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Home My WebLink AboutPermit Mechanical 1997-09-26UOOD STOVE/INSERT INSPECTIOI'I APPLICATTON CITY OF SPRINGFEILD BUILDING SAFET\' DIVISIOI{ 225 Fifth Street Springfield, 0regon 97477 SP6lINGFI€LO Of f ice: 726'-3759 INSPECTI0N LINE;' 726-3769 I €n ood Sto Job Loca t ion: Assessor-< l{ap il Ovner Add ress : Ci ty:S ta te: Value o PeIlet Stove/Insert Prelirfiinary Inspection is S15.00 (pripr to install Uood .Stove/Pellet/Insert Permit is S15.00 + S.75 s f insert) rcharge + S.45 administrative Ta>: Lot i: Phone: #: Zip Code: a atlon o tate su fee + 510.00 issuance = 526.20 total \ Type of Inspection Requested: Contractor: Address:hone #: Ci ty:State:,co Construction Contractors Regi:stration S:/6t By signing 'this permit/application, f agree to on(s) as required (726-3769). I state that all the information on this tion is correct and .tha I further t t-the appliance f am installing meets smoke .emission standards as set by the Oregon Departmen t of. Environmental Quality or the Federal Environnrcntal Protection Agency and I agree to provide the testing appr:oval number to the itrspector at the tirne of inspection. I also understand that if I am requesting a prc).iminary inspection, the vall covering may req u ob removed. {? ure Date e / lJOODSTOV FOR OFFICD USE PELLET./INSDRTREQUTRED INSPECTT0N(S) : Date of Application: TotaI Amount Collecte Receipt {l: PRELIMINARY - Job 1l Issued By -Checked for Deliquencies: dam Clrccked for Ilistorical Status: t.\hD-J SPRTNG€IELO uooD Sr(rvErrNSERT INSPECTI0N APPLICATTON CITY OF SPRINGFEILD BUILDING SAFETT DIVISIOI{ 225 Fiftlr Srreer Springfield, Oregon 97477 0ffice:. 726-3759 INSPECTI0N LfNE:- 726-3769 €n ;f-J:.I Itcl;t I Job Locat ion: Assessors Hap il \n \3 0vner Add ress : Ci ty: Value of Vood Sto ellet Stove/fnsert: Ta>: Lot fi: Phone: #: Zip Code: Prelirfrirrary fnspection is S15.Vood .Stove/pe}1et/fnsert permi fee + 510.00 issuance = 526.20 Type of Inspection Requested Con t rac [or: Address: Ci ty: Construc tion Contractors Regitst By signi ng (pripr ro insrallation of insert)s S15.00 + 9.75 srare sur.charge + S.45 administrativetaI Zip Code: o$Expires: to call for ins pection(s) as requi red 00ti r {tr (726-376e). IleciipC /J: ,T" permi t./applicatio1 s rare that aII the t and .tha t I vas provided vi th the ion on this permi t/application is correctstove Safety info rmation for vood burni ngappliances a nd prelim inary inspection standards. I {urther state that_the a pplianceI am instaL ling mee ts smoke .emission standards as set by the 0regon Depar tmen tEnvi ronmen t al Quali ty or the Federal Environnrcn tal pro te cti on Agency and f agree to qtprovide the test 1ng approval number t o the irrspector at the rime of ins pection. falso understand rha t if f am requesti removed.ng a prc).iminary ins pection, the vall coveringmay be required to be o re Da te ======== = = == = === ======== =======:======================================FOR OFI].tCU USE REOUIRED TNSPECTTON(S) :UOODSTOI/E /PELLET./TNSDR?Date of Applicarion:PRELTffTNA.R Y -L'-- To ta-l Amoun t Co,l-Lec ted..Job #: fssued By: -;lrecked for De-liquenci,es: q Chccked for Ilistorical Status, State: OOIW ( ooMMENCED OR lS ABANDoNEq FQR lr.rr ;s,iht$lffiffidffi !ffi\ ?l.i liJ.li.,],,,' AUTHORIZED UNDEB THIS PEBMIT 'S NOT S} ..GFIELO '- ELECTRICAL PERHIT APPLICATION CitY Job Number SCHEDULE BELOV approval, Zor225 TIFTE STREET SPRINGFIELD' OREGON INSPECf,ION REQTIEST: 0FFICE z 726-3759 INSTt) ?r6s9:JJ-3:l - AlthorlzodSignature, ALLATION Nev Residential-S MuIti-FamiIY Per Service Included: 97 471 726- 0 31.4 F ingle or dvelling unit'A ry1 lt ION3-o a JOB DESCRI C- El"ectrical Contractor Permits are non-transferablg tll expire ii-""tf. is not started vithin 1B0 days of issuance or ri vork is suspended for 180 daYs. 2. COMRASTOR INSTALIATION ONLY 1000 sq.ft. or less sach additional 500 sq. ft or Portion thereo f Each Manuf'd Home' or Modular Dvelling Service or Feeder SUBTOTAL OF ABOVE 52 State Surcharge 3Z Admini.strative Fee TOTAL Services or Feeders Installation, Alterations or Relocation: rt'\ 200 amps or less & 201 amPs to 400 amps - 401 amPs to 600 amPS - 601 amps to 1000 ?mPs- Over 1000 amPs/vo1ts - Reconnect OnlY I tems $ 40.00 s s0.00 s 60.00 s100.00 s130.00 s300.00 $ 40.00 Cos t $ 8s.00 $ 1s.00 not 40. 40. 20. 36. lm-Do i ncluded ) Sum ON B ci ty-Phone Supervisor License Number Expiration Date C. Constr Contr. Number Expiration Date Signature of Supervising Electrician Temoorary Services or Feeders ii.l.fl"ii"", ALteration or Relocation .00 .00 .00 il8il 6dva Ovners Name Address (S 7 b Ci ty pn"," 71tc'4*O OVNER INSTALI"A'TION The installation is being made on property f ovn vhich is not intended for sale, Iease or rent. rt: DATE: RECEI D. Branch Circuits Nev, Alteration or Extension Per Panel' One Circuit Each Addi tional Circuit or vith or Feeder Permit $ 3s.00 $ 2.00 200 amps''or less S 40 ioi ;;; to 4oo amPs - i :: over 4b1 to 600 amPs - $ BU 0ver 600 amPs or L000 volts see Service,,L/8oo Miscellaneous ( Service/feeder -Each installation Pump or irrigation $ sign/outline Lighting- $ t imi ted Energy/Res - $ Limited Energy/Comm $ D i E 00 00 00 00 5 RECEIYED B tTt 00 I Permit #:/3 (" Address 1S I S 37t^- Issued by / rh il,*Date Q 1,,lqv Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities l{ote.- Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the folpwing statement Ui|orc abuildingpermit canbe issued. This statement is required "for resiiental bufldiig, electrical, mechanical, and plumbing permits' Licensed architucr and engineer-applicants, exempt from registration under ORS 701'010(7)' need not submit this statement. This statement will be filed with the permit' Fill in the appropriate blanks and initial boxes 7 and2, and either box 34 or 38, l. I own, reside in, or will reside in the completed structure' 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or uPon comPletion. W 3,A.. My general contractor is (Name) I will instruct my general contractor that all subcontractors who work on the registered with the Construction Contractors Board' (Signature of permit applicant) (White copy to issuing agency permit file, pink copy to aPPlicant) Contractor regis. # structure must be OR 38. I will be my own general contractor If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the ccB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certifY the above information is correct and that I have read and do understand the Information C ction Responsibilities on the reverse side form ///rzNotice to Pro (Date)