HomeMy WebLinkAboutPermit Mechanical 1996-12-4
-
.
SPRINGFIELD
VOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth. Street
Springfield, Oregon 97677
Office:
INSPECTION LINE:
726'-3759
726-3769
-
,., Co, "/XJK/YJ~'
'q
Phone: ~:
Zip Code:
. q71f77
Value
S tove/Inser t:
Preliminary Inspection is $15.00 (pdor to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge +
fee + $10.00 issuance = $26.20 total
.'
$.65 administrative
Type of Inspection
Requested: 1._ ~'
/ It W
(J(A
r I i.t
Phone ~:
Contractor:
Address:
Ci ty:
State:
Zip C;ode:
Construction Contractors 'Registration ~:
Expires:
By signing ,this 'pemi t/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and .that I vas provided vi th the Vood Stove Safety. information for vood burning
appliances and prel~minary inspection standards. I further state that the appliance
I am installing' meets smoke .emission standards as set by the Oregon Department of
Environmental Quali ty or the Federal EnvironnH?ntal Protection Agency and I agree to
provide the. testing approval numbel' to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the vall covering
may be required to, be removed.
Signature
bate
=======================================================================================
FOR OFFICE USE
Date of Application:
REQUIRED INSPECTION(S): VOODSTOVE/PELLET/INSERT
1]_1-/-1 V
/6. fJ7)
PRELIMINARY.. t/
II: 16t6/a:; .
---
Job
Total Amount Collected:
"Checked for Deliquencies:
I~..
Issued By: ~
Check.ed for iJistori,cal Status:
11~
Receipt
II: 2.'~f5~