HomeMy WebLinkAboutPermit Mechanical 2001-3-12
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. ..,. r Job# 01-00219-01
~age 1 of 2 :
TRANS#:01-0004648
DATE:MAR 12 2001
AMT RECD:l $ 30.00
CHANGE:$ 3.50
CASHIER:003
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00219-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
location Of Proposed Site: 4872 C St Spr
Assessors Map#: 17023241
lot: Block: Addition:
Tax lot #: 00237
Subdivision:
Owner:
Address:
Don Rice
4872 C Street
Phone Number: 541-746-3868
City/State/Zip: Springfield, OR 97478
New Value: $0
Scope Of Work: Wood or Pellet Stove
Pellet insert in masonry fireplace.
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
Office Use
land Use:
Zoning Code:
Bedrooms:
Range:
# Of Buildings:
Occupancy Group:
Heat Source:
Sq. Footage:
To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
working day.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
-Area (Sq. Feet)
Main: Accessory:
# Of Stories:
I
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Mechanical
03/12/2001 4648
03/12/2001 4648
03/12/2001 4648
03/12/2001 4648
03/12/2001 4648
Value/Quantity
Fee Amount
Minimum Mechanical Permit
Administrative Fee - Mechanical
Pellet Insert
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
2,020
$.00
$.45
$15.00
$10.00
$1.05
$26.50
$26.50
/
Gra:-;d Total
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I Job# 01-00219-01 I Page 2 of 2
By signing this permitfapplication, 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.
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Signature I,
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Date