HomeMy WebLinkAboutPermit Mechanical 2001-12-31SPRINGFIELD
Job# 01-01439-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 ot 2
Job Number: 01 -01439-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 01500
Subdivision:
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225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 1515 00006th St Spr
AssessorsMap#: 17032642
Lot: Block: Addition:
ctTY oF SPRfiNGFfiELq OREGON
Owner: Pearl Dutton
Address: 1515 6th Street
Scope Of Work: Wood or Pellet Stove
lnstall pellet stove
Phone Number:
City/State/Zip:
New
541-746-0440
Springfield, OR97477
Value: $O
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
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To request an inspection call the 24 hour recording at
a.m. will be made the same working day, inspections
working day.
-.i before 7:00
will be made the following
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Required lnspections
Mechanical
Freestanding Pellet -After installation
Construction Types
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory:
ros
# Of Stories:
Gurrent Units:
Census Code:
Total:
I\rts Units
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Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical lssuance
1213112001
12t3112001
1213112001
12t31t2001
7647
7647
7647
7647
2,500
$15.00
$3.60
$30.00
$10.00
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Job# 01-01439-01 Page2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
State Surcharge - Mechanical
Total Mechanical
12t3112001 7647 $3.15
$61.75
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 prelimina ry inspection,
the wallcovering may be ired to be removed.
Signature
$61.75
/g- J/ -d /
Date
WOOD STO\TEIINSERT INSPECTION APPLICATION
CTTY OF SPRINGFIELD
COMMUMTY SERVICES DIVISION. BUILDING SAFETY
225 Fifth Street
Springf.eld, Oregot 91 411
SPFI}lCFIELI'
Office: 725-3159
INSPECTION LINE: 726-3'1 69
Job Location: / 91 6*' s +-
Assessors }vlap #:i)es 26"{ Z Ta:r /fx>o
Paa \,1{r:r'r
Address /fr f fL s*-'/6- OqqO
city: SPA sute a7 7
Value of Wood StovelPe[et t *o**' ZJaO @lease circle appropriate appliance)
Preliminary Inspection is $45.00 (p4-orlsin{talladon of insert)
Wood StovelPelletllnsert Pd, t$fl-Js (ry)tudes Permig Issuance Fee, State Sr:rcharge & Admin Fee).
!'pe of Inspection Requested:
Address
Citr
Constnrction Contractors
By sigdng this permit/application, I agree to call for an inspection(s) as requircd (726:j'769)-. I stat€ that
aU infor.utio on this appUcatioolpernit is correct ard that I was prwided with the Wood Stove Safety
information for wood burning appliances and preliminary insPecdotr standarats. I firrth€r state that the
appliance I am installing meets smoke €mission sta[dards as set by the Oregon De,partmcnt of
Enviroomeotal Quality or the Federal Ervironmental FroteCion Agency and I agree to provide the testing
approval numberto the insPector at the time sf inlpection I also rmderstand that if I am reEresting a
preliminary inspection,the coverrtrg maybe required to be removed.
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FOROFFICEUSE
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REQUIRED INSPECTION(S) :
Date of 3/o
Checked for DelinErencies:-
VALIDATION:
Job #:cy-otq77-ol
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