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HomeMy WebLinkAboutPermit Mechanical 1996-10-22 '.. . SPRINGFIELD YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRING FEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 726-3769 ':'" City: S;29S- ~~~r~~ ~~'/I-;,;;;-- Assessors Map ll: /7 -02- ;> f- "-icy' Tax Lot #: O\Jner: ~r'~G ~t'~C8~~ /~ eeL-:> Address: 5'2~,5' /c::?""~/~./'"'~ c;.-. Phone: #: ??A~ 'State: ~-) Job Location: ,- ~~/o/ Zip Code: 72c:.........2d'~. ?':/ ~Q , , - Value of Yood Stove/Pellet Stove/Insert: /5:j~, ~'eJ . , Preliminary Inspection is $15.00 (prior to installation of insert) Yood Stove/Pellet/Insert Permit i~ $i5.00 + $.75 state surch~rge + fee + $10.06 issuance = $26.20 total Type of Inspection Requested: ~~~~~ ~~~~ Cona-actor: ~u-~~" $.45 administrative " Address: ' Phone #: City: State: Zip C;ode: . Construction Contractors Registration #: Expires: By signing this permit/application, I agree to call for inspection(s) as required (726~3769). I state that all the information on this permi~/ap~lication is ccirrect and ,that I \.fas provided \.fi th theYood Stov<i Safety information for \.food burning appliances and preliminary inspection standards. I further state that the appliance I am installing meets smoke .emissiQn standards as set by the Oregon Department of Envi~onmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at th€! time of inspection. I ,also underitand that if I am requesting a preliminary inspe~tion; the \.fall covering may be required to be removed. -Dt('J' ~.ud. Signa tl,ll-e I)...f:. Ii) - 22 '. q/.p Date --------------------------------------------------------------------------------------- -----------------------------,---------------------------------------------------------- . , , FOR OFFICE ..., YOODSTOVE~L~NSERT /0 "' <: ""2 ....:9<6: , -:26. .:< 6 USE REQUIRED INSPECTION(S): x PRELIMINARY Date of Application: Job #: ~~/Y<Y Total Amount Collecte9: Receipt #: -::;;?'3Z~ Issued By: ....?~= Checked for Historical ~t:s: . -,/' ~hecked for Deliquencies: . ':