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Home My WebLink AboutPermit Building 2003-12-1 l , .' . Lll i' OF SPRI1~hl'l~LU Building/Combination Permit PERMIT NO: COM2003-01189 ISSUED: 12/01/2003 APPLIED: 12/01/2003 EXPIRES: 06/01/2004 VALUE: ~ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 657 QUARRY RD ASSESSOR'S PARCEL NO.: 1703353406900 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Gas fireplace Owner: MICKEL DON R Address: PO BOX 71 SPRINGFIELD OR 97477 Phone Number: 541-747-4871 I CONTRACTOR INFORMATION' Contractor Type Mechanical Contractor KEITH LEESMAN License 72082 BUILDING INFORMATION' Expiration Date 04/04/2005 Phone 541-995-6157 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: .~I;)~:,\ Impe~v.i!lus Surface Area: I DEy.E\ISbrMENT INFORMATION' 0<0'\- \)~:,o . I ., ~ f::- ... _\ o.~' o.~" ~\J' & ~o 'RE;QUIRED PARKING ~~' IV' (,'\) ,0 ,0 ,0 !:'I(jv 0'" <<Ji t.><< ':'&,,'!!rlay Dist: r/>~ 0 0 i~ x-Tot~l~ ~0 {' . \.~" ((;.. '\~ ~W Street Trees Rqd: o~" ;!>, 'S',~ o'?' I!&"ndic'ilpped: Go' ~ '?'<.:.~<(; ~ Paved Drive Rqd: ,0($ 0'<:> 0",0 ",if' '" d-co~~~{tr ~V ~ ~'" f.> ~ _-:.0 R,0,,~ ,0 '~ro ~0' ~o" ~'\~ ~<(;I.~~'\) I;)~~'\S' % of Lot Coverage: 0'-' 00 " c'S' <:P~ ,~,~ "r>'-' ~~y..? :I;)<<;.:.,,<<'~-l. <<<(; ,v.f\0'" ~.0{':):)C~~~ \~o:.\)'~'r,:,f> ~ ~~~':..<or:.:::, 'oJ' I PUBLIC IMPROVE-Mj,Nis:i~(IP" r/>':" U~~0\00;~'0'0;' <:J _~ ,_ .~,_ ;>) ~ Ci _0 ,-" ....~ o~ .go .lovSidewalk T.ype: r ~O.,.... "<.'-.- R)' ~ ~o .c 0$' "Ql ~ DownspoutslDrains: C" (,1; 'S)'" C' "'~ <' R-3 VN Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project , Paee 1 of2 . j . . Ll1 l' OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2003-01189 ISSUED: 12/0112003 APPLIED: 12/0112003 EXPIRES: 06/0112004 VALUE: 0' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541~726-3676 Fax 541-726-37691nspection Line I Fees Pail! I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Gas Fireplace LP Gas Tank & Piping Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $15.00 $12.00 $18.00 12/1/03 12/1103 12/1103 1211103 1211/03 1211103 2200200000000001815 2200200000000001815 2200200000000001815 2200200000000001815 2200200000000001815 2200200000000001815 Total Amount Paid $62.65 I Plan Reviews I 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 Rell\Jir~? InsDections I 1 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 2 Rough Mechanical: Prior to Cover 3 Final Gas: When all gas work is complete. 4 Final Mechanical: When all mechanical work is complete. By signature, 1 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. ~.~_?;;:~ L Owner or Contractors Signature r--L /2////<, Date Paee 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-01189 COM2003-01189 COM2003-0 1189 COM2003-O 1189 COM2003~0 1189 COM2003-O 1189 Payments: Type of Payment CreditCard ~ ~i -"',..,.,....- --.._~ J Receipt #: 2200200000000001815 Description -Mechanical Issuance Fee- Gas Fireplace + 7% State Surcharge + 10% Administrative Fee LP Gas Tank & Piping Minimum! Adjustment Mechanical Received By Check Number Batch Number Authorization Number Paid By DON R. MICKEL Jrnp 000234 066551 City of Springfield Officiiil Rec~ipt Development Services Department Public Works Department Date: 12/0112003 IO:47:I1AM Amount Paid Item Total: 10.00 15.00 3.15 4.50 12.00 18.00 $62.65 How Received In Person Payment Total: Amount Paid $62.65 $62.65 . .