HomeMy WebLinkAboutPermit Mechanical 2001-09-20SPFINGFIELD
225 North Fifth Street
Springfield, OR97477
Job# 01-01029-01
RESIDENTIAL PERMIT
City Of SPringfield
Community Services Division
Building SafetY
Pagel of2
Job Number: 01-01029-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 04605
Subdivision:
Location Of Proposed Site: 715 S 00037th St Spr
AssessorsMaP#: 17023143
Lot: Block: Addition:
crrY oF SPRTNGFTELD, OREGOTV
Owner: Bryan Cunningham
Address: 715 S 37th Street
Scope Of Work: Wood or Pellet Stove
Wood insert
Phone Number:
City/State/Zip:
New
541-747-8080
Springfield, OR 97478
Value: $O
Contractor Type
Mechanical Contr
Contractor Registration # Expiration Date
Ye Old Town Sweep
81905 Davisson Rd, Creswell, OR 97426
Phone
541-485-4957
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 a1726-3769. 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.
Required lnspections
Mechanical
Wood Stove -After installation
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?Census Code: Does not apply
Height (feet):
Proposed Units:
Area (Sq.
Main:Accessory:Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit 0912012001 6749 $30.00
[t'-r '
tr
# Of Stories:
Current Units:
Jo b#01 -01 029-0 1 Page2 ot2
Paid On ReceiPt#Value/QuantitY Fee Amount
icalMechan
Fee
Administrative Fee - Mechanical
Woodstove lnsert
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Signature
0912012001
0912012001
0912012001
0912012001
6749
6749
6749
6749
2,500
$3.60
$1s.00
$10.00
$3.15
$61.75
$61.7s
2a ol
Grand Total
BysigningthispermiUapplicati.on,.laglT-t?callforaninspection(s)asrequired(726-3.769).lstate
that ail information on this apprication i. "orrJJi.
iiurtn"r itat" tnitine appriance r am installing
meets smoke "ri.sion
,ianilrrOi ,, set Oy'iir-e'Ot"gon Department of Environmental Quality or the
Federar Environmentai iiotection Agency ,"JrIgrJ" 10 nrovrog irre testing approvar number to the
inspector at the time ;ii;;;;;ti;". iarso ,"i"i.lino tnai it t am requestin! a'preliminarv inspection'
inl'*"ircovering may be required to be removed'
Date
WOOD STO\IEIINSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DTVISION -BUILDING SAFETY
225 Fifth Street
Springf,eld, Oregon 97 411
SPFIi.GFIELD
Office: 126-3759
INSPECTION Lt{E: 7 26'37 69
Job Location:
'1 t5 5. 3rt5 3r,
Assessors Map #:IZ Z3 (-( 3
Value of Wood
Preliminary Inspection is
Wood Stove/Pelletllnsert
I)pe of Inqpection
Cltrts /rt /out
Ta:<oqkf
1Anl
g+.q-7 -o80
o
Stwellnsert- (pleasecircleappropriateapp[ance)
$45.00 ofinsert)
Pemit, Isstrance Fee, State Surcharge & AdminFee).
3i\5a^r+{\ilrQ <,**""rx{t:<a )
e
o S5 ora.L 8q -25 13
city4t<Sw<(( sta,., O( zp' 9?q2\<
Constnrction Contractors z3g (/o oz
By siedng this permir/application" I agree to call for aninspection(s) as required Q26-3769\. I state tbat
all information on this application/p€rmit is correct and that I was prwided \rith ths Wood Stove Safety
information for wood burniag appliances and preliminary insp€ction standards. I firrther state that the
aqrpliance I am installing meAs snoke emission standaxds as set by the Oregon Departuent of
Ervironmental Quatity orthe Federal Eavironmental Frotection Agency and I agree to prwicle the testing
approval ilrrnb€r to the inspector at the time sf inspectior I also rmderstand that if I am regesting a
preliminary inspection, the wall colering maybe reryired tobe removed-
7/zo/o1
$61.75
Signature Date
FOR OFFICE USE
REQIJTRED INSIECTION(S): WOODSTO\IEIPELLeImISrnIS--'TnSUMINARY-
Date of oTzoc)Job ol-o tc z _4(
Checked for Deiinquencies :i-
VALIDATION:
-1V 1n;.rt bLC( '
Checked for Historical