HomeMy WebLinkAboutPermit Mechanical 2002-11-15City of Springfield
Mechanical Permit
Status: Issued
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
541-726-367 6 Fax
541-726-3769 Inspection Line
PERMITNO,:
ISSUED:
APPLIED:
EXPIRES:
MEC2002-00111
tut5l2002
tUt5t2002
sltsl2003
SITE ADDRESS
ASSESSORS PARCEL NO.
114 WOODLANE DR
1703262201700
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: Install wood insert
W
MRHALL
II4 WOODLANE DR
SPRINGFIELD OP.97477
541-746-3554
ME CHANICAL CONTRAC TOR:
cHRls B WINSLOW s4l-89s-3s93
81905 DAVISSON RD
CRESWELL OR 97426
CCB # 52381 Expiration Date: 01/1012004
Description
+ 7o/o State Surcharge
+ 8% Administrative Fee
-Issuance Fee-
Minimum/Adjustments - Mech
Wood Stove
3. l5 Ut5/2002
3 tt/15/2002
tll15/2002
1U1512002stUt5/2002
To Request an ing at 7 26-37 69. All inspections before 7:00 a.m. will be made
the same working day,after 7:00 a.m. will be made the wo*ing day.
Required Inspections:os
1 Preliminary tnspection: Prior to the installation of solid fuel appliance which will be vented through an exir
chimney.
2 Wood Burning lnsert: After installation.
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certif, that all
information hereon is true and correct, and I further certifu that any and all work performed shall be done in accordance with
the Ordinances ofthe City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I
further certiff that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I
further agee to ensure that all required inspections are requested at the proper time, that each address is readable from the
at the approved set of plans, if applicable, will remain on the site at all times during conshuction.
Receipt Number
I 20020000000000024 I
120020000000000024 I
120020000000000024 I
l 20020000000000024 I
l 20020000000000024 I
Cashier
dib
dib
dib
dib
dib
street,
or Contracton Signature
I of I
Date
Z-
.o'
"r)f
WOOD STOVE/INSERT TNSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMLINITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97 47 7
SPRIi'GFIELE,
Office: 726-3759
INSPECTION LINE: 726-37 69
CITY OF OFEGO'U
Job Location:
Assessors Map #
t-I i6'3 7 LZ Z TaxLot#: OlToO
Owner: 7vl rzrrvtr s tJ*t /
Address:4 7L/b-3ss{
City S .,nc f,)iol State: 0 alrr
Value of Wood Stove/Pellet Stove/Insert ZfOO ry (please circle appropriate appliance)
Address: glltX Dsr,s 99r- s {? 3
approval qumber to the inspector at the time of inspection. I also understand that if I am requesting a
inspection, the wall covering may be required to be removed.
t/-t{-4 7
Date
FOR OFFICE USE
Preliminary Inspection is $ [@(prior to installation of insert) ,z't r , Zf
Wood StoveiPelleUlnserff,ermit is $U-0e-+ t.ob state surcharge + $.45 Administrative Fee + g1g.qJ f C'/ -
Issuance. L--' \-----l
Type of Inspection Requested:
Contractor:/ at*t 22
REQUIRED INSPECTION(S WOODSTOVE/PELLET/INSERT V- PXrjI-T]MINARY 1,"
,.
Date of
Total Amount Collected: €'/':Receipt #
t ,--Checked for Delinquencies Checked for Historical Status:
Construction
By signing
all
appliance'l
Environmental
I$
to call for an
is correct and that I
and preliminary
smoke emission standards
I state that
Stove Safety
I further state that the
agree to provide the testing
\- --r
(;
ZA
!)
Federal Environmental
..t
tob*: J,ilet ZooL^C_<l-ltl
Issued ey: \ 6