HomeMy WebLinkAboutPermit Mechanical 1999-11-24
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WOOD STOVElINSERT INSPECTION APPLICA nON
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION - BUILDING SAFETY
225 Fifth Street
Springfield, Oregon 97477
,<C;2- {'~l"'.J ~ 9\
/761).2/1-
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Address: <;Z:,'l 4\,,""\<:1...\ Dr-.
City: .5;r"-\~ State: /')r.>~..J
JJ. (J (J
Value of Wood Stove/Pellet StovelInsert: ...., / ~ DO , -
Job Location:
~.
Assessors Map #:
Owner:
Office: 726-3759
INSPECTION LINE: 726-3769
Tax Lot#:
ao S-oO
Phone#:~(j 7- ~/'1L{
Zip:
97L{??
(please circle appropriate appliance)
Preliminary Inspection is $15.00 (prior to installation of insert)
Wood Stove/Pellet/Insert Penn it is $15.00 + 1.0':) state surcharge + $.45 Administrative Fee + $10.00
Issuance.
NOTICE:
Type of Inspection Requested: l1dI8 PI=RMIT !=:"'AII FXPIRF IFlHEWORK
~TJ:ENTIO~:?rEjrC!1laW requirQld.RIZED UNDER THIS PERMIT IS NOT
Contr~dOrW rule~~bv the ()rAMnn '1!H'ti.'.
Notification Center. Tilose rules al-'Yffilrffil'tHcuUN I;:'AtlAI~UUNCU rUN
Addfers,r\R952-Q~-rA1()\%Elah ()A~N'i~Ii)AVPI=RI()fl Phone#: 71.( 7- .;2.llI,-\
0090. :ou may obtain copies of the rules by ,
City: calling the center. (Note: thA tAIAiS.ta~;A Zip:
numberforthe Oregon Utility Notification
Construction COnttuciorS Regisfrlitiog#:14\
By signing this pennit/application, I agree to call for an inspection(s) as required (726-3769). I state thRt
all infonnation on this application/penn it is correct and that I was provided with the Wood Stove SRfety
infonnation for wood burning appliances and preliminary inspection standards. I further state that the
appliance'l lIII1 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 'lumber to the inspector at the time of inspection. I also understand that if IlIII1 requesting a
preliminary inspection, the wall covering may be required to be removed.
iiud M ~~
Signature 7
Expires:
FOR OFFICE USE
REQUIRED INSPECTION(S): WOODSTOVpjpELL~
Date of Application: 1(/ J..'fl '1 r ~ #:
Total Amount Collected: tf (. S-V Receipt #: 0'3 C. 2..fS-z.
Checked for Delinquencies:
Checked for Historical Status:
/(-;Ltf-97
,
Date
PRELIMINARY Y' (. ?-'j<15"~pJ
qCj/(.() (, . /7---
Issued By: d tJk