phone:
State:
Zip:
Expires:
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Zip: q 7 '775!
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By signing this permit/application, I agree to call for an inspection(s) as required (726-3769).
I state that all information on this application/permit is correct and that I was provided with
the Wood Stove Safety information for wood burning appliances and preliminaty inspection
standards as set by the Oregon Department of Environmental Quality or the Federal
Environmental Protection Agency and I agree to provide the testing approval number to the
inspector at the time of inspection. I also understand that if I am requesting a pr.eliminary
inspection, the wall covering may be required to be removed.
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Signature:
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"yy, '~^'\,::"fZ,,~"~i~1!ff7;;:"~:'
FOR OmCE USE
Date of Application:
/2-// ffi /t9 ?
, I
Checked for Delinquencies:
Checked for Historical Status:
Shared Drive{T:VBuilding FormsIWood Stove Pennitll..{l7.doc