HomeMy WebLinkAboutPermit Building 2001-9-11
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I Job# 01-00981-01 I
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Page 1 of 2
TRANS# : 01--0006663
DATE:SEF' 11 2001
AMT REeD:l $ 61.75
CHANGE:
CASHIER:061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00981-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 5335 Daisy St 62 Spr
Assessors Map#: 17023300
lot: Block: Addition:
Tax lot #: 01300
Subdivision:
Owner:
Address:
Barbara Koroush
Phone Number: 541-747:'5656
City/State/Zip: Springfield, OR 97478
New Value: $0
5335 Daisy sp 62
Scope Of Work: Wood or Pellet Stove
Install woodstove
,..IO<:(..'f'
Office Use \x '\\-\<(;. ~~ ~Q'\
Quad Area: land Use: # Of)'BUilttings,:\CO
CJ-.\ 0' c.W'" 9...
# Of Units: Zoning Code: c;(\(i"'~. ~,.l~'0occup'~acy Gr.o~u"""p:
1:l..\1R\ \ \'Y <'{ 0" n --:'(,\ .....,,\'(:~
Constr. Type: Bedrooms: \~v X\w.' \ ~ltIeat Source:'
Water Heater: Range: -<,\\'0 \'~ \"'I~~ \J~ S\~. l~t;ge:
\ '(\ ,,,o.:\t.- ~Q.. ~
. \\ '(\v X;.\.l '" ~,
To request an inspection call the 24 hour recording at 726-3769. AIIfiD~R~cti~S"ie:(u~~ed before 7:00
a.m. will be made the same working day, inspections requested aftef.Jioo f\::.'J'~~ill be made the following
working day. t>-\,\i
Wood Stove
I
-After installation.
Required Inspections
Mechanical
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main:
Accessory:
\0
'0\\
-:\~2f) 0~.\\\~....~
QV\" -\',\ "or.
\'7}1\I ~, I ~\e~~ ~~/..i\' ro.,Q'\ #
^~ .,,.'" \. ,,\3 ,n#v
"r.-~" 0_'\'\.\'" . ~ ~ c::J:Jr-- '0'1
~.~3' . (:JC.....) :l d.) ~~ \)v<,~
..;:.\0\ ~ 6'j~)~:; "(,,OS ~~"\ 0 \'(\0 ~ o<{\e
~€ ~'V\9~"'~ef\\e".~.\(). '{{\\Cl '~\ef> c~ \o\Ov-r: ~~O'{\
# Of Stories: ~O\\O~ ,\o'{\H~ignt'(~e,~t)':')~o.,\'{\e "-\0\\\\0
\ .'\c'O' n.IJV ....'0\:0. .,,,\"" .\",~ '"" '\
Current Units: "'\0\\" a ~()(Pr.op'osed ,l!Inits;)\\\\' nn./},~n'
\" 1'4'{' 't\'-' 'f!:.~:--' ell' 1)0,,";.1
Census Code: Does 'Qo?ap'ply">'V \'{\e oe O,\eQl ~\y'!J'!)"'"
~r"\t!Ju ~X\'{\~ it ",,<,e. '" '\#'21
o'(j, e'\ \0 r<!;~ '\,;)
Total: '{\'V'{\''O ce~
Fee
Paid On Receipt#
Mechanical
09/11/2001 6663
09/11/2001 6663
09/11/2001 6663
09/11/2001 6663
Value/Quantity
Fee Amount
Minimum Mechanical Permit
Administrative Fee - Mechanical
Wood stove
Mechanical Issuance
999
$15.00
$3.60
$30.00
$10.00
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Job# 01-00981-01
Paid On Receipt#
Mechanical
09/11/2001 6663
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Page 2 of 2
Value/Quantity Fee Amount
Fee
State Surcharge - Mechanical
Total Mechanical
Grand Total
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 inspection. I also understand that if I am requesting a preliminary inspection,
the wall covering may be required to be removed.
fj~_ K~ q-/I-oj
Signature . . Date
$3.15
$61.75
$61.75