HomeMy WebLinkAboutPermit Mechanical 1993-2-18
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
. BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
L <?~"7 ;t?",-VC=(;;>~C-L.
,-
I? -02 /6-;;>:;;;>
,J?L7/7 ,~/~
Address: -;2Pt!:? ~7fA:=,5> ,/?!.&fF/h/r
City: .~~{J~~ ~~ State:
Job Location:
Assessors Ma~ #:
Tax Lot #: 4l~~
Owner:
IP~
~<
Phone #~) 4:;4/"3-'7//5
Zip: 9~r~/
Value of Yood Stove/Pellet Stove/Insert: ;'~l/_~
(please circl~ appropriate appliance) ,
Prelim;n~~Inspection is $15.00 (prior to installation of insert)
CoodJStov.,;t'pellet/Insert Permit is $15.QQ + $10.00 IC!C!II"'Ae.El + ~
~p ~</~. ,1!?
Type of Inspection Requested: JA....~.P<~ VG""
Contractor: r~/"fFt;:H;??-~~ c;.-d/>/~ "
Address: '-177 kstt... 7"2 /r}? ~?~
I' :.:- PP", h St~e:
~ ,r t::.--/;-_
state surcharge.
Phone #:
7&:0 - ~?J:7.
City:
~-
/~/1 -
Zip:
Construction Contractors Registration #: ~/~
Expires: -::? -'2e>--9t1f/
By signing this permit/application, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit is correct and
that I was provided with the Yood Stove Safety information for wood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the wall covering
ma . b reqUi:$;:rz~~ -Z(N /t1?J
() ~' Da te' f
. FOR OFFICE USE
REQUIREDINSPECTION(S)'= ~DSTOVYrELLET/INSERT .. >
PRELIMINARY
Date of Appiication: .""7':';'~ 4::>
Total Amount Collected: :;2;-G:7~
Job #:
92/C/C/?
Receipt #: 7~.c'~
Issued By:
. a....?'~ Af"" ...
" ~ ~/4"'~"7C--_
Checkeo for Historical Status:
Checked for Delinquencies:
. '
ltt..r1'l1flP,Jtm.o~ llw, ~ I~
fhe'folioWin9. ~pToi~ctl.aS;~~~rnl\IIeQt' :\ar..ri;:4~ .OWI . 1r.1",
..,.. a-n.d'does~not\J!a.q!.!I~~J~~.I~ rcl.rm age \;'",11
zonlOgi' . . ., , ,.'
'ep~rovelt.. . -;:-'\ {) ELECTRICAL PERHl.T APPLICATION
97/,7 7 t!o~rnt'1 l Uh- Q ~/--/7
726-. 3?-.63::- _ ,y)-~" City Job Number f 2/";'9<- .
f'Jal~. . .~ ~'D ~
M\hOf~ s\gnature.::J;S ;~;'(::;(1M'l';tETi?"PEE scnEDULE BELOY
LOCATION OF INSTALLATION . ,
t.,Q8, :RIVe.~-el( st-
225 FIFTH STREgT
SPRINGFIELD, OHEGON
INSPECTION REQUEST:
OFFICE: 726~3759
1.
7A.L.DESCRIPTION
J .04 '7 r ~.(
. ~ ..--
JOB DESCRIPTION
Hou ~< ~...\ ec::tn c:.
t'~~C)6
Permits are non-transferable and expire
if work is not started within 100 days
of is~uance or if work is suspended for
180 days.
2. CONTRACTOR INSTALI..ATION ONLY
Electrical Contractor 1=...I~~""'tZ 'C(QcAr,,-
Address (lD .f'{\o V'\ rot' ,
Ci ty ~u",eo"'L'
Phone b&'7-21 i (
Supervisor License Number 3577 5
Expiration Date q~
0'1 '&'9 0
Constr Contr. Number ~.s ~ L;:"." ;.-
Expiration Date ~ 1(1'~/'72-'
Signature of Supervising Electrician
~~.
Owners Nam~ 2M i. p~~
AddressA6() '~-hY\nrtr
Ci ty $ru~ UllStXi~nc ?fh- ~4?)'
O\lNER INSTALLATION 1US
The installation is beirig made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~~~~:~~:~---!'~~~~~--------
HECEIVF.D BY: .. ..,..,_.:-R-~---_._._.-
New Residential-Single or
Multi~f~mily pe~ dwelling unit.
Service Included:
A.
1000 sq.ft. or less
Each'addition~l 500
sq. ft or portion
thereof.
Each Manuf'd Home or
Modular Dwellirig
Service or Feeder
B. Servites or 'Feeders
Installation~ Alterations or
Relocation:
200 amps or' less
201 amps to 400 amps
401 a~ps.to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Items
Cost
Sum
~ $ 85.00
~5".O-O
. .2--$ 15.00
3~ . t14J
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installatiqn, Alteration or Relocation
200 amps ~r less
201 amps to 400 amps
Over ~01to.600 amps
Over 600 amps or 1000 volts
D.
Branch Cir'cui ts
$ 40.00
$ 55.00
. $ 80.00
see "D"
above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each instalt~tion
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Li'mited Energy)Comm
. ,
One eft-cult
Each Additional
Cir~uit ~r ~ith Service
or Feeder Permit
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 35.00
$ 2.00
not included)
$
$
$
$
J/'S.~
.. .:;; 7r
--1:20..7,r'
40.00
40.00
20.00
36.00
~
I
",)B NO. q Z, 44-1
~,,~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEEf
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: 1<ot-.l 'f<01?E:.~,S
LOCATION: G,~ B I -:fZ::,Lu E::~E:..L L
l (-O-z. -?C? -?? - Y:<OOc.:.
DEVELOPMENT TYPE: L-Pl2- - ~E:.w <?r-{Z.
BUILDING SIZE:
,LOT SIZE
.SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. ~~5B X $0.192 PER SQ. FT.
C::;11'i'*)
--- ~
2. SANITARY SEWER-CITY
NO. OF PFU'S l6 X $39.78 PER PFU
(See Reverse)
~ t<oo;;
--- .-/
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
I X \ .OO? X $401.05
~~O~)
---- ----
X
X $401. 05
$
X
X $401.05 $
SUBTOTAL (ADD ITEMS 1,2) & 3) $ l?~ , 0-+
4. ADMINISTRATIVE fEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
c;- '9?i)
"-- ---
TOTAL -C ITY SDC $ \ (., -, 0 c;.;t
5. SANITARY SEWER-MWMC
NO: OFPFU'S \6 x $13.62 PER PFU + $10 MWMC'ADMIN. FEE $~?Sl~
(Use PFU Total From Item 2 Above)
'~~L~
~ Kip Burdick
SDC Coordinator
10 /, ~ /11-
I {
$ y--z, o~
TOTAL-MWMC SDCG~V
TOTAL SDC $ ~ B B? ","'7
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
t.--
FIXTURE UNIT CALCULATt6N TABLE: Number of New Fixtures X L
For remodels, calculate only the NET additional fixtures)
....
Equivalent = Fixture Units (NOTE:
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT FIXTURE
EQUIVALENT UNITS
Z-
2 4
1
2
3
6
2 'Z-,
6
6
1
3
2
1/Head
2 1-
2
1 1-
6
4 8
1-
Bat htu b.......__.........................--.... --............... --...........
D rin king Fountain.....................................................
Floor Drai n................................................................
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub /Clotheswasher....... ....... .....:....... ........
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator ;Water Station/Etc........
Receptor For Commercial Sink/Dishwasher /Etc..
Shower, Single StalL.................................... .., .... ...'
Shower, Gang. ................;... ..... .... ......................... ...
Sink, Bar, CommerciaL..........................................
Urinal, Stall ;Wall..... .................................. ................
Wash Basin/Lavatory, Single..................................
Water Closet, Public Installation.............................
Water Closet, Private................. ......... .....................
Miscellaneous:
1-
TOTAL FIXTURE UNITS
~
\'
CREDIT CALCUU\TION TABLE: Based on assessed value. If im,provements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1.-'
1979 or before
1980
1981
1982
1983
1984'
$2.83
2.76
2.71
2.60
2.46
2.33
1985
1986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0.25
0.87
0.50
0.16
'i
,., . c:L '2.. X $ \. I . C7 7 1 I.., ~
Credit for Parcel or Land Only If Applicable t.- D/' '-f' "b ...,- {,..o
(Rate X Assessed Value)
Improvement (if after annexation date) X $
(Rate X Assessed Value)
CREDIT TOTAL = $ Yl, o~
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Resid ential... ............................ ............... .......... 0.4
Commercial...................................................... 0.9
Industrial..... ............ ....... .......... ..,... .......... ......... 0.45
Governmental.... ....... ........ ..... ........................... 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT