HomeMy WebLinkAboutPermit Mechanical 1991-10-25
SPRINGFIELD
VOOD STOVE/INSERT INSPEC
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location:
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Assessors Map #: 1?-t!j-;:;:-2?--~2
Ovner: 5."1./ I ~ q/--'/-tv k/
Address: 5'2 /.:::> ~AAt./?:-,:-,-r:
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City: E ?e''6L'S/t::::> State:
Tax Lot #: tP"5S'e$>C
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Phone #: I./...~I./-?~~/
~. Zip: q:J 7"'~r _
Value of Vood Stove/Pellet Stove/Insert:
(please circle appropriate appliance)
(jfreliminary,Inspection is $15~prior to installation of insert)
wOOQ ~lOVe/Ye~~et/~nsert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested:
,P!:>FL/ ^'7
Contractor:
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
Expires:
By signing this permit/application, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit is correct and
that I vas provi~ed vith 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 of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number, to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the vall covering
may ~ required to be removed.
~~~ 0 ~-(--UA~~ /O-2S-~/
Signature( r t/ / Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT
PRELIMINARY
y
Date of Application: It!) -z. <}-9/
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Total Amount Collected: ,~ .
Job #:
q//"2?Y
Receipt #: -;Z/tI:~
Issued By:
~- ~-~
P/--- ~ /'. r
Checked for Historical Status:
Checked for Delinquencies: