HomeMy WebLinkAboutPermit Mechanical 1994-10-19
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~OOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location:
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Assessors Map #: / '/ ....tP '"2 - '3 y. 7"''9'
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P);t/)':'Lb State: c7t.
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Value of ~ood Stova(feflet
C7 ,.
Tax Lot #:~o~6
Owner:
Phone: #:
71/'b" ~:5B~Y
97y:?G;
Address:
City:
Zip Code:
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Stove/Insef't':-) Q t/ e;~
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Address:
City:
Construction Contractors Registration #: ~~~Expires:
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By signing this permi t/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and that I was provided wi th the ~ood Stove Safety information for wood burning
appliances and preliminary inspection standards. 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(?;:C;) ::;lvedo
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Sign'a ture '-"" . ~). -
/L:>/9-7cr
Date .
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REQUIRED INSPECTION(S):
FOR OFFICE USE
WOODSTOVE~ET/INSERj)
t'
PRELIMINARY
Da te of Application: /e:::!:?~-?t::7
Total Amount Collected: 2~.~C::>
Job #: QC//31'9
Receipt
#: /y/1/
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Issued By' ~~
Checked for Historical ~atus:
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Checked for Deliquencies: