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HomeMy WebLinkAboutPermit Building 2001-11-21 ;. - . I Job# 01-01290-01 I . Page 1 of2 TRANS#:01-0007313 DATE:NOV 21 2001 AMT RECD:l $ 70.75 CHANGE:$ 9.00 CASHIER: 061 ~ 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: $0 Address: Scope Of Work: Wood or Pellet Stove Pellet stove ....:f.. "f''P . M'(:..~ 0' Office Use " ~". ~f;)~ Quad Area: Land Use: ~ii~t~t8t~ ~ # Of Units: Zoning Code: eft;. coy..~~~<?-o'tif. Group: Constr. Type: Bedrooms: O,,\Vo ~~~ -u'~':V H ource: Water Heater: Range: ~ ~CO~~",<;l.$-~('\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 \. -. '" . Fee State Surcharge - Mechanical Total Mechanical Grand Total Job# 01-01290-01 Paid On Receipt# Mechanical 11/21/2001 7313 . 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. .~ /G~ Signature lI- t/~ ;3C() I I Date , ..." ~ . 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 ." . 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: D ::;:; -; -1O:;'(J DD ;{,:._.-iZ C"J1'TlfT1C,O :ro u # C"J:De;,z .. :D'Z..OO CQCi1J-..l.<:1---'- ::c rrl I. ..........P~r-.JO r'f1t>"J- ......0 ;;0 --J 0 "" ...oor-.J~..J o. . au C1'O~,JOj--J. t-.J.OUlI--'-GJ