HomeMy WebLinkAboutPermit Mechanical 2001-11-16Job# 01-01273-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of2
SPITINGFIELD T*1\Llc1l+ll\illILrtt
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MT BTN
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 102 Woodlane Dr Spr
AssessorsMap#: 17032622
Lot: Block: Addition
Job Number: 01-01273-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 01800
Subdivision:
ctTY oF SPRTNGFTELD, OREGOTV
Owner: Pamela Gillen
Address: 102 Woodlane Dr
Scope Of Work: Wood or Pellet Stove
Replace existing wood stove insert
Phone Number:
City/State/Zip:
Alteration
541-747-6057
Springfield, OR97477
Value: $0
Contractor Type
Mechanical Contr
Contractor
ABC Stove Service
PO Box 108, Dexter, OR 97431
Registration # Expiration Date138ct? 5'\5.D3
Phone
541-937-8618
Office Use
Land Use:# Of Buildings:
Occupancy Group:
Heat Source:
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Zoning Code:
Bedrooms:
Range:
erilc
may obta
l -0010 tnr
090. Yot Sq. Footage:
ci ron UtiltrY
To request an inspection callthe 24hour recording at 726-3769. All
a.m. will be made the same working day, inspections requested
working day.
Required lnspections
Mechanical
-After installation
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq. F
Main:Accessory:
NOTICE: --\
THIS PERMTT SHALL EXPIRE IFTHEIIUOH(
AUTHORIZEO UT'I JiN TH I S PEHMTT ETOT
# of stories: Q,QMIfEU0EF0BISABANDoNEDFoB
Current Units: ANy frOp$GffitslQCI'
Census Code: Does not apply
before 7:00
a.made the following
Total:
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit 11t1612001 7273 $30.00
: u.]
Ii(-ii 1i
lnsert
Job# 01-01273-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Administrative Fee - Mechanical
Woodstove lnsert
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Grand
11t16t2001
1111612001
1111612001
11116t2001
7273
7273
7273
7273
1,000
$3.60
$15.00
$10.00
$3.15
$61.75
$61.75
1t- te -f,)
Date
I
3PFtHCF!ELE'
Ofrce: 126-3159
INSPECTION LINE: 726-3769
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COT.,NUTUTTTV SERVICES DTVISION - BUILDING SAT,ETY
225 Fifth Street
Springf,eld, Oregon 91 411
Job D \D(5o5 LWvt C D (?_
Assessors MaP 70 3ZCLZ o (gcx)
Y ftfnr-E
D}o 1.t1 t .o51
>f€6v?_.-
$ooo Glease circle appropriate appliance)
Value of Wood StovelPellet
Type of In$ection Requesteal:
0
q
TgK v
oz
Q26-3169). I state that
the Wood Stove SafetY
information for wood br:rning appliances and preliminary inspecdon standards. I firther state that the
appliance I aminstalliug meas moke emissistr standar<ls as setbythe OregonDeparurccrt of
Environnental Quatity or the Federal Euvironmental Protecion Agency aad I agree to provitle the testing
appro\/al number to ft6 in$ector at the time of inspection- I also understand that if I am reqrsting a
the may be reqrired to be removed.
ll-lb'o)
Date
FOROFFICE USE
\,
Freriminary Inspection is $45.00 (priol to installation of inse,lt)
Wood Stove/peltetllnsert psrmit is $61.75 (inclutles Permit, Issuaace Fee, State Surcharge & Admin Fee)'
cejLi 7H 3Lto
L.
REQ1JIRED
Date of It 0t
Checked for Delinqrencies : _
VALIDATION:
WOODSTO\IEIPEITETIINSERT PRELIMINARY
Job ot-o /273- o
Checked for Historical Stcfrrc.
Constnrction Contractors
By signing this to for an as rcquird
all information