HomeMy WebLinkAboutPermit Miscellaneous 2002-1-17
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I Job# 02-00067-01 I
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Page 1 of 2 ,
TRA~S#:01-0007B03
DATE:JAN 17 2002
AMT RECD:2 $ 61.75
CHANGE:
CASHIER: 005
CITY OF SPRINGFIELD~ OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00067-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1111 Dixie Dr Spr
Assessors Map#: 18020524
Lot: Block: Addition:
Tax Lot #: 00200
Subdivision:
Owner:
Larry Berg
1111 Dixie Drive
Phone Number:
Address:
Scope Of Work: Wood or Pellet Stove
Pellet Stove
City/State/Zip: Springfield, OR 97478
New Value: $0
Contractor Type
Manuf Home Install
Contractor
Larry Berg
1111 Dixie Drive, Springfield, OR 97478
Registration # Expiration Date
Phone
Office Use
Land Use: # Of Buildings:
Zoning Code: Occupancy Group:
Bedrooms: Heat Source:
Range: Sq: Footage:
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To request an inspection call the 24 hour recording at 726-3769. All inspections r~q~~t~~::&ef~i~;6i:i'~~~'~ ,:;::::"""~ ;''::: /0
a.m. will be made the same working day, inspections requested after 7:00 a.m. will'be:m~e~ t~e.foll.~~i,~g~ .)e. .I',': -:. :'r,!..', ""
working day. c-/" "'~'/o,,,,- " 1,';;'/' _ ~ .. ,'--
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ReqUired Inspections '" ".,..... .......c.,<. '. r1;. .
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Mechanical l-i'r€.r,..... .:....~. \ .:,....\, :,\ l)h,'7";1'" J
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Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Freestanding Pellet
I
-After installation.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
[""Area (Sq. Feet)
I Main: Accessory:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
# Of Stories: Height~fe~ENCED OR IS ABANDONED FOR
Current Units: ProposediUlll~AY PERIOD.
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Mechanical
01/17/2002 7803
Value/Quantity
Fee Amount
Minimum Mechanical Permit
$15.00
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Job# 02-00067-01
Paid On Receipt#
Mechanical
01/1712002 7803
01/1712002 7803
01/17/2002 7803
01/17/2002 7803
Fee
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
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Page 2 of 2
Value/Quantity Fee Amount
2,000
$3.60
$30.00
$10.00
$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,
..w,"_~"' :'/:o/mm"",.
/-/'1-/77.--
Date