HomeMy WebLinkAboutPermit Mechanical 1998-10-13
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SPAINCFIE:LO~_' . '_. ~
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uooo STOVEIINSERT INSPECTION .APPLICAllirJ'rICE: ___ ..ci~.. . .. .. . . ... .... . ...
CITY OF SPRING FEILD ________ ~_V
BUILDING SAFETY DIVISION THIS PERMIT SHALL EXPIRE IF THE WORK
225 Fifth Stl"eetAUTHORIZEDUNDERTHISPERMITt5lffiGce:, '726'-3759
Spring~ield. Ocegon 97477 COMMENCED OR IS A8AN~~PtJRLINE;-' 726-3769
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Assesso1"::; Hap ~: " / 76 ~'S/ ~ <i ,/ Ta~: / Lo t ~:
,Ovner: '~r~/l It ,qT'; ~ C.....UL , _
Address:lf(};1.:) ,'r'.;.~~ ,S/ Phone: #:
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Value of Vood Stove/PelletStove/lnsert:
Job Location:
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City:
State:
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, Zip Coqe: '
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Preliniinal"y Inspection is S15.00,'pd9J:" to installation..o~ insert). ,,___,______.__-
Vood ~tove/Pellet/I~sel"t Per~it is S15.00 . S.75 state surcharge + S.~5 adminiitrative
fee · S10.00 '~ssuance ~ S26.20 total . ,
Type of Inspection Requested:
tv~ sJ~
-:-~~-
Contl"actor: ~~ ~
Address: ifo'2-S~ -~4 "Ct
City: )-fI~/~ State: & ;(.
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Construction Contractors "Regi'su"ation f!: -
Phone ~:7 Z (.;.- (S-! Z:. :3
ZipC;ode: ' '9 7(.,j 7 r.
Expires: '
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,By signing .this permi tlapplication, I agree to call for inspection(s) as required
(726-3769). I state that all th~ information on this permit/apPlication is cor~ect
and .that I vas provided \Ii th the \lood Stove Safety' information for \lood burning
appliances arid prel~minary inspection standards. I ~Urtherstat~,-that_the appliance
I am installing' meets smoke.emission standards as set by the Oregon Department. of.
'Environmental Quality or the Federal Environnlclltal Protection Agency and I agree to
provide the. testing approval number to the inspector at the time of inspection. I
, also unders.tand that if ,I am reQuest'i~g a pl"climinary ins&{Oction, the \lall covering
may, be l'equll"ed to. be removed. ^:rTENTION:Oregon law reqUires yo 'I't' .
L . . - t"\ 'd by the Oregon Uti I y
.~. / . / j / follow rules adopte. e rules are set forth , '
. , ~ /{ (".,4 ~~og=~~_~g~~g~1~~~OUg~ OAR 95~-~0J: iJ / / ~ I ?y ,
c;?:l a ture. " , !II '0 Y "- may obtain copies otOijtteu ~~ 'I /
: , ,,' .,', OO~ailinOUthe center. (Not~: .t~e tel~~hO~~n ' ,
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REQUIRED INSPECTION(S): \.lOODSTOVE/PELLETIINSERT )...{ ~ PRELIMINAIH "' ','
Date of Application: ,
I( / 2- / 1 f
~~" 2-0
Job'll:
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By' ~ IJJ
Total Amount Collected:
Re~'eipt II: 03/915
Issued
'-Checked, for Deliquencies:
Checked for Histori,cal Status: