HomeMy WebLinkAboutPermit Mechanical 2007-8-30 (2)
Status
Issued
225 Fifth Street, Springfield, OR
541- 726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1945 H ST
ASSESSOR'S PARCEL NO.: 1703361204400
PROJECT DESCRIPTION: Wood stove
Owner: TREVOR ROLLMAN
Address: 1945 H ST
SPRINGFIELD OR 97477
Contractor Type
Mechanical
Contractor
OWNER
# 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
Springfield
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01313
ISSUED: 08/30/2007
APPLIED: 08/30/2007
EXPIRES: 02/29/2008
VALUE:
TYPE OF WORK: Wood Stove
TYPE OF USE: New
Residential
Phone Number: 541-746-5168
I CONTRACTOR INFORMATION I
klW.~lq'lireS ~!J to
I... I c.,mON: Oreg~ bJ:'n~'megorAXmyation Date Phone
follow ru'eseo~~~teThn~o rlllp(=l are set forth
~.!a........ hOAR95~-UUI-
B 0090 You may ==lls of the rU~~ebY
teltlti1gI\(q8 center. (Note:. t~e te'~t~Jt~ize:
.lI........epfQltltba~gon Utility Notl Sq Ft 1st Floor:
numu ..... . 1-800-332-2344).
Type ofGIlil1l9r IS Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
I DEVELOPMENT INFORMATION I
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
, Compact:
I PUBLIC IMPROVEMENTS I 1\\t. 'NO~\{
l101\Ct: \1 S"~\.\. ~~lJ\IAe\S ~01
\~\S ?t.~~t.O U~Ot.R-~~~.gJ}s:
~U\\-\O t.O OR \5 ~
CO\\l\\\I\t.~C l\'l PER\OO.
;..~'l ~ ao 0
I Valuation Description I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Pa2e 1 of2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01313
ISSUED: 08/30/2007
APPLIED: 08/30/2007
EXPIRES: 02/29/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Minimum/Adjustment Mechanical
Wood Stove/Insert
Amount Paid
Date Paid
Receipt Number
$20.00
$5.00
$2.50
$4.00
$17.00
$33.00
8/30/07
8/30/07
8/30/07
8/30/07
8/30/07
8/30/07
1200700000000001131
1200700000000001131
1200700000000001131
1200700000000001131
1200700000000001131
1200700000000001131
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.
Reouired InsDections I
Wood Stove: 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.
- -.....\ ~(ZJ:.
<6/~o/07
Owner or Contractors Signature
Date
Pa2e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-01313
COM2007-01313
COM2007-01313
COM2007-0 1313
COM2007-01313
COM2007-01313
Payments:
Type of Payment
CreditCard
c Receint 1
RECEIPT #:
1200700000000001131
Date: 08/30/2007
Description
Wood Stove/Insert
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
TREVOR ROLLMAN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 086544 In Person
Payment Total:
Page I of I
1 :32:49PM
Amount Due
33.00
17.00
20,00
2.50
4.00
5,00
$81.50
Amount Paid
$81.50
$81.50
8/30/2007
ZZ5 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)7Z6-3753 · FAX: (541)726-3689
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City Job Number
Job Location:
COW( 'Le>o7- 0 f:Sf 3 L
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(7D3 "3b( L
Assessor's Map:
Tax Lot:
04 'fCD
Owner:
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Address:
City:
'7i{b. bib?
Zip: Q14, 71
Phone:
State:
Df2.
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Preliminary Inspection for wood bu~ inserts is $61,50 (prior to insert). QU \0
Wood Stove/Pellet/Insert Permit is 01 ,50 (includes applicable fees and ~~~.\)\\\\\'Jn
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oO~ \"e \'r~ Ote~~ one:
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Contractor:
Ow/\eT
Address:
City:
Construction Contractor's Registration #:
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. Expires:
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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.
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Signature:
Date of Application:
Checked for Delinquencies:
C7- c> r313
Checked for Historical Status:
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Shared Drive(T:)/Building Fonns/Wood Stove Pennit 7-07,doc