HomeMy WebLinkAboutPermit Mechanical 1993-4-26
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: I \~, I i'J11()FI 1-10'=
Assessors Map II: \ Pi'A[){ 0 \~~
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Owner: b~ () {MI4.(.J;41l . \ CAJKIAl'\
Address: -1.1 ~ ~ LAIlRt--:!- Aut=
City: ~otZ'A.\l' '::,F( Y\ State:
Value of ~OOd StoveAfe;let Sto~~nsert:)
(please circle appropriate ayy:~once)
Tax Lot II: /()CCl(Y')
nt7
z..~q\~
Phone II: ~-Z1 1 Z 7l/7-l'f)("
Zip: q )</77
Preliminary.Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcharge.
Type of Inspection Requested: )=>e€..I1l"."6CJ 'I- FJJf.JA...!..
Contractor:. Lf:;,: ILl '.1 ('~AIS772'JC.~'&)
Address: ~Q~- ~A_"I t:IIA I Phone 1I:~'i?'~-<'I~~
City: (::.,l',l'-AJf-::-- State: r>c Zip: q.,I./D;>
Construction Contractors Registration II: S 77J~r"'" Expires: IIIq3
By signing this permit/applic~tion, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this application/permit is correct and
that I was provided with the Vood Stove Safety information for wood burning
appliances and preliminary inspection standards. I further state that the appliance
I am installing meets smoke emission standards as set by the Oregon Department of
Environmental Quality or the Federal Environmental Protection Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also understand that if I am requesting a preliminary inspection, the wall covering
may be required to b~Lc"'~,
f;'"'lG,L"'H \:<,"c:wc. &, ~ _ u 9" f/P~ JI t-/Jzee,/q \
SIgnature 1 Dat~
FOR OFFICE USE
REQUIRED INSPECTION(S): VOODSTOVE~T/~
Date of Application: 4. 2-l r?'~ Job II:
Total Amount COll:=~:$' 4tJ, f{ 0 . 1
Receipt II: ~~W Issued BY~ f\(f\/'.
Checked for ~linqUencies: ~~.:: for Historical
PRELIMINARY
C( WS'2:R ~
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Status: