HomeMy WebLinkAboutPermit Mechanical 1992-12-16
SPRINGFIELD
Preliminary ,Inspection is $15.00 (prior to installation, of insert)
Yood Stove/Pellet/Insert Permit is $15.00+ $10.00 Issuance + ~
11 - ,1fj
Type of Inspection Requested: ~E Lu'(?~
Contractor:, L.~e tJ-, 'I C,,'ll,\t;ea:II~,J
Address :~7\ (UIL5:.el... 1
YOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: 2221l Coc./-J 'tlf.11)6
Assessors Map #: /~~-Z$/'2
Ovner: RKt+I\-lUI" M~ /?, ~S' ~~tJlJ..)
I
Address: 1-221'"\ { ()C H bit
CitY:~R.II.Y"F=IFln State: ()z
Value of \lood Stove~ellet StoVe/Inser~;I\ Z:Z.bQ '?2
(please circle appropriate appliance)
City:
~ u(,(S~
State: rrrJl(
Construction Contractors Registration #: 57ZC:,(')
Office: 726-3759
INSPECTION LINE: 726-3769
Tax
to< t, <?~....
Phone #: 7 Lc' - ~-"?q '3
Zip: C(?(jl/
state surcharge.
Phone
#:lar?-aq(..,V'
Zip: Q7l!O(
Expires: 1I1Q"z
.
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 vas provided vith the Yood Stove Safety information for vood 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 vall covering
~required to be removed.
8!:J'i~,.. (J. Vcl.u.._.o....rJ.a ~k6~(;~~.
Signatu(e ,
FOR OFFICE USE
/ '7 -/6-<7"2...-
7"'& -;;> S-
Issued By: "~~
/JIr '
------ ~ecked for Historical
REQUIRED INSPECTIQN(S): YOODSTOV~LLETiINSERir)
Date of Application:'
Job #:
Total Amount Collected:
Receipt #: ~~,~~
Checked for Delinquencies:
r?_IJdo?"
Date .~
....---
PRELIMINARY
.q 2/7/9-
Status: