HomeMy WebLinkAboutPermit Mechanical 1992-1-22
VOOD STOVEIINSERT INSPECTION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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225 Fifth S.treet
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: 5/Jb. .S- HlJ2f77'77'.;>ti- ,
Assessors Map II: /~/) J_ I'l d/17)
Owner: 0) 2 ~ - /...t//..e-p
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Address: ;: ~ "l j,- C / ') /,
Tax Lot II:
(.? 'L.. 9/-1
City:
j.LJ/7J
State:
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Phone II: . 74 ? - ~ 7 cJ ~
Zip: q 74';1&
Value of Vood Stove~~ove/Insert:
(please circle approprlate appliance)
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood StovelPelletlInsert Permit. is $15.00 + $ .75 state surcharge +
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$10.00 Issuance,
Type of Inspection Requested: ~~/~/~~
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Contractor:
Address:
Phone II:
City:'
State:
Zip:
Construction Contractors Registration II:
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 applicationlpermit 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 Ouality 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 prellminary inspection, the wall covering
may be required to be removed.
Sign;C'~~f ~^ M' '"
/ - ,;>',,2 -9:::J.
Date
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTO~~NSERT ~ PRELIMINARY
Date of Application: / '- 2.2 - 9 ? Job II: 9 2I'YJ <S /
Total Amount. Collected: "25, 'lS-
Receipt II:
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Issued By:
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Checked for Delinquencies:
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Checked for Historical Status: ~