HomeMy WebLinkAboutPermit Building 2001-11-21
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I Job# 01-01290-01 I
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Page 1 of2
TRANS#:01-0007313
DATE:NOV 21 2001
AMT RECD:l $ 70.75
CHANGE:$ 9.00
CASHIER: 061
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01290-01
225 North Fifth Street
Springfield. OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 2210 Debra Dr Spr
Assessors Map#: 17032611
Lot: Block: Addition:
Tax Lot #: 02500
Subdivision:
Owner:
Bernard Charlebus
2210 Debra Drive
Phone Number: 541-988-3566
City/State/Zip: Springfield. OR 97477
New Value: $0
Address:
Scope Of Work: Wood or Pellet Stove
Pellet stove ....:f..
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Office Use " ~". ~f;)~
Quad Area: Land Use: ~ii~t~t8t~ ~
# Of Units: Zoning Code: eft;. coy..~~~<?-o'tif. Group:
Constr. Type: Bedrooms: O,,\Vo ~~~ -u'~':V H ource:
Water Heater: Range: ~ ~CO~~",<;l.$-~('\O<?-\~'b.Footage:
. .,~v lJ"'- ~'<"-
To request an inspection call the 24 hour recording at 726-3769.~UJ~liads~requested before 7:00
a.m. will be made the same working day, inspections requested aftef~~~~i\i. will be made the following
working day. l>-~
Freestanding Pellet
I
-After installation.
Required Inspections
Mechanical
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
jArea (Sq. r d)
I Main: Accessory:
.')
.' . ~ '"
o.~' ~""'\o'\\'
\0-,-01 ~0 O~,<l~,o e .;.}\ f:j\:J\'
of<. .~e '" 0-' .,7.' _ ,,'I
. ~.('\,e~ 0-0'1 a ~I)\e O'''~ J ,,;,6"
-':' " R\0 oJ""v X\ . X\e ~3
.' ,: . 0-(,,0 ,.'\'I".'(\~O~~ 0\ '\l ~eQ"O 'is;,f<.
~ - .1)\0'" f":o.e \\:J" 0" .. . e '\v0'
# Of Stories: ~. '~o'l'l . . of<. (j'<HeightjfeJt): .s. '" ~ .\
\0' 9-\~ f:j'-' :o'\.v ..." "'~'~l. 0~'
Current Units: _v ,,'\v ,,~'/; P,roposed Units:, ',r.,-- ,
\~v\,. """,':I ~\I" .....\....... .n' $,/100-
Census Code: Does.not apply ",e\:' "'')~'O;'''\:J\:J''?)
" ~",\). . Q, \\. ." . '\'''
\l~ I v~\"" " '>?,~\'"
Total: <:\I)\(\\)e (jef<.'<
Fee
r
Paid On Receipt#
Mechanical
11/21/2001 7313
11/21/2001 7313
11/21/2001 7313
11/21/2001 7313
Value/Quantity
Fee Amount
Minimum Mechanical Permit
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical Issuance
600
$15.00
$3.60
$30.00
$10.00
\.
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Fee
State Surcharge - Mechanical
Total Mechanical
Grand Total
Job# 01-01290-01
Paid On Receipt#
Mechanical
11/21/2001 7313
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Page 2 of2
Value/Quantity Fee Amount
$3.15
$61.75
$61.75
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 covering ma be required to be removed.
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Signature
lI- t/~ ;3C() I
I
Date
,
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e
SPAINQPIELD
WOOD STOVElINSERT INSPECTION APPLICATION
. CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759.
INSPECTION LINE: 726-3769
JobLocation: 'j l-/O f) c IJ ~ If- Ai ~
AssessorsMap#: /7() <. 2b(( TaxLot#:OZ-s<:J 0
Owner: 1f P A IV ~fI..f). fi.. b W f-. €JJ d i tj
Address: 12~/(J /2ePI<Ir -4-1-~Phone#: 'l?f":Jfbh
City: ~/ . State: tY'q_ .. Zip:-f1!f71
Value of Wood S~~nsert,;". If (please circle ~n.v.t'..:ate appliance)
. on of insert)
lIdes Pemrlt, Issuance Fee, State Surcharge & Admin Fee).
Type of Inspection Requested:
Contractor: ~ .
Address: 'Z Z./d D &B Alt-
. Cl~ty: ,tfPJ/ .
I 'I. ' .
C on Contractors ReglStIatIon#:
State: (tH..
Phone#: ttftt 3766
Zip: tl1fE77
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Expires:
By signing this pemrltlapplication, I agree to call for an inspection(s) as .......:...J (726-3769). I state that
allinfonnation on this applicationlpermit is correct and that I was provided with the Wood Stove Safety
information for wood burning appliances and JlT"limin.'Y inspection standards. I further state that the
appliance I am installing meets smoke emission standards as set by the Oregon D..t'~....ent of
Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing
approval "~.L_. to the inspector at the time of inspection. I also understand that if I am requesting a
~1i~Mmaybe . to be ,oved. L/..'ZtJ .....z"tJe1(
Sigxmture Date
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVElPELLET/INSERT PRELIMINARY
Date of Application: I ( /Z ( !o ( Job #: ('j I - 01 Z. '70 - 0 I
I f
rl._"....... for Delinquencies: Checked for Historical Status:
VALIDATION:
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