HomeMy WebLinkAboutPermit Mechanical 2001-12-11
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I Job# 01-01367-01 I
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Page 1 of2
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SPRINGFIELD
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CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 01-01367-01
225 North Fifth Street
Springfield. OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 1696 W Quinalt St Spr
Assessors Map#: 17032732
Lot: Block: Addition:
Tax Lot #: 00121
Subdivision:
Owner:
Sammie Mayfield
1696 W Quinalt Street
Phone Number: 541-268-2038
City/State/Zip: Springfield, OR 97477
New Value: $0
Address:
Scope Of Work: Wood or Pellet Stove
Install woodstove
Contractor Type
Mechanical Contr
Contractor
Ye Old Town Sweep
81905 Davisson Rd, Creswell, OR 97426
Registration #
52381
Expiration Date
1/10/2002
Phone
541-485-4957
Construction Types:
Occupancy Groups:
# Of Buildings:
# Of Bedrooms:
Handicap Access? 0
iArea (Sq. Feet)
I Main: Accessory:
((<.'#-
-~.'"
Quad Area: Land Use: "\",,~f~l/dings:
# Of Units: Zoning Code: ~lC.~Wp~Cy Group:
Constr. Type: Bedrooms: ~ ..",U; ~":!1@frsource:
Water Heater: Range: ..,~~~~~~~~.~~\i-'Sil. Footage:
II ~~~- ~....
To request an inspection call the 24 hour recording a~~l. . sP~,!9)lS requested before 7:00
a.m. will be made the same working day, inspections rllJU'e~, e ' rJ'i,$Ia.m. will be made the following
working day. ~~ \0
R . d I'~ ~ . _c.,\O~;~\'l."
eqUlre rftipectlons o.~". t;\,) \0' o.
1..- Mechanical I \~~~e O~0QP~0'00~Rl~^'"
. . o~ ~0 'O~ f?Jf>" S'{ll
-After installation. .O~e<:fj 0'0'\ 0~,s.e O~f?o. ~y>\e 13
"'\O~. ~09\0 ~OS ~Q,v:.. 0\ ~e ~O~. o~
.A.lC.~\ ~e'O~ t;\\e~' \c~~O ~\0'O e\e\0~~\c~\~
l'-" ~~" 00 .<:lC 'f;l.CO '.~ ~O
\0\\0. ~'i.\O~'/,RlC\ O'O\~ ~O\~'i.~\'Ill #".
_\o\~\C~f?J'5 ~~'\ t;\\e~' "O~ ",:>'/,''1)
\~ O~ ...toY> n,,0 O~e"'r:;<:l'"
# Of Stories: \~.~l!igm~~~)~e \"~
Current Units: C~~~q){lltS~'O
Census Code: Does not apply ~Y>~ 00
Office Use
Insert
Total:
Fee
Paid On Receipt#
Mechanical
12/11/2001 7475
Value/Quantity
I
Fee Amount
Minimum Mechanical Permit
$30.00
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Job# 01-01367-01 I
Paid On Receipt#
Mechanical
12/11/2001 7475
12/11/2001 7475
12/11/2001 7475
12/11/2001 7475
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Page 2 of 2
Value/Quantity Fee Amount
I
Fee
Administrative Fee - Mechanical
Woodstove Insert
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Grand Total
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.
2,500
$3.60
$15.00
$10.00
$3.15
$61.75
$61.75
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Signature
/2 (1/ /0 l
Date
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SPRINCPIBLD
WOOD STOVElINSERT INSPECTION APPLICATION
. CITY OF SPRINGFIELD
COMMUNITY SERVICES DMSION - BUILDING SAFETY
t'
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759,
INSPECTION LINE: 726-3769
I c., q Co W. GkllM\ t
/703, Z73Z
Owner: 5ClrY1('Y1I~ \M~I fjel cl
Address: I <.0 Cj c,., C> u.:t II'a \ t .
City: 6ft l M ~ l'< I cl State: 0 t<
I ~
Va1ueo~StoveIPelletStove@. 2.500
,
$+
Job Location:
Assessors Map #:
TaxLot#: (;) 0 ( Z I
Phone#: !'7'.{!) 2(08-2038
Zip: 77t.(77
(please circle a"".o".:ate appliance)
F'rP.limin.'Y Inspection is $45.00 (prior to installation of insert)
Wood StovelPelletlInsert Permit is $61.75 (includes Permit, Issuance Fee, State Surcharge & Admin Fee).
. . , -t I Furl ~/JYVL
Type of Inspection Requested: N e\AJ W cod. .fl-r...ef)b CL~ w .e-c.I~(\ce ."
Contractor: C'vH't':> vJ\VV3\c'-'J ~B.A: L{e c)ld 1bwV\ s~
AddresS: B I q 0 S ./Jo...\JI-S50,^ R ~ , Phone#:" 'Z c..:, -738 Z
City: C ~ s ~, l State: C lC. Zip: ~ -, <-{ 2 (.,
Construction Contractors R.egistration#: . ~ 2 3 8 ., Expires: I .II 0) 0 "Z-
By signing this permit/application, I agree to call for an inspection(s) as -~.;.J(;'26.3769~te that
all infonnation on this application/permit is wuw. and that I was provid;d:~afety
infonnation for wood burning appliances and pJ'P.limin.ry inspection standards. I further state that the
appliance I am ;not.ll;"g meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agem:y and I agree to provide the testing
a.......w.ol number to the inspector at the time of inspection. I also understand that if I am requesting a .
plP.limin.ryinspection, the wall cOvering maybe __......:...J to be removed.
~1?~ -
Signature
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. 12-/// J CJ (
Date '
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVElPELLETIINSERT PRELIMINARY
Date of Application: I z,lt f I Job #: 0' - c) 1.3 6 7 -O(
Checked for Delinquencies: Checked for Historical Status:
1:90; :>mHS\i3
: 39N\:!H8 VALIDATION:
Iii.' 1:9 $ ;::: o::mJ HI\:!
'[DO;:: n 330: 31\:!0
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