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Home My WebLink AboutPermit Building 2007-7-30 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01126 ISSUED: 07/30/2007' APPLIED: 07/30/2007 EXPIRES: 01130/2008 VALUE: Status' Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2680 21ST ST ASSESSOR'S PARCEL NO.: 1703244202721 Springfield TYPE OF WORK: Pellet Stove PROJECT DESCRIPTION: Install pellet insert TYPE OF USE: Addition Residential Owner: DA VIS JENNIFER Address: 90889-B HILL RD SPRINGFIELD OR 97478 I CONTRACTOR INFORMA nON I Contractor Type Mechanical Contractor OWNER License BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: Height of Structure: Secondary Occupancy Group: T e of Heat: Primary Cons1lkliffibhmtle Oregon law requires y r Type: Secondary C<Wlkal\ltfNleiJ~pted by the Oregon Type: # of BedroonNotification Center. Those Nles are Path: In OAR 952-001-0010 through OAR ed Building: n/a nnan V.mu:nav obtalr) copies of the calling the center. (Note: ENT INFORMA nON number for the Oregon Utili Center 111-800432-2344). Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Phone Number: 541-736-6620 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: fJ~,!,J.O~. THIS PER- AYi~ MITSHAll . CQMMj; tiElfliNPER =RE IF THE WoRK AtW'fa::::~:D~='J/,: NOr I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Page 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01126 ISSUED: 07/30/2007 APPLIED: 07/30/2007 EXPIRES: 01/30/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectionLine Total Value of Project Fees Paid I Fee Description Amount Paid Date Paid Receipt Number Total Amount Paid $0.00 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. Reouired Insoections I Pellet 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 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 times during construction. ~ ~I\~-~ Owner ~ Contract~rs Signature l~ ~()-D! Date Pal!e 2 of.2 (..;r ~~ ~ ."~1 J~ ~ ~ ."r;::d1 ,'. .11 ~\ k' ..-J1 ~ ~1 ~1 . 4 ~1 ~1 ~ .,,~~ ~~ ~ ~ !O\~ 1.,.--.1 00\ ~4 ..-1 ~ r=-:H ~ ~1 ~ ~) ~1 ~m =--~1 ",1 ~ ~ e) l~ ~ "Tr4.~ 'I-~ ~ ~ ~ .i <II ; r::" c,,~zvc7'IT~T OF SPRiN"'~EIEiD,e OREGO" N'" '~,~~:~];(;'\~;:,:ft .I \.J, ._b,~~, '8 ~. . - ' '':;. ,-;:., ,.,. :>>~~ ~0~ 225 FIrm STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689 City Job Number.0::Jrrl W07 --- 0 \ I ~ Y Job Location: ~{.p (;;7 2.J.$1 ...s r Assessor's Map: \ 1 0 S ~ L\--' 4-- ~ 0 Tax Lot: ;::::r7~ I , (\. \ Owner: ~ ~"'- -; re-V- h \\ \ " Address: ~-~(lXO ~,. ~~ ~ City: ~ J. . State: . ~ Phone: 541\ /L\(o-eoCo8 Zip: q/L{t ~ Preliminary Inspection for wood burning inserts is $61.50 (prior to insert). Wood Stove/Pellet/Insert Pennit is $71.50 (includes applicable fees and surcharges). Contractor Information Contractor: Address: ~-l \J Phone: City: Construction Contractor's Registration #: State: Zip: Expires: 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 preliminary 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 preliminary inspection, the wall covering may be required to be removed. signature;~_ ..~^ ~~ ~- . -0.-- ., - u__~~_____ I I FOR OmCE USE Date: ~ ,-- 3D- drol Date of Application: C--O"-~U ~~1 ;:}0o'l Checked for Delinquencies: Checked for Historical Status: Shared Drive(T)/Building FormsfWood Slove PemllI7-07.doc 225 Fifth Street Sp~ingfierd; Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01126 COM2007-01126 COM2007-01126 COM2007-01126 COM2007-01126 COM2007-01126 Payments: Type of Payment Check cReceint 1 RECEIPT #: 2200700000000001211 Date: 07/30/2007 Description Pellet Stove/Insert -Mechanical Issuance Fee- Minimum/Adjustment Mechanical + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JENNIFER DAVIS Item Total: Check Number Authorization Received By Batch Number Number How Received Ih 2020 In Person Payment Total: Page 1 of I 2:29:25PM Amount Due 45.00 20.00 5.00 2.50 4.00 5.00 $81.50 Amount Paid $81.50 $81.50 7/30/2007