HomeMy WebLinkAboutPermit Mechanical 2000-09-20Job# 00-01416-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
SPRINGFIELD
Page 1 of 2
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AHT HE[D:? $ ?6.50
IHANGE:
IASHIER:061
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 4010 E 00016th Ave Spr
AssessorsMap#: 17033443
Lot: Block: Addition
Job Number: 00-01 41 6-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 06600
Subdivision:
ctTY oF SPRINGFTELD, OREGOTV
Owner: David Carvo
Address: 1430 Willamette
Scope Of Work: Mechanical
Phone Number:
City/State/Zip:
New
503-267-1878
Eugene, OR 97401
Value: $800
This is a copy with a new Application Number
Quad Area:
# Of Units:
Constr. Type: (VN) Wood Frame
Water Heater:
Office Use
-
Land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group: Dwelling
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
SHALLEXPIRE IFTHEWOHKMechan
ERMITISNOTWood Stove -After installation AUTHORIZED UNDERTHISP
COMMET'JCED ORISABANDONED FOR
Construction Types(VN) Wood Frame
Occupancy Groups: Dwelling
ANY lsoDAYPERIOD
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory:
Minimum Mechanical Permit
Mechanical Administrative Fee
Woodstove
Mechanical lssuance
# Of Stories:
Current Units:
Census Gode: Does not
Total:
Paid On in
09t20t2000
09t20t2000
09t20t2000
09t20t2000
rul
forthe
3263
3263
n UtilitYN otitication
Height (feet):
Proposed Units
Fee Amount
$.00
$.45
$15.00
$10.00
n
Centnri$ i
800
Job# 00-01416-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
State Surcharge For Mechanical Permit
Total Mechanical
09t2012000 3263 $1.05
$26.50
Grand Total
By signature, I state and agree that I have carefully examined the completed application and do
hereby certify that all information herein is true and correct, and I further certify that any and all work
performed sha ll be done in accordance with the Ordinances of the City of Springfield and the Laws of
the State of O n. I further state that contractors and employees who are in compliance with
ORS on this I further agree re that all required inspections are
r time project ad readable from the street.
$26.50
WOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfi eld, Oregon 97 41 7
SPllI,{GFIELO
Office: 726-3759
INSPECTION LINE: 726-3769
C'TY OF SPR OREGO'V
/-h -/-Job
Assessors Map #:t7037 "{L{ 3
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Tax Lot#OCbo
/>*4
City zip:,
stove/Insert: q@ * (please circte appropriate appliance)
Total Amount Collected 3c,6:Issued By:
CheckedforDelinquencies:-CheckedforI{istoricalStatus:
7*/*7y'
Value of Wood Stove/Pellet
Preliminary Inspection is $ 15.00 (prior to installation of insert)
Wood Stove/PelleUlnsert Permit is $15.00 + t.o5 state surcharge + $.45 Administrative Fee + $10.00Issuance. ' I
Type of Inspection
Contractor:
Address: Phone#:_
City: State: Zip:_
Construction Contractors Expires
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 Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing
approval to inspector at the time ofinspection. I also understand that ifI am requesting a
be required be removed.
07 zo oo
Date
FOROFFICE USE
REQUIRED INSPECTION(S): WOODSTOVE/PELLET/TNSERTj)---_PRELTMINARY_
Date of Application:o?zoeo Job#: oo ^o(1/6'O I D:r
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