HomeMy WebLinkAboutPermit Mechanical 2001-10-250Job#1 -0 1 1 183-0
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RESIDENTIAL PERMIT
Gity Of Springfietd
Community Services Division
Building Safety
225 North Fifth Street
Springfield, OR974t7
Location Of Proposed Site: 2Z9O OOOOgth St Spr
AssessorsMap#: 17032612
Lot: Block: Addition:
Job Number: 01-01 1 83-01
Office:726-3T59
lnspection Line: 726-3769
Tax Lot#: 01317
Subdivision:
Owner: Tiffanie Soper
Address: 2290 Bth Street
Scope Of Work: Wood or Pellet Stove
Pellet stove
Phone Number:
City/State/Zip:
New
541-736-0626
Springfield, OR97477
Value: $O
Contractor Type
Mechanical Contr
Contractor
ABC Stove Service
PO Box 108, Dexter, OR 97431
Registration # Expiration Date
\ )..N{
Phone
541-937-8618
Office Use
-
Quad Area:
# Of Units:
Gonstr. Type:
Water Heater:
Land Use:
Zonino Code:
Bedro-oms: UO'
Range: tON S\
roup:
Sq'.
To request an inspection callthe 24 hour recording at 769, 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
Required lnspections
Pellet lnsert
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq
Main:Accessory
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ication
# of{
arr-*,
Census Code:Does not apply
Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit 10t25t2001 7087 $15.00
CITY OF OREGON
Fee
Job#01 -01 1 83-0 1
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Administrative Fee - Mechanical
Pellet lnsert
Mechanical lssuance
State Surcharge - Mechanical
fotal Mech anical
Paid On
10t25t2001
10/25/2001
10t25t2001
10t25t2001
Receipt# Va Fee Amount
$3.60
$30.00
$1O.OO
$3. r5
$61.75
7087
7087
7087
7087
1,995
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. I also understand that if I am requesting a preliminary inspection,
the wall covering may be uired to be removed.
$61.7s
tflzs/n
Datd
WOOD STOYE/INSERT INSPECTION APPLICAIION
CITY OF SPRINGFIELD
COMMUMTY SERVICES DIVISION. BUILDING SAI'ETY
225 Fifth Street
Springf.eld, Oregot 91 417
SPFT}lGFIELD
Off.ce: 726-3'759
INSPECTION LINE: 726-3769
Job
Assessors Map Ta:r
Owner:
Address:
Citj4
Value of Wood
Contractor:
?3(o.LL
(please circle appropriate appliance)
Preliminary Tnipection is $45.00 GfiofToinstallation of insert)
Wood StovelPelletllnsert Permit t$61.?5 (incluttes Permit, Issuance Fee, State Surcharge & Admio Fee).
dr
CrV
Citr 7 efl--
Construction Contracton
By siming this permit/applicatior;I agree to call;or ao in$ection(s) as reErired (726-3769). I state that
all information on this application/permit is correct aod that I was provided with the Wood Stove Safety
infsrmation for wood burning alryliances and preliminary inspection stadads. I firther state that the
appliaocc I aoinsa[ingmeets smoke emission standads as setbythe OregonDeparmcot of
Environmelrtal Quatity or the Federal Environmental ProtectionAgeocy and I agree to provide tle testing
app:roral number to the inspector at the time sf inspection-I also understand that if I amrequesting a
preliminary inspection, the maybe required tobe removed.
FOROFFICEUSE
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REQUIRED INSPECTION(S):WOOD STO\IEIPELLET/TNSERT
Date of Applicatim:Z;a/Job ol -o/ ( y3 -o
Checked for DelinErencies:
VALIDATION:
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T;pe of Inspeaion Reqr:ested:
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Checked for Historical Staflrs:-:E>=-{-t E, ;tlT) f)
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