HomeMy WebLinkAboutPermit Mechanical 2001-1-30
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I Job# 01-00084-01 I
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TRANS#:01-0004341
DA TE : ,J AN 30 2001
AMT RECD:2 $ 26.50
CHANGE:
CASHIER:059
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CITY OF SPRINGFIELD~ OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00084-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759 .
Inspection Line: 726-3769
Location Of Proposed Site: 4633 Daisy St Spr
Assessors Map#: 17023243
Lot: Block: Addition:
Tax Lot #: 07801
Subdivision:
Owner:
Address:
Pam Harrison
Phone Number: 541-747-5113
City/State/Zip:
Springfield, OR 97478
Value: $0
4633 Daisy Street
Scope Of Work: Mechanical
Woodstove
Needs Preliminary inspection to determine if chimney is useful for fire or lining for wood stove
Alteration
Preliminary Inspection
Wood Stove
Office Use
Quad Area: Land Use: # Of Buildings:
# Of Units: Zoning Code: Occupancy Group:
Constr. Type: Bedrooms: , .~ Heat Source:
Water Heater: Range: f~~:n:c~',.': ..... Sq. Footage:
l\I"'j"" ""~~' ..
. . . :tV I,Jr\l"":. _ :~lt ~... ..'.... .
To request an inspection call the 24 hour recording atr72~376~!IAII....Ir.~pe~tlons re.quested before 7:00
a.m. ~ill be made the same working day, inSpeCtions.1~s~~e'd:~f!~!i?&~qJ~;r:n.,.wil!.9J;m~de the following
workIng day. c' II' Ou mal' ")bt ' lI1fOLiqt 0' ~'. .) I'.
a ''''1\''' ,'., :::II" , . I '"'1 l.,
· 61:;1 nr. .. ... , I ')'11)' , 'WI;;) -.,.., ,
R.n..... I' . t-:..t;~y ".IQ. ,,^ ".-1..
eqUlreul nsp~C?t9nsf:""'" \"J(.J[,. 'I :'. d.... {!J/:J3 U
I Mechanical '-'1 J~r,).. I, ,,;:.' -:;. r~/dpncl/o~'
-Prior to the installation of solid fuel appliance whiCh~i)i'bg)~Write.O.::\hrough an existing chimney.
-After installation. I
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
NonCE.
# Of ~WNesJAM;T Height (feet):
currE1~iTl!Jiji~~ZF'D SHALL EXp;!$r..op..osed Units:
C CA. 'r.- D~' ItA I,.., -" t: If' r~r:-
ensus/,,,,~~~C .oes not:app'I~Sp _ '7c WORk
IIAh. tnt''''.,.. 'E.AnA/T
."., 780DAY -"'\IABAND lVI, /SNor
Total: PER/CD, ONEDFOR
Fee
Paid On Receipt#
Mechanical
01/30/2001 4341
01/30/2001 4341
01/30/2001 4341
01/30/2001 4341
Value/Quantity
I
Fee Amount
Minimum Mechanical Permit
Administrative Fee - Mechanical
Wood stove
Mechanical Issuance
1,000
$.00
$.45
$15.00
$10.00
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Job# 01-00084-01
Paid On Receipt#
Mechanical
01/30/2001 4341
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Page 2 of 2
Value/Quantity Fee Amount
Fee
State Surcharge - Mechanical
Total Mechanical
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein 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. I further state that only contractors and employees who are in compliance with
ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are
, r/.uest~t the prope~ t~e and th~~he project address is readable from the street.
~ /?u/AJ.- .ym//M~ 1- 3D-Of
Signature / ' Date
$1.05
$26.50
$26.50