HomeMy WebLinkAboutPermit Mechanical 1996-10-9
I
STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fif th S t l.-ee t
Springfield, Oregon 97477
Office:. 726-3759
INSPECTION LINE: 726-3769
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Job Location:
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Assessors Hap j:
O....ner : ~~\
Tax Lo t ll: c:J5'"3&:>-o
Address: 3~""2-
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State: 0-
Phone: ff: 74 I - eo Ie
Zip Code: q,ct 1'7 .'
Value of Vood Stove/Pellet Stove/Insert:
14Co~
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Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total '
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Type of Inspection Requested:
Phone ~:
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State:
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Zip C;ode:
\. Construe tion Con trac tors Registration #: to l S'Z..c;-
Expires: ;;g-g..~?
By signing thispermi 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 ....as provided vi th the Vood Stove Safety information for vood 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 0{
Environmen tal Quali ty or the Federal Environmcll tal Pro tee tion Agency and I agree to
pr.ovide 'the' tes'ting. app'roval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the ....all covering
may be required to be removed.
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Signature
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Date
=======================================================================================
FOR OFFICE USE
REQUIRED INSPECTION (S) : \.lOODSTOVEq'1!ELLEt'{SINSERT.
Date of Application: /?'-q....~6
~ PRELIMINARY
Job 11: qG/3~2
Total Amount Collected:
'2.6:~c:.:>
'~hecked.for Deliquencies:
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Issued By: ~~;. ~
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Checked for Historical ~atus: ' -- ,
Recei p t ff:::2 ,y&?;>'