HomeMy WebLinkAboutPermit Mechanical 1995-8-31
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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: #:
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?..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
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. ...EQR OFFICE USE ./
INSPECTION(S): \lOODSTOV~L~~/INSERT t./" PRELI~NARY ,
Date of Application: A,3\QV Job #: Y D~i2..-l
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Total Amount col~ted:
Receipt #~~~-l)
Checked for Deliquencies:
Checked
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Issued By: r: ~ J
for Historical Status: