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HomeMy WebLinkAboutPermit Mechanical 1995-8-31 ~' . ..' UOOD STOVE/INSERT INSPECTION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: ~fl'J .JA.~"'flt '2..1 Assessors Map #: \ ~~lhS1i) Owner: 6/fJU"-" to', ~'.skt Address: 49''; JAS~".,c KJ City: S;;AJI.""J(.'.nJ State: OIL Value of \lood Stove/Pellet Stove/Insert: /7 7f/~ Phone: #: ~ ~ ?..1~-93.3Y Y Tax Lot #:JJQ.?D\ Zip Code: 9N7,,/'-?7t'JV Preliminary Inspection is $15.00 (prior to installation of insert) \lood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative fee + $10.00 issuance = $26. 2~ t~~al . \\ \ \ 1- 'YP' .f '''P'''''' .."",.d, 'xl/ILO ~ti) \(U\Qj\) contractor:~~ o<\tlL\ ~OJl\\'N\ ~ \e~ \ Address: \)-() \~~ -MC\\C) - \y Phone #: t.oK3'Q2~C) City: ~Cl..-., State: ~ Zip Cpde: C\1l:02.--- Construction Contractors Registration #:_-.v&..CCl6 Expires: /i) -"2K-96' By signing this permit/application, I agree to call for' inspect-ion(s) as required (726-3769). I state that all the information on this permit/application is correct and that I was provided \lith the \lood 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 pr vide the testing approval number to the inspector at the time of inspection. I S) understand that if I am requesting a preliminary inspection, the wall covering y be required to be removed. Date ======================================================================================= . ...EQR OFFICE USE ./ INSPECTION(S): \lOODSTOV~L~~/INSERT t./" PRELI~NARY , Date of Application: A,3\QV Job #: Y D~i2..-l ~tn ,~() , Total Amount col~ted: Receipt #~~~-l) Checked for Deliquencies: Checked \ I - Issued By: r: ~ J for Historical Status: