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HomeMy WebLinkAboutPermit Mechanical 2000-10-11 II J .. -. I Job# 00-01529-01 I . Page 1 of2 TRANS#:01-0003449 DATE: OCT 11 2000 AMT RECD:l $ 40.00 CHANGE:$ 13.50 CASHIER:061 CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-01529-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 5576 Glacier Dr Spr Assessors Map#: 18020411 Lot: Block: Addition: Tax Lot #: 00900 Subdivision: Owner: Donald Kindt 5576 Glacier Dr Phone Number: 541-726-0834 City/State/Zip: Springfield, OR 97478 New Value: $3,100 Address: Scope Of Work: Wood or Pellet Stove install pellet stove Quad Area: # Of Units: Constr, Type: Water Heater: Office Use Land Use: Zoning Code: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq, Footage: 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 working day. Freestanding Pellet I -After installation. Required Inspections M h . I NOTICE: ec amca .. r I HiS PERMIT SHALL EXPIRE IFTHE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? D [Ar~a (Sq. Feet) _ Main: Accessory: # Of Stories: Current Units: Census Code: Does not apply Height (feet): Proposed Units: Total: A TTENTION:Oregon law requires you tll Inlln,,, rl ,I,,,, "rlnntorl hv 'ho nrAnnn Utilitv t____ . Paid On R~n~llrrt#UU" v~V~lUe/6"1~litim"" a'''~J I;.'~ount ~C; ..P~r'\t:''' nn, ...,.j ..\.a.......I!"."dcCJ~.._~n. Mechanicalnon Vnl' rrlay obtain copies of the rules by 10/11/2000 344!lallino thp center. (Note: the telephone $.00 10/11/2000 3449.!11bGl for (hI" Oreaor, Utility Notificatiol" $.45 10/11/2000 3449 ' ;-3,100:'~." $15.00 10/11/2000; 3449 $10.00 J Fee Minimum Mechanical Permit Mechanical Administrative Fee Freestanding Pellet Stove Mechanical Issuance / . .. Fee State Surcharge For Mechanical Permit Total Mechanical Job# 00-01529-01 . Page 2 of2 Paid On Receipt# Mechanical 10/11/2000 3449 Value/Quantity Grand Total By signing this permiVapplication, 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. J also understand that if I am requesting a preliminary inspection, the WaJ~7ring may be~reqUired to be removed. /2/~:z%-- ~d1 7/'- .---- Signature Date i/ Fee Amount $1.05 $26.50 $26.50 /0 hi do