HomeMy WebLinkAboutPermit Mechanical 2001-9-5
....
.
I Job# 01-00957-01 I
.
Page 1 of2
TRANS#:01-0006607
DA TE : SEP 05 2001
AMT RECD:1 $ 101.75
CHANGE:$ 40.00
CASHIER: 003
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-00957-01
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 3905 Richland St Spr
Assessors Map#: 18020641
Lot: Block: Addition:
Tax Lot #: 06300
Subdivision:
Owner:
Arlen Sage
3905 Richland Street
Phone Number: 541-746-3828
City/StatelZip: Springfield, OR 97478
New Value: $0
Address:
Scope Of Work: Wood or Pellet Stove
Installing Pellet insert
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.
Pellet Insert
I
-After installation.
Required Inspections
Mechanical I
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
,Area (Sq. Feet)
I Main: Accessory:
# Of Stories:
Current Units:
Census Code: Does not apply
Height (feet):
Proposed Units:
Total:
Fee
Paid On Receipt#
Mechanical
09/05/2001 6607
09/05/2001 6607
09/05/2001 6607
09/05/2001 6607
Value/Quantity
Fee Amount
Minimum Mechanical Permit
Administrative Fee - Mechanical
Pellet Insert
Mechanical Issuance
1
$15.00
$3.60
$30.00
$10,00
, . "
.
Fee
State Surcharge - Mechanical
Total Mechanical
Grand Total
Job# 01-00957-01
Paid On Receipt#
Mechanical
09/05/2001 6607
.
Page 2 of2
Value/Quantity
I
Fee Amount
$3.15
$61.75
$61.75
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.
~ p ~ e<-A/~
Signature
r/;~ IcY (
Date