HomeMy WebLinkAboutPermit Mechanical 2002-3-5
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Job# 02-00249-01
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Page 1 of 2
TRANS#:Ol-OOOB21B
DATE: MAR 05 2002
AMT RECD:2 $ 61.75
CHANGE:
CASHIER: 061
~
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00249.01
225 Fifth Street
Springfield, OR 97477
Office: 726.3759
Inspection Line: 726.3769
Location Of Proposed Site: 595 River Hills Dr Spr
Assessors Map#: 17033413
Lot: Block: Addition:
Tax Lot #: 03500
Subdivision:
Owner:
Address:
Chuck Johns
595 River Hils Dr
Phone Number: 541.746.0731
City/State/Zip: Springfield, OR 97477
New Value: $0
Scope Of Work: Wood or Pellet Stove
Install wood stove
Contractor Type
Mechanical Contr
Quad Area:
# Of Units:
Constr, Type:
Water Heater:
Contractor Registration # Expiration Date Phone
Midgleys 19364 10/20/03 541.343.1131
1678 W 7th Ave, Eugene. OR 974020",CE: EIFiHE\NORI<.
N . . ...vo\R __
Office-tJ$'€,PF~M\l ::>""'~--1HISPERM\l ,::>\~V'
.. IZEOUNOER "F'.nl=OR
Land Use: AlJ1HOR ORISA\3AN'#<0f BiJilClings:
Zoning Code: COMMENCEO RIOO, Occupancy Group:
Bedrooms: AN'< 1800A,<PE Heat Source:
Range: Sq. Footage:
Wood Stove
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. \ 1\ .,~ I~ : ::''.tl,..,;,r.::;~ . U"' I'" "
;' '. \....- 0 '''9- l,.o.1 ll~)
. . ..'; I " "...~ _.;"rl h'l \ii0 ..... ._ '"'ot 1'10
ReqUired Inspections. \"~'" '''~', se \UI"~ -, - _ r "'i-
i" .... -, -- n~ ~r"u~ '"1 c" '.,er. fno n -'AR S;)Z-,,"
Mechanical,,". ',") ~I, '!;OI\1roUg ~ I ru'''';'uY
.'- . - ..\jQ1'U\ I, " " e 01\',9 ,......
". -J;"~ c':>- n"Y o':Jt31f1 cOl-\~~\1ete..ep\1o,:e
j"dO, ':'v\.J,i;:cent8r. tNcteU:ilil" Nc~ilicatlon
C3\\I\'~1 .'" 0"90n I '~AA)
.", rtne ,.... ...... 2.,......,.
',umbe1IO ,.:... i.w~0-~6L~ ..'
c",rM;,'"
.After installation.
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? D
rArea (Sq, Feet)
Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Mechanical
03/05/2002 8218
Value/Quantity
Fee Amount
Minimum Mechanical Permit
$15.00
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Job# 02-00249-01
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Page 2 of 2
Fee
Paid On Receipt#
Mechanical
03/05/2002 8218
03/05/2002 8218
03/05/2002 8218
03/05/2002 8218
Value/Quantity
Fee Amount
8% Administrative Fee. Mechanical
Woodstove
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
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 approva) number to the
inspector at the time of insp ction. I also understand that if I am requesting a preliminary inspection.
the wall c~::,;: ~ay be r uired to be removed. ...3 6:-' {L-
'-If W-f'Aj (...J / a
3.187
$3.60
$30.00
$10.00
$3.15
$61.75
$61,75
Signature
0-
Date
..
{lc-/.dl.J _17~1 ~~
'U:;:;;' ,be' ~SL~e~
.
SPRINOPIELD
225 Fifth Street
Springfield, Oregon 97477
WOOD STOVFJINSERT INSPECTION APPLICATION
, CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUILDING SAFETY
---.
Job Location:
59.J ".e vet.. Hr.L{~ D-t..
f70'S3L;/ J
~~...t~jcl 97<177
o ~ ..r<:JO
Tax Lot#:
Assessors Map #:
Owner:C'tlaCk: 'f ;(CU/ /~t/)/5-
Address:.5Y'5 ~ ;-kL/s D<
,
City:_ ' ~/~/c1
Value ~O(tS~ellet StaveI!nsert: ~/ % 7
Phone#:
'7</~ -07;;J I
0/7<177
State:
ca..
Zip:
(please circle ~"...~...;ate appliance)
Prelim;n.'Y Inspection is $45,00 (prior to installation of insert)
Wood StovelPelletlInsert Pennit is $61.75 (includes Pennit, Issuance Fee, State Surcharge & Admin Fee),
Type of Inspection Requested:
Contractor: ~CJ ~5 .
Address: /678 'aJ.e.~ 7n-I
City: ~ Met State: ,{2..
I
Construction Contractors Registration#:' tf/19 ~ (p~/
Phone#: 3-1,3 - //3/
Zip: 97~O2-
Expires: /6 -20-03
By signing this pennitlapplication, I agree to call for an inspection(s) as required (726-3769). I state that
all information on this application/pennit 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 Department of
Environmental Quality or the Federal Environmental Protection Agens:y and I agree to provide the testing
~"".v.ol number to the in.,..~_,v. at the time of inspection. I also understand that if I am requesting a
p~ insp~o;Y5 ~)7 may be required to be removed.
c.A'~ ~U 'd?-,5.-CJ2-
Signature Date
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVE/PELLETIINSERT PRELIMINARY
Date of Application: 0 30'S 0 L.- Job #: 02 - 00 1.- y / - 0 I
Checked for Delinquencies:
Checked for Historical Status:
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VALIDATION: