HomeMy WebLinkAboutPermit Mechanical 2002-09-17Job# 02-01117-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2 @
SPR!iIGFIELD
225 Fitth Street
Springfield, OR97477
Location Of Proposed Site: 553 S 00037th St Spr
AssessorsMap#: 17023143
Lot: Block: Addition:
Job Numbe r: 02-01 1 17 -01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 04502
Subdivision:
ctTY oF SPRINGFIELD, OREGON
Contractor Type
GeneralContr
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Gontractor
Ronnie D Shru
3955 Alcona
New
\t
13
Use
-
# Expiration Date
4t30t2003
Phone
541-746-0697
Owner: Steve Kictehen
Address: 553 S 37th Street
Scope Of Work: Wood or Pellet Stove
lnstall pellet stove
Phone Number: 541-521-9773
City/State/Zi oR 97478
$o
Heat
\!,e
\$
Zoning Code:
Bedrooms:
Range:
To request an inspection call the 24 hour recording at 726-3769. All
a.m. will be made the same working day, inspections requested
working day.g$
\n"t o\
Preliminary lnspection
Freestanding Pellet
Construction Types:
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
(Sq. Feet)
-Prior to the installation of so
-After installation.
through an existing chimney
1\B
# Of Stories: Height (feet):
Gurrent Units: Proposed Units:
Census Code: Does not apply
Main:Accessory Total:
# Of Buildings:
Occupancy Group:
Job# 02-01117-01 Page2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit
8% Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
09t17t2002
09t17t2002
09t17t2002
09t17t2002
09t17t2002
1 0634
1 0634
1 0634
10634
10634
1,100
$15.00
$3.60
$30.00
$10.00
$3.1 5
$61.75
Grand Total
By signing this permiUapplication, 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
$61.7s
*"*ff:,o:removed
9 -i7 -a'L
Signature Date
225FIF|H STREET . SPRINGFIELD, OR 97477 o PH:(541)726-3753 r FAX; (541)726-3689
cityJobNumber C'Z -O lllT-0(
Job
Assessors
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Address 593 -S s>+L )J-Phone s2/-?))>
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City
Value of Wood StovelPellet
Preliminary Inspection is $45.00 (prior
lVood Stove/Pellet/Insert Permit is $61.
ftoPuis
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(please circle appropriate appliance)
Issuance Fee, State Surcharge & Admin Fee.)
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Construction Contractors Registration I2///
Bysigningthispermit/application,Iagreetocallforaninspection(s)asrequired(7.26.3769).Istatethatall
information on this application ipermit is correct and that I was provided with the wood Stove Safety
information for wood burning appliances and preliminary inspection standards as set by the oregon Department
of Environmental Quality or the Federal nrri-rr-"rtal i'roteition Agency and I agree to provide the testing
approval number to tfr. irrrp""tor at the time of l'spection' I also understand that if I am requesting a
;;;il;"t insp"ction, ir'"'*", covering may be riquired to be removed '
For 0ffice Use
?OL/
Date of APPlication
O--'for Historical Status
Checked for Delinquencies
Stured Drive(T)/Building FomJwood Stove ?emitl-O2'd@
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