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HomeMy WebLinkAboutPermit Mechanical 2002-3-5 - Job# 02-00249-01 .. 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 - Job# 02-00249-01 . 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: :D ::;:: -i -i<:::l ;0 :D:D :::0 -i :z: ", fi1 ClJ 0.. *I: . CJ 0:3:.~ D ...DC) (0 1'..3::::0 I---l ::c I ~n.w.C)o rr1 :c Ul 0 ;:::ODQ'-. 0 .. z ~ I'-.J co QQ. Ot'..J O"-m--Jo~ f-l.... tnr-'.:JCQ VALIDATION: