HomeMy WebLinkAboutPermit Mechanical 2001-12-07225 North Fifth Street
Springfield, OR97477
Location Of ProPosed Site:
Assessors MaP#: 17033613
Lot: Block:
Job#01 -01 356-0 1
220 00021stSt SPr
Addition:
RESIDENTIAL PERMIT
CitY Of SPringfield
CommunitY Services Division
Building SafetY
Page 1 of 2
Job Number: 01-01 356-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 06200
Subdivision:
Scope Of Work: Wood or Pellet Stove
Wood stove installation
PhoneNumber: 541-736-0288
City/State/Zip: Springfield, OR97477
New Value: $O
Registration #
1 9364
Owner:
Address:
Contractor TYPe
MechanicalContr
Cheryl Dorbolo
220 21sl Street
Contractor
Midgleys
1678 W 7th Ave, Eugene, OR 97402
Phone
541-343-1 131
Quad Area:
# Of Units:
Constr. TYPe:
Water Heater:
Office
Land Use:
Zoning Code:
Bedrooms:
Range:
r$'{
# Of Buildings:
Occupancy GrouP:
Heat Source:
Sq. Footage:
Area (Sq. Feet)
Main:Accessory:
Current Units: Proposed Units:
Census Code: Does not apply
Total:
Fee Paid On Receipt#Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit 12107t2001 7457 $15.00
SPRINGFIELD
II
(feet):
To request an inspection callthe 24
a.m. will be made the same working
working daY.
hour
day,
Wood Stove
Gonstruction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? [
-After
CITY OF OREGON
Job#01 -01 356-0 1
Page? of 2
ReceiPt#ValuelQuantitY Fee Amount
Mecha nicalFee
Paid On
1210712001
1210712001
1210712001
1210712001
Administrative Fee - Mechanical
Woodstove
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Signature
7457
7457
7457
7457
2,900
$3.60
$30.00
$10.00
$3.15
$61.7s
$61.75
2--\ -o \
Date
SPBT,I.GFIELD
WOOD STO\IEIINSERT INSPECTION APPLICANON
CITYOF SPRINGFIELD
COMMUMTY SERVICES DTVISION . BI]ILDING SAFETY
225 Fifth Street
Springf.eld, Oregot 97 477
Office: 726-3159
INSPECTION LINE: 726:3'769
zzo z(il >+-Job
Assessors Map 33€/i
o si
Sp,..JdLln n
Value of Wood StovelPellet
Preliminary Inspection is $45.00
Wood StovelPelet^osert Pemit
Tax c 6rc<;
o v
$!u t
circle appropriate appliance)
of insert)
Pemit, Issuance Fee, State Surcharge & AdminFee).
o()
Type of Inspection Requestd:
CYrr 6-tr t\
t.75
\
Constnrction Contractors Regisfation#: Expires:_
By signing this permit/application, I agree to call for an inlpectio($ as required (726-3769). I stare thatall infornation onthis application/permit is correct and that I was provided withthe Wood Stove Safetyiaformation for wood burning appliances ard preliminary inspection stadards. I further state that &ea1ryliance I am iostalling meets smoke emission staJrdards as setbythe Oregon Departuent ofEnvironmental Quality or the Federal Euvironmental ProtectionAgency and I agree to prwide the testingapprovalnumber to 1[s inspector at the time of inspeAion- I also rmderstand that if I am reEresting a
covering maybe reErired to be removed.
OA
FOR OFFICE USE
REQTJIRED INSPECTION(S): VIOoDSTO\IEI?ELLET/INSERT-PRELIMINARY
Date of 07o Job
Checked for D elinqr:encies :_
VALIDATTON:
Checked for Historical Status:
6-o