HomeMy WebLinkAboutPermit Mechanical 2001-11-16
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Job# 01-01268-01
Page 1 of 2
TRANS#:01-QQ07266
DATE: NOV 16 2001
AMT RECD:2 $ 61.75
CHANGE:
GASHIER:061
225 North Fifth Street
Springfield, OR 97477
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01268-01
Office: 726-3759
Inspection Line: 726-3769
*
Location Of Proposed Site: 45 Lorie Ct Spr
Assessors Map#: 17032241
Lot: Block: Addition:
Owner:
Address:
Tax Lot #: 02700
Subdivision:
Henrietta Bown
Phone Number: 541-741-8547
City/State/Zip: Springfield. OR 97477
New Value: $0
Scope Of Work: Wood or Pellet StDve
45 Lorie Ct
Install pellet stove
Contractor Registration # Expiration R\l.~~'\ Phone
Midgleys ~~-fff(; \S~0541-343-1131
1678 W 7th Ave, Eugene, OR 97402 <"-j.,,,>{?l o"c.""~~ cO""
~- .l \ v .,e., ...S'"
G~' l(Ir- _,{" O~v
Office US\\~\- "c.~~'\~\)~Q"c.~ t;,<o~~Q . .
Land Use: ~~\S~ 1(\\1.€ O""\S~ Of BUlldangs:
Zoning Code: ~~O ~~C"c.Q ",~\~'cupancy Group:
Bedrooms: O~~ Q~~ Heat Source:
Range: C; ",'l \'Ot:) Sq. Footage:
l'
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. inspectiDns requested after 7:00 a.m. will be made the following
working day.
Contractor Type
Mechanical Contr
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Freestanding Pellet
I
-After installation.
Required Inspections
Mechanical
.q)~'\O
o.1lW35) \.l\\il\'l
l\ \a.\l'l te otegol\ e\ \o\\~
,OtegO 'O'l \~e eS a,te S f,'?-'OO\'
~,,'ii\O~;OOQ\e~~ose tll~ OJ>."" 9 tll\eS 'o'l
~ >Il tll\eS l\wt. \~tOllg 0\ \~e ~ol\e
\0\\0 '0(1 Ce, nO\O ~nQ\eS \e\eQ \\0(1
# Of Stories: ~\O~I\\Ca,\1 <':2..Height\(fe-et):"e..\~e ~\O~I\\C'(j.
\~ ~9" ~"ov \".0\ "'\'l\~
Current Units: .~O~ -/0" 'Propose'd UnitS:I,1 ","..1,'\.
I". ,v v.'.' \lUI' :2.-':~'
Census Code: DoeS[fot9JPIlIYJ \~e .",e Ote aOO'?'?>
C\>I." \ot ,\' . \.u
I rtI'oet l\\at IS
Total: (Ill Ca
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
rArea (Sq. Feet)
Main: Accessory:
Fee
Paid On Receipt# Value/Quantity
Mechanical I
11/16/2001 7266
Fee Amount
Minimum Mechanical Permit
$15.00
e
Job# 01-01268-01
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,
,. Fee
Page 2 of 2
Value/Quantity Fee Amount
I
Paid On Receipt#
Mechanical
11/16/2001 7266
11/16/2001 7266
11/16/2001 7266
11/16/2001 7266
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
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 is correct. 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 cDvering may be required to be removed. I /
y~ 7/g~ \\/(b/O!
~~rn ~I
2,500
$3.60
$30.00
$10.00
$3.15
$61.75
$61.75
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SPRINGFIELD
WOOD STOVE/INSERT INSPECTION APPLICATION
. CITY OF SPRINGFIELD.
COMMUNITY SERVICES DMSION - BUILDING SAFETY
;1
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759.
INSPECTION LINE: 726-3769 '
IobLocation: 1-/ S- LoR..., ~ c +-
Assessors Map #: 170 3. Z. Z 4. (
Owner: 0 IhV 'E;. Irk", r. {~ JJ .
Address: Lf '\ Lo IL, e;- C +-
c;PtZ/!V(,..AEL.'0. Stale:
Tax Lot#: 02 7cr 0
Eoo//\./
Phone#:
7lf/ -"?5;'S'-{ 7
'77'177
City:
Value of Wood St~St~:
o(L
2- 'SOD
Zip:
(please circle ~"".w".:ate appliance)
~lim;nary Inspection is $45.00 (prior to installation of insert)
Wood StovelPe11et/Insert Pennit is $61.75 (includes Permit, Issuance Fee, State Surcharge & Admin Fee).
Type of Inspection Requested:.
Contractor.
//1/1 I f.\ CrCr= r s::
If::, 7:r t I _ 7/k
f:=-u..b-&V ('J
Ave
Phone#: 3'7'3 -j / "5 /
Zip:' 97f{O 2-
Construction Contractors Registration#: J 93(, '(. Expires: i 0/3110 L
I I
By signing this pemritlapplication, I agree to call for an inspection(s) as required (726-3769). I state that
all infonnation on this application/permit is correct and.that I was provided with the Wood Stove Safety,
information for wood burning appliances and pYP.Hm;nary inspection standards. I further state that the
appliance I am installing meets smoke emission standards as set by the Oregon D_,,~_ent of
Environmental Quality or the Federal Environmental Protection Agency and I agree.to provide the testing
approvaI number to the in..r---- at the time of inspection'. 1 also understand that if I am requesting a .
preliminary inspection, the wall cOvering may be required to be removed.
@ '.:~ W. Affl-'~
Signanne , . .
FOR OFFICE USE
Address:
City:
State: 0 e...
dY:f
1:90:~3IH8lJ8
: 39NlJH8 VALIDATION:
SL"1:9 $ Z:a83~ lWlJ
1:00Z 91: ^ON:31lJQ
99ZLOOO-1:0:#SNlJ~1
REQUIRED INSPECTION(~: WOODSTOVFJPELLET/INSERT PRELIMINARY.
Date of Application: /;//0r .. . Job#: 01 - 0 (2b& -0 (
Checked for Delinquencies: Checked for Historical Status: