HomeMy WebLinkAboutPermit Mechanical 2000-07-18SPRINGFIELD
Job# 00-01121-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 424 S 00040th St Spr
AssessorsMap#: 17023144
Lot: Block: Addition:
Job Number: 00-01 121-01
Office: 726-3759
Inspection Line: 726-3769
Tax Lot#: 01602
Subdivision:
ctTY oF SPRfiNGFIEL4 OREGON
Owner: Jerry Abell
Address: 424 S 40th
Scope Of Work: Wood or Pellet Stove
pellet stove
Phone Number:
City/State/Zip:
New
541-726-9798
Springfield, OR 97478
Value: $t
Quad Area:
# Of Units:
Gonstr. 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
Pe!let lnsert -After installation.i!'l (J
009
c
numoe
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? [
Area (Sq
Main:Accessory:Total:
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
NOTICE:
Fee
Minimum Mechanical Permit
Mechanical Administrative Fee
Pellet lnsert
Mechanical lssuance
Paid On
07t18t2000
07t18t2000
07t18t2000
0711812000
261
261ANY 180 DAY PERIOD.2611 1
2611
OR ISABANDONED FOB $.00
$.45
$15.00
$10.00
Mechanical
Job# 00-01121-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
0711812000 2611 $1.0s
$26.50
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,
wall covering may be required be
sig re
$26.50
' t /.,'oo
Date
State Surcharge For Mechanical Permit
Total Mechanical
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97 47 7
SPRiI'IGFIELO
Office: 726-3759
INSPECTION LIIIE: 7 26-37 69
OREGO'VCITY OF SPR
l,
Job
Assessors Map #laOZ3(qq
Owner:
Address:
Tax Lot#:c>t Lo z
Phone#: 7 2l ?7" fl
qau76
Value of Wood Stove/Pellet Stove/lnsert:QAA a, O O (please circle appropriate appliance)
Preliminary Inspection is $ I 5.00 (prior to installation of insert)
Wood Stove/PelleVlnsert Permit is $15.00 + t.o5 state surcharge + $.45 Administrative Fee + $10.00
Issuance.
Type of Inspection Requested:
Contractor:
Address Phone#:
City:zip:
Construction Registration#:_
By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that
all information on this application/permit is correct and that I was provided with the Wood Stove Safety
information for wood burning appliances and preliminary inspection standards. I further state that the
appliance'i am installing meets smoke emission standards as set by the Oregon Departrnent 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
inspection, the wall may be required to be removed.
n^tB-oO
Date
FOR OFFICE USE
REQUIRED INSPECTION(S):WOODSTOVE/PELLET/INSERT PffiLflvfD{lrR#-
Date of Application:o OA Job oo-o((z(-of
Total Amount Collected Z6 56 *, Z6( f rcrr"a
D= --{-{ E';TJ}D7J 12.rqmcoc3..4+t]f, c-{ .... E(3
r...1 r H
I#l Fr (3
fE(}r.J C)trr. r'.J r.J, c)o.LNOFC>(=F
FaC.]m-E:D
(:)mo.mH..
Checked for Delinquencies:- Checked for Historical Status:
)6