HomeMy WebLinkAboutPermit Mechanical 1993-10-11
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: ~S/ /7P~I~ ~'
Assessors Hap II: //"'D:7..~?-;/ Tax Lot II: O~d
Owner: ~FA7' r....~:I!/t:..:;
Address: -5i~~~~ . Phone II: ?"Y'~- '7~<'5J
City: ~~_ State: ~~ Zip: 7.......~>:::>
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Value of Vood Stove/Pellet Stove/Insert: ~PdS.....a
(please circle appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stov~Insert Permi t is $15.00 + $10.00 Issuance + $.75
Type of Inspection Requested: ~c.~ --;'c.--~
Contractor: f)C....,...../'f'~ C~A~~""-
Address: ::<~., e '"3.t:? 7.:7 4R"/!!!P
City: FL$;F~~ _ State:
state surcharge.
&;:?f.
Phone II: qA?~-~_~3
Zip: ~y~
Construction Contractors Registration 1I:-6'7?,?~ Expires:~-9Y
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 was provided with the Vood Stove Safety information for wood 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 wall covering
may rfbe requl~to; r~1-:~~ /6 _ J/ _ C? 3
Sign re ' Da te
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE~ET2lNSERT
~PRELIHINARY
Date of Application:
/p-yrq ";i
.L::::>.: ":>, S--
" Job II:
"93/5'Y'9
Total Amount Collected:
Receipt II: /O~'3
Issued By:
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Checked for Historical Status:
Checked for Delinquencies: