HomeMy WebLinkAboutPermit Mechanical 2001-9-13
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Job# 01-00994-01
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Page 1 of 2
TRANS#:01-0006687
DATE:SEP 13 2001
AMT RECD:2 $ 61.75
CHANGE:
CASHIER:061
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RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00994-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 605 Northridge Ave Spr
Assessors Map#: 17032621
Lot: Block: Addition:
Tax Lot#: 02216
Subdivision:
Owner:
Chris Kaisar
Phone Number: 541-744-7064
City/State/Zip: Springfield, OR 97477
New Value: $0
Address:
605 Northridge AV
Scope Of Work: Wood or Pellet Stove
Contractor Type
Mechanical Contr
,0
R' . # E -,;:~Ut~";~~'\D!I.~t
eglstrallon xplra Ion. a e.
r.~' 0" Q;"'" R>'
...l\rJ'O\e~","!::~~7:\j < '0'1 541-343-1131
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o~ '," .,},', 'r~ \JI '"
.....:,...~ ~\\.,i ,.....~ .....C b\"'~ ,,^O~.^(!i.
.,:.';- \:U __.,u- x....) 0' ~cv. 2).'"
Office Use '" ,:. ,~')) '.:" ",,\0 ,;,eo 0 'Ie ~\'V
,:,;" c c. "c,~ Q~. ,,<, ",0
Land Use: /,,<() ,*,0- r:5',.\li:l .;,,~G,#;Of,'Buildings:
~ I' f:o" ~~ :-;-,~ \,. ()':Y'
Zoning Code: "o,'po$; ~\.,o n."\;) .\ 0'0. {'\.I:! Occupancy Group:
"" "C" \jV :C>.., ('\\-. c.:"" ..,..
Bedrooms: 'Q~,\,?-<:j ,.) ~ c7- 0,0 Heat Source:
Range: 'I;',,~O"~,--\,o ....~e \'Z\'e,.", "Sq. Footage:
" ,,0; .,,~~ \0 _f"
\J- C;Oo' :.02' c_~\'
To request an inspection call the 24 hour recording at 726-3769. ~l.IiiRspections 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.
Pellet stove
Contractor
Phone
Midgleys
1678 W 7th Ave, Eugene, OR 97402
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
!
Required Inspections
Mechanical - --l
Freestanding Pellet
-After installation,
~a~'f..
,\y...~ ~a'\
~~ ~\S
~i-\l~ \l~~~ ~a~
~. ':;(-.~\.\. '\~S C~~'V
r:;'\\C ~'\ s ~'V~~ '.9~~'V
# Of Stories: ~ ,~,c.. 9~~Height (feet)~
,\,1'''' 2'''' 0" "
Current Units: ,-<,\0 Prop.osed,Units:
\\". ~,-,- 'C.'"
Census Code: Does not\'apRJy~~ ,,)>.'19
C,o" 0,1:\ "
I .-\ ,<,
Total: ~~
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
rArea (Sq. Feet)
Main: Accessory:
Fee
Paid On Receipt# Value/Quantity
Mechanical 'I
09/13/2001 6687
Fee Amount
Minimum Mechanical Permit
$15,00
Fee
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
.
Job# 01-00994-01
Paid On Receipt#
Mechanical
09/13/2001 6687
09/13/2001 6687
09/13/2001 6687
09/13/2001 6687
.
Page 2 of 2
Value/Quantity
Fee Amount
3,400
$3.60
$30,00
$10,00
$3,15
$61,75
$61,75
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 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 ins ction, I also understand that if I am requesting a preliminary inspection,
the wall covering may be r quired to be removed,
siC0/t-
C?//3 k I
Date
.
.
J
WOOD STOVElINSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: ":'03 77~~9""
l/()~ zb Z- (
k <:v-s~'-
. Address: &-lJ.5 /10~~1.p
City:~ ~ur~ lei State:
, / ;f
Value of Wood StovelPellet Stove/Insert: dfoo
~
Assessors Map #:
Owner: (?-Il~ S'
Tax Lot#:
(1) 2- 'Z ( (,
ax
D~
Phone#:
?<lc/ - 7oCoY
97'/77
Zip:
(please circle appropriate appliance)
preliminary~tion is $15.00 (prior to installation of insert)
Wood Stov elle nsert Permit is $15.00 + $ ,75 state surcharge + $.45 Administrative Fee + $10.00
Issuance.
Type of Inspection Requested: ,m,..A")[,.,~ A'tl.-/
Contractor: ~9 4~
Address: /67R /../) '77fr
<t?
City: I' ..k0..g-=t'
i
State:
Phone#: c7<1.3 -/13/
Zip: 9?~cJ2-
/0/,;(0/ C) '3
a
([)19.,8G~/
Expires:
Construction Contractors 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 Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing
approval "umber to the inspector at the time of inspection, I also understand that if I inn requesting a
prelimnnspection, ~e."l1 covering may be required to be removed,
~ e~!7 ~ 9-/2-0 J
Signature Date
FOR OFFICE USE
REQUIRED INSPECTION(S): ~ODYOVElPELLET/INSERT {PRELIMINARY
Date of APlilication: 0 9 1/ ..5/6 / Job #: 01- 0 0 9- '7 l.(- 0 (
Total Amount Collected: ? / ~ Receipt #: 66 r 1 Issued By: '0tt:
Checked for Delinquencies:
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Checked for Historical Status:
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