HomeMy WebLinkAboutPermit Mechanical 2007-8-14
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225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 · FAX: (541)726-3689
City Job Number
Job Location:
C6~ 'Z.PO 7..- 01/7 L
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1703 'Zb z.,Z
Tax Lot:
OLfoo ~(
Assessor's Map:
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Owner: Tp ) !-hi oJ (' i ~1'
Address: I '7 {'p () st-. J
City: S (JJ "'1~J c:.; ~ ( ~
State: (!;) f(
Phone:3,;S ${ - g3 3 CJ
Zip: l.} 7 'f 7 '7
Preliminary Inspection for wood burning inserts is $61.50 (prior to insert). ~v..
Wood Stove/Pellet/Insert Pennit is $71.50 (includes applicable fees and surcharges). \\t:.. ~a ;'\;
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Contractor:. A1 ~, 01' ,~l ,', (( ~ JID1~~::~~C~\) l~V.\()\)o
Address: '-I (( Ci (", I f4 I,., ) Ie'...' ~,9a(} \)~ Phone:
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CIty: ;):) /'. h ') 1- : Ii (') State: . 1-,
Construclion Contractor's Registration #: :2 ':) 71/""
7Y7-'7t.tl/";-
Zip: C; 7 Y 7 K
Expires: I 2. /c 1
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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 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:
L
Date:
:1/1 ~ /07
Date of Application:
g!;Cf/07
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FOR OrnCE USE
Checked for Delinquencies:
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Shared Drive(T:)iBuilding FormslWood Stove Pennit 7-07.doc
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 176 V ST
ASSESSOR'S PARCEL NO.: 1703262204007
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01192
ISSUED: 08/14/2007
APPLIED: 08/1312007
EXPIRES: 02/14/2008
VALUE:
Springfield
TYPE OF WORK: Pellet Stove
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Pellet insert installation
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot coverag~()~~
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Owner:
Address:
TED HUDGINS
176 V ST
SPRINGFIELD OR 97477
Contractor Type
Mechanical
Contractor
MARSHALLS INC
# of Units:
Primary Occupancy Group: R-3
Secondary Occupancy Group:
Primary Construction Type VB
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
Phone Number: 541-338-8380
I CONTRACTOR INFORMATION.
License E XDh:M.wrtc:D ate Phone
\ W fequn~~~\bl
__ u''1M' eleWbn. e:. ... (\rA~jbiuU? 541-747-7445
~l L,-nT. _~'L~O U7 tf.. se\ I\,"W:.
BUlLDING.l~PfUI'lilIITtlose fU\es ~~ 952-001.
Notif\C9.tlon ~O;':001 0 ttlrou,gtl OU~ ru\es bY
# of Stofi\~AR 952- obtain cOpies ~i.~tft\one
Height qf~\l~O\le~a'/entef. {Note: ,t~%(h~~atl0or:
Type of H~\ing ttle ~tle Oregon Utl\I~%l ~)~nd Floor:
Water TYWUmber tor tef is 1_800-332.~q ,t Basement:
Range Type: Cen Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
I DEVELOPMENT INFORMA nON I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal.!:e 1 of 2
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
+ 5% Technology Fee
+ 8% State Surcharge
Minimum/Adjustment Mechanical
Pellet Stove/Insert
Total Amount Paid
Total Value of Project
Fees Paid.
Amount Paid
Date Paid
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2007-01192
ISSUED: 08/14/2007
APPLIED: 08/13/2007
EXPIRES: 02/14/2008
VALUE:
Receipt Number
1200700000000001033
1200700000000001033
1200700000000001033
1200700000000001033
1200700000000001033
1200700000000001033
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.
Pellet Insert: After installation
$20.00
$5.00
$2.50
$4.00
$17.00
$33.00
8/14/07
8/14/07
8/14/07
8/14/07
8/14/07
8/14/07
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. / oj/" '
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Owner.or Contractors Sig~ture
$81.50
I Plan Reviews I
Reouired Inspections I
------
Pal.!:e 2 of2
?1;;~~ ?
Date
225 Fifth Street
Springfield, "Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01192
COM2007-01192
COM2007-01192
COM2007-01192
COM2007-01192
COM2007-01192
Payments:
Type of Payment
Check
cRecein'l
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200700000000001033
Date: 08/14/2007
1l:13:20AM
Description
Pellet Stove/Insert
M inimum/ Adjustment Mechanical
-Mechanical Issuance Fee-
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Amount Due
33.00
17.00
20.00
2.50
4.00
5.00
$81.50
Paid By
MARSHALLS lNC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
19935
In Person
Payment Total:
$81.50
$81.50
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8/14/2007