HomeMy WebLinkAboutPermit Mechanical 2001-10-26SPHINGFIELE!
Job# 01-01192-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 oI 2
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2524 00031st St Spr
AssessorsMap#: 17021933
Lot: Block: Addition:
Job Number: 01-01 192-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot#: 01200
Subdivision:
ctrY oF SPRiNGFiELD, OREGOTV
Owner: Scott Adair
Address: 2524 31sl Street
Scope Of Work: Wood or Pellet Stove
Pellet stove
Phone Number:
City/State/Zip:
New
541-953-1 195
Springfield, OR 97478
Value: $O
Contractor Type
MechanicalContr
Contractor
Marshalls Heating
4110 Olympic Street, Springfield, OR
97478
Registration # exniratlonnp€$$rr)o.*grrone
-,.,,,:'iiIiii 8ffi]^""
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
Land Use:
Zoning Code:
Bedrooms:
Range
p: Accessory Structu
To request an inspection call the 24 hour recording at726-3769. 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
Handicap Access? [Census Code: Does not apply
Area (Sq. Feet)
Main:Accessory:Tota!:
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Minimum Mechanical Permit 1012612001 7105 $15.00
w
Job# 01-01192-01 Page 2 of 2
Fee Paid On Receipt# Value/Quantity Fee Amount
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Mechanical
10t2612001
10t26t2001
1012612001
10t26t2001
7105
7105
71 05
7105
3,075
$3.60
$30.00
$10.00
$3.15
$61.75
Grand Total
By signing this permiVapplication, 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,
the wall ng may be required to be removed
$61.75
/r/r6/ar
Date /
WOOD STO\TEIINSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMI.]NITY SERVICES DIVISION . BT]ILDING SAT'ETY
225 Fifth Stest
Springfi.eld, Oregon 91 417
SPFI}IGFIELTI
OEce: 726-3159
INSPECTION LIIIE: 7 26-37 69
*Job
Assessors lvlap .*r +d )A
3 sl- s+-
..fl (please circle appropriate appliance)Value of Wood
Tlrpe of Inspection
Freliminary Inspection is $45.00 (pqq:toiqtafladon of insert)
Wood Stove/pAteUnsertpermitis@i.Z1gilUaes Pemig IssuanceFee, State Surcharge & AdminFee).
Coilractor:a (/:q ilrb [nr C
City:7
Constnrction Contractors Regisffiion#:
By signing this permit/application, I agree to call for 2a inTection(s) as reErired Q26-3769). I state that
Af ioforoati* o" tlis appUcationlpqmit is couect and that I was prwided with the Wood Stove Safety
infomration for wood br:rning appliances and fretiminary insp€ction standards. I firrther state tbst the
appliance I am installiag oeas smoke €oission statdards as set by the Oregon De,parmelrt of
Eirironmertal agaliry &tUe f.aerat EuvironmatalProtectionAgency and I agree to providethetesti4g
approval u16ber to the inspector at the time of inspection- I also rmderstand that if I am requ€sti4g a
maybe rcErired to be removed.
Signature Date
FOR OFFICE USE
REQUTRED INSPECTION(S): WOODSTO\iEIPELLETANSERT_ -f PRELIMINARY-
Date of 6-c Job o o( l?z-a
Checked for DelinErencies:- Checked for Historical
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VATIDATION:1p{
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