HomeMy WebLinkAboutPermit Mechanical 2001-10-02Job# 01-01078-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
SPRINGFIELD
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 454 00039th St Spr
Assessors Map#: 17023114
Lot: Block: Addition:
Job Number: 01-01 078-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 01601
Subdivision:
crTY oF sPRrNcFrELD, OREGON
Owner: Tom McLennan
Address: 454 39th Street
Scope Of Work: Wood or Pellet Stove
Pellet stove
Phone Number:
City/State/Zip:
New
541-747-3121
Springfield, OR 97478
Value: $O
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
Mechanica!
Freestanding Pellet -After installation
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
# Of Stories:
Current Units:
Census Code:
$IORK
Area (Sq. Feet)
Main:
Fee
Accessory:Total:
Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit
Administrative Fee - Mechanical
Pellet lnsert
Mechanical lssuance
1010212001
10t02t2001
10t02t2001
10t0212001
6874
6874
6874
6874
700
$1s.00
$3.60
$30.00
$10.00
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Job# 01-01078-01 Page 2 of 2
Fee Paid On Receipt#Value/Quantity Fee Amount
Mechanical
State Surcharge - Mechanical
Total Mechanical
10102t2001 6874 $3.1 5
$61.7s
Grand Total
By signing this permiUapplication, I agree to call for an in spection(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 req uesting a preliminary inspection,
$61.75
the wallcoverinoc--i
/lmrus //
may be required to be removed.
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Signature Date
WOOD STO\E/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIEID
COMMI.'MTY SERVICES DTVISION . BUILDING SAEETY
225 Fifth Strcst
Sprinefiel4 Orc9or91471
SP}IItrGFIELD
Offi,ce: 726-3759
.
INSPECTION LINE: 726-3769
It-Job
Assessors }vfap
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Address: alS Tl^
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Value of Wood
keliminary Iospection is $45.00
Wood StovelPelletllnsert
T)pe of rnspection
tzl
ok 1111e
a7 (please circle appropriate appliance)
ofinsert)
Permit, Issuance Fee, State Srucharge & AdminFee).
$
Construction Contractors
By sieBing this permit/application, I agree to call for aninspection(s) as reErired (726-3169). I state that
all information onttris application/permit is corect and that I was provided with the Wood Stove Safety
information for wood burning appliances and preliminary insp€ctim standards. I firrther state tbat the
alrpliaace I aminstallingmeets smoke missionstardards as setbythe OregonDqratu€ntof
Euvironmental Quality orthe Federal Enrdronmental Protecion Agency and I agree to provide the testing
approval number to the inspector at the time qf inTectioL I also understand that if I am requesting a
preliminary inspeqtion, the wall covering may be required to be removed.
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FOR OEFICE USE
Date' ,/
REQUIRED INSPECTION(S): WOODSTOVE/PELLET/INSERT
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VALIDATION:
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