HomeMy WebLinkAboutPermit Miscellaneous 2001-11-19
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I Job# 01-01278-01 I
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Page 1 of2
TRANS#:01-0007278
DATE:NDV 19 2001
AMT RECD:2 $ 61.75
CHANGE:
CASHIER:061
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SPRINGFIELD
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01278-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3558 Douglas Dr Spr
Assessors Map#: 18020612
Lot: Block: Addition:
Tax Lot #: 02606
Subdivision:
Owner: Greg McCauley
Address: 3558 Douglas Dr
Scope Of Work: Wood or Pellet Stove
Phone Number: 541-736-8032
City/State/Zip: Springfield, OR 97478
New Value: $0
Install pellet stove
Contractor Type
Mechanical Contr
Contractor
ABC Stove Service
PO Box 108, Dexter, OR 97431
Registration #
73806
Expiration Date
5/15/2003
Phone
541-937-8618
h'
n.~V \..0.... ~
Office Use. -T' ,,~ Iv ole~O(l 5..\\011'
(.i~Q J I \'{\2 .- ?lie. ~n~rtJ\-
'" ~" -\eo v) #,Of.BUlldlngs:s'o':l
..:." ~ a..u.o',J 1'''os~ __nf\" (''Ie
:: '",'eS .,el. "Occu~ancy Group:
. .' \v\ (\\; \(w......-. D' \,,- ....,<,\0\'<0.
\0\\0" >,,011 Ce . .00,\0 ,Heat Sou,rce: ..>\011
"c~, CO, 'r v-' .~,. .~,c~'
Water Heater: Range: ~o\\" u g,f::>'2.- "o'OW' :\~_qA::oot~ige:
'""'~~. ...r.a'l ._: \. .\h\\\~.,'
,\\- _'(Ov' ce\'''- g~'\- }[.~.,
To request an inspection call the 24 hour recording at 726-37:6-91~~l,l.IinS~~fti.on'Sl~~.(;I}!es'l~'before 7:00
a,m, will be made the same working day, inspections requested afterc7,:06'a,m:'will be made the following
working day, 1IIl'" ce'''-
, ,0
d'
Quad Area:
# Of Units:
Constr. Type:
Land Use:
Zoning Code:
Bedrooms:
Freestanding Pellet
I
-After installation,
Required Inspections
Mechanical
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
iArea (Sq. Feet)
I Main: Accessory:
NO'f\C'e.~ EXPIRE IF'ThIEWORl<
iHISPERMITSHA~RiHIS PERMITISNOi
Al}iHORlZEDUND A1BANDONEDFOR
:!Ilr.F.D OR IS '" '"
# Of Stories: Q;i8lg\l'f.tTe1l1):, ERIOD.
Current Units: ,~$&'d~Jits:
Census Code: Does not apply
Total:
Fee
Paid On Receipt#
Mechanical
11/19/2001 7278
Value/Quantity
Fee Amount
Minimum Mechanical Permit
$15.00
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Job# 01-01278-01
Paid On Receipt#
Mechanical
11/19/2001 7278
11/19/2001 7278
11/19/2001 7278
11/19/2001 7278
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Page 2 of2
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Fee
Value/Quantity
Fee Amount
Administrative Fee - Mechanical
Freestanding Pellet Stove
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
By signing this permiUapplication, 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.
\--1')/1 fYl/ ~drj / J - /q- 0 I
~~m U ~
2,195
$3.60
$30,00
$10,00
$3,15
$61.75
$61.75
...
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SPRINCFIELD
WOOD STOVElINSERT INSPECTION APPLICATION
. CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUTI..DING SAFETY
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225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759,
. INSPECTION LINE: 726-3769
Job Location: ~S-5'2s DOl.Ae;.\a.c.... 'Dr_
AssessorsMap#: / BoZ o{;(Z Tax Lot#: 02 &:::k:,
Owner: ,A/A-NC7 TUD D ~GIU:-~IYlC~/j
Address:~~ Dr.l.l('_In" 0 r. Phone#: 73(", - %(.3 2-
City:tS.p(LM.C\,., lrl,<..J State: nE:.. Zip:q 1 <./ '1 8"
.(J
Value of Wood StoveIPe11et Stove/Insert: 21 / '35. ~ (please circle ~>,>,.v>,.:ate appliance)
py"lim;~:.~_:;.:_;..:-::j $45.00 P'^ '-"'1l:''ion ofinsert). .
Wood SLU~ Permitfs $61.~es Permit, Issuance Fee, State Surcharge & Admin Fee).
Type of Inspection Requested:
Contractor. ABC- .~i lJJ
Address: .p.O. B (j....p (0 X
City: O~ W ~r State:
'S,P f
Phone#: .
q37- <&o/~
Of 7'1? I
Construction Contractors Registration#: .
()Q..
1 ~ 5S'" 0 (apires:
Zip:
By signing this pennitlapplication, I agree to call for an inspection(s) as required (726-3769). I state that
all information on this applicationlpermit is correct and that I was provided with the Wood Stove Safety
information for wood burning appliances and prelimin.'Y inspection standards. I further state that the
appliance I am insta1ling meets smoke emission standards as set by the Oregon r;'>,~~l:Ilt of
Environmental Quality or the Federal R..';'u~ental Protection Agency and I agree to provide the testing
approval number to the inspector at the time of inspectioa I also understand that if I am requesting a .
preliminaIy inspection, the wall ~ may be required to be removed.
"-1'la .Jl(1.A~t".-I. .
SignatUre (j
/I - I €; -e)/
Date
FOR OFFICE USE
190 ~ ;:J3IHS\:KJ
~39N\iHJ VALIDATION:GgL"19 $ G:GJ3~ lW~
WOG 61 I\ON=31\iG
8LGLOOO-10:#SN\i~1
REQUIRED INSPECTION(SY WOOYSTOVFJPELLETIINSERT
Date of Application: / ( / ( '7/0 ( Job #:
I /
Checked for Delinquencies:
PRELIMINARY
01 - 0 / Z 7 g--O /
Checked for Historical Status: