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HomeMy WebLinkAboutPermit Mechanical 2001-3-12 ....... .. ?;' I '. . ..,. 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 2~~f. ' /I! .. , .., .7 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. ~/J71Lf~ ~f Signature I, "q - /~ ---0 \ Date