HomeMy WebLinkAboutPermit Mechanical 2001-12-7
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I Job# 01-01354-01 I
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Page 1 of 2
TRANS#:01-0007451
DATE:DEC 07 2001
AMT RECD:2 $ 61.75
CHANGE:
CASHIER:061
SPRINGFIELD
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01354-01
225 North Fifth Street
Springfield. OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 5747 High Banks Rd Spr
Assessors Map#: 17022800
Lot: Block: Addition:
Tax Lot #: 01100
Subdivision:
Owner:
Mr Burgoin
Phone Number: 541-747-3276
Scope Of Work: Mechanical
City/State/Zip: Springfield, OR 97478
,) Value: $0
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ontractor _0'::- ,,' e..,s rat,unJ" ~(t:ltP'!ra Ion ate
,,:'~ ()"Q' ~'b' 'f:'v lo.~' ~r ~"
Ye Old Town Sweep ,,>~'~~,~ ~'<.'(5'~\~8t0"'0 0,~00~\~"l10/2002
81905 Davisson Rd, CresweU:"O~'~~'\Cl~ c,o~ .~_,~.~.
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Q d A L H'''U.-:1> ~<,j ~'I> 0~ 0,0 s:,~ # Of B 'Id'
ua rea: an,~~' tlf -0..:) 0v 0 \;13 UI mgs:
# Of Units: ZoiiinQlt'^i1e:,,~ ~~ i/o Occupancy Group:
.~ :1':'~ ~...'!) \0 ~0
Constr. Type: Bedrogm!b~ -s>0\ v0~ Heat Source: lk-
Water Heater: Range: <:-..:)~ Sq. Footage: ~~~&
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To request an inspection call the 24 hour recording at 726-3769. All inspections requested befor,&4fo$-"'~r!t
a.m. will be made the same working day, inspections requested after 7:00 a.m, will be made th~I~~
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eqUlre nspec Ions ~v 0" .Q,'('
Mechanical ~. t:-~ ~ :!??v:" Q'
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Height (feet):
Proposed Units:
5747 High Banks Rd
Address:
New
Install wood fireplace insert
Contractor Type
Mechanical Contr
Phone
541-485-4957
Insert
I
-After installation.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
[Ar~a (Sq. Feet)
_ Mam: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Mechanical
12/07/2001 7451
Value/Quantity
Fee Amount
Minimum Mechanical Permit
$30.00
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Job# 01-01354-01
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Page 2 of2
Fee
Paid On Receipt# Value/Quantity
Mechanical I
12/07/2001 7451
12/07/2001 7451 2,695
12/07/2001 7451
12/07/2001 7451
Fee Amount
Administrative Fee - Mechanical
Woodstove Insert
Mechanical Issuance
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
requested at the proper time and that the project address is readable from the street.
~#H~~ .---> /z/7/0(
Signature Date
$3,60
$15.00
$10.00
$3.15
$61.75
$61.75
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SPRINQPIELD
WOOD STOVElINSERT INSPECTION APPLICATION
'CITY OF SPRINGFIELD,
COMMUNITY SERVICES DMSION - BUILDING SAFETY
-'"
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759,
. INSPECTION LINE: 726-3769
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Assessors Map #: /7 () Z2 '1?oO
Owner: hrI (' B vV' qa V'\
Address: c; f '-I ~ Hi,1II &//1 K5 i<f) I Phone#: -, L-tl-32,<.o
City: ~r f ~ 1',' p r J State: t>~o
Value of Wood StovelPe11et StoveIInsert: zc&>q 5 - (please circle ~"..."".:ate appliance)
I
Preliminary Inspection is $45.00 )Pti-.v ~tion of insert)' .
Wood StoveIPe11et/Insert P~ludes Permit, Issuance Fee, State Surcharge & Admin Fee).
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. Type of Inspection Requested: New wood. .fT<eD\ac.e...:DiSev1 wi ~cleare:~
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Contractor: C~..\sW\l\S'C\\.(j ~~A, Y-e,OIJ.1711,AIV'\ Q..l."-......e~0
Address: 8 \ C1 () S. J'JO\J \ "S.SoV\ I'<D I Phone#: 72 Co -,!3 8 L
City: eN.' sv-re \ I . -- -. ~SUt~: ore. -- Zip:- - Of (L/ L ~
Constroction Contractors Registration#: S-z ~8 ( Expires: I / II /0 2-
I /
By signing this permit/application, I agree to.call for an inspection(s) as required (726-3769). I state that
all infonnation on this application.._.....:.~ is correct and that I was provided with the Wood Stove Safety
information for wood burning app1iances and preliminary inspection standards. I further state that the
appliance 1 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
~"".u,.1 number to the in.,..__~_. at the time of inspection. I also understand that if I am requesting a .
pre1imin.'Y inspection, the wall cOvering may be required to be removed.
Job Location:
Tax Lot#:
blfOO
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Zip:
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Signature ~
/2) 7/0/
Date' I
FOR OFFICE USE
T90:~3IHStJ::J
: 39Nl!H::J VALIDATION:
~L'T9 $ G:G::J3~ lWtJ
WOG J..O ::J3Q:31tJG
T~9LOOO-TO:#SNtJ~1
REQUIRED INSPECTION(S): WOODSTOVFJPELLETIINSERT
Date of Application: i zlo 7 ~ t Job #:
I I
Checked for Delinquencies:
PRELIMINARY
ol-OI3~I.{-O I
Checked for Historical Status: