Loading...
HomeMy WebLinkAboutPermit Mechanical 1996-4-2 VOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth S.treet Springfield, Oregon 97477 . Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: t:1 /13 ,.?(a.Ii..JzJJ._ ~l.t, -1~J. 9;1i/77 Assessors Hap 1I: Tax Lot 1I: Owner: OM ml/L )(J41.L (/ Address:....2.LiJ 3 Of DJ J -"dL .4J;i M i: City:..d;hl;';JJuf)~ .. Value of Vood StoveAl'el1et Stoverrnserp /7J? '7. 00 (please circle appropriate appliance) State: ()~ Phone 1I: 71j0~0~5 Zip: 97477 Preliminary Inspection is $15.00 (prior to installation of insert) . Vood Stove/Pellet/Insert Permit. is $15.00 + $ .75 state surcharge + $10.00 Issuance. Type of Inspection Requested: fl~ /"c?S<be.r-' Contractor: j:).p.f1 I"~I .jIJ},A"; L'J.J Address: P. O. Bt'tfl /o'i , flutp)., City: State: ()/2. Phone 1I: 937-3<;3S Zip: C; 1'13/ Construction Contractors Registration 1I: '13ft:>C" Expires: ->://S /9'1 By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that all information on this application/permit 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 Quality 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 (!1!S~~~~~emoved. . ~111.4/;i/./. YJl.Ilu -'/--1- fG Signaturell 1; Date FOR' OFFICE USE Date of Application: VOODSTOVE~T/INSERT~ -1(2-/]'(- .. ;: I: -:2..<::;. :2- 0 PRELIMINARY REQUIRED INSPECTION(S): Receipt 1I: 2..l9 '/ 2(.. Issued By: c9~CJ~~)1 #-~ Total Amount. Collected: Checked for Delinquencies: Checked for Historical Status: