HomeMy WebLinkAboutPermit Mechanical 1996-10-18
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SPRINGFIELD.
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YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Stl:eet
Springfield, Oregon 97477
Office:.
INSPECTION LINE:
726-3759
726-3769
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Assessol-s Map ~:' l-702~-33L/.
O\lner: · ~Ja~Vlii abc{C~ .f2Ijj]
Address:31QS eVJtl~{C< t:+
City: 59'(\' ~)rJ
Job Location:
Cf,
Tax Lot #: ()(')/(J7
I
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State:
Or(
Phone: #: 7J.{o --)030
Zip Code: Q7'-17 9("
Value of Yood St /Pellet Stove/Insert:
~iminal-Y I:pectionis $15.00 (prior' 'to installation
Yood STov. sen Permi t is $15.00 +, $.75 state
fee + $10.00 issuance =$26:20 total
of insert)
surcharge, + $.45 administrative
Contractor:
. P'" -1iV1A1'~)/
Type of Inspection Requested:
,
Address:
,
Phone It:
Ci ty:
State:
Zip C;ode:
,
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Construc~ion Contractors Registration #:
,
Expires:
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 \laS provided vi th the Yood Stove Safety information for vood burning
appliances an~ preliminari inspection standards. I furth~r 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
piovide the testing approval number to the inspector at the time of inspection. ~
also understand that if I am requesting a prcJ.iminaryinspection, the \lall covering
may be required to be removed.
Signa tUl-e
Date
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1
FOR OFFICE USE
REQUIRED INSPEC~ION(S): YOODSTOVE/PELLET/INSERT
Date of Appncation: IO/lrg,.q ~
Total Amoun t Collec ted: 4.J C; f r.J7J
Receipt #: 2352 q
Job, #:
PRELIMINARY L
. q(~142_L(
Issued By:
!j;p
'~hecked for Deliquencies:
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Checked for Historical Status: