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: