HomeMy WebLinkAboutPermit Mechanical 1995-12-20
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
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(70 ~~t11 /
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Address: 7'7,1 It:rtJV<J
City: S9f(., ;Vc..,-r-:.,'& LlJ
Job Location:
Assessors Hap J:
Tax Lo t ft:
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O...ner:
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Value of Vood Stove/Pellet Stove/Insert:
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Phone: ft: 7.). &, - 9 (", 9Y-
Zip Code: q 7 <.J. 7/
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Preliminary Inspection is $15.00 (prior to installation of insert) -
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative
fee + $10.00 issuance = $26.20 total
State:
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Type of Inspection Requested:
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Address: ,53.) J. fJ1 A,',.) ~
City:J;,,e..;,J4-r- ,'eLn
Contractor:
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Phone ft: 7 Y I,. - t. ;.).:J.. /
Zip Gode: c:; 7 <Iii
d'/77
By signing this peL'mi t/appUcation, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/ap~lication is correct
and that I ...as provided ...i th the \lood Stove Safety information for ...ood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standard:> as set by the Oregon Department of
Environmental Quali ty or the Federal Environmental Protection Agency and I agree to
pr.ovide 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
be requiL-ed to be r ved, , '
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State:
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Construction Contractors RegistL'ation 'ft: .".lIA "7_'/.:{
Expires:
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Date
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'FOR OFFICE USE
REQUIRED INSPECTION(S): \lO~DSTOVE~IN'SERT ~~
Date of Application: 1;2 20 -7:[0
Total Amount Collected: J(() ,d-flJ
Receipt ft: ;2tfltJ ~ v
Job
PM,LIHINARY
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Issued By:
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"Checked for Deliquencies:
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Checked for Ilistorical Status: