HomeMy WebLinkAboutPermit Mechanical 1996-11-12
VOOD STOVE/INSERT INSPECTION
CITY OF SPRING FEILD
BUILDING SAFETl DIVISION
225 flfth St,eet
Sprlngfleld, Oregon 97477
Offlce
INSPECTION LINE
726-3759
726-3769
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Address ~~ 7"2;~ (;ho~ [)r
Clly ~'")Y\V\o.-f:k1(j . State ()t< _ Zlp
Value of VoodcJ~ellet Stove/Insert. l , ';). f)y)
Job Locatlon
Ta> Lot ~
()'~ 7/)()
Phone
~ 5;3 '~73 -3'1/7
q 7'17K /
Code
Prehliillla,y Inspectlon lS $15 00 (pllor to lnstallatlon o[ lnsert)
Vood Stove/Pellet/Inse,t Pelmlt lS $15 00 + $ 75 state surcharge + $ 45 admlnlstratlve
fee + $10 00 lssuance ~ $26 20 total
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Type of Inspectlon Requested
Contracto, (?((rAf~ S
Address 't;C)7t/ V;VtP hr&-v,c [2 Phone # 3'1ij-fJ5f52
Clty nAf),lrl/~ State tJP. ZIp Code C(7CfilC;-: -
construct~on c4ntract~~s Reglst'at~ '. ~ - ~
By slgmng th,S permll/apphcatlon, I -agree to -~all ~for InspectiOi1ts-)-aS-l'eftU"-r~
(726-3769) I s ta te tha t all the lnforma tlon on thIS perml t/ appllca t lon lS correc t
and that I vas provIded .Il th the Vood Stove Safety lnformatlon for vood burnIng
appllances and prel,mlnary InspectIon standards I further state that the applIance
I am lnstalhng meets smoke emlSSlon standarJ~ as set by the Oregon Department at
EnvIronmental Quah ty or the federal Envlronn,cntal Protectlon Agency and I agree to
provlde the testlng approval number to the lllspector at the tlme of InspectIon I
also understand that l[ I am requesllng a p'C] lmlnalY lnspectlon, the wall covenng
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REQUIRED INSPECTION(S) VOODSTOVE/PELLET~
Date of Apphcall~n I{ /f14'~
PO ( )V
Job 11
PRELIMINARY
1 fo(53n
Total Amount Collected
ReceIpt #
,1~7(~ 7
Issued By
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'Checked [0' Dellquencles
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lhcc~ed [or HIstorIcal Status
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