HomeMy WebLinkAboutPermit Mechanical 1993-10-21
18 \ 0 lAu"o/"l ( ~ 15{" ---' M L .
Assessors Map #: \ rt~ ~\
O'Jner: R icJ/lwa i 1)1'r?)! r1 ~~ Ktl-( ~fY
Address: 1810 LfU^5r.riclfL ~f' ~ Phone
City: &, ~0l.. ~ . State: (~~~D\OY\
Value of \lood\t)ea;iiet ~1(5S-D . Bo
(please cir;le appropriate appliance)
,/ ~':-'--~,
Preliminary.Inspection is_$l?,OO (prior to ins~l~tion of insert)
\lood Stove/Pellet/Insert Permi t is---$-t5-:-00#$io.0~Issuance + .s.75
<....- "--.---
Type of Inspection Requested: pro( - p.z;{ leA----
Contractor:_ Mir!\1J.fA /\c:
A~dress: 4\5\ ~~.~kr\ ~tro 0 t
Clty: Q5a.e f\ Q , State: (Q-f.
Construction conQ.actors Registration #: i q "5& L)
\1000 STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location:
\)q,p
726-3759
726-3769
Office:
INSPECTION LINE:
Tax
Lot #: [X)\r[)
#: 7 L/7. L/-P.,(.R3
Zip: q--kl7 7
state surcharge.
Phone
#: ,.'2A ~- ,,~~
qrJ4r) \
Zip:
EXPires:~
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 'Jas provided 'Jith the .\lood Stove Safety information for 'Jood 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
aJ~n understand that if I am requesting a preliminary inspection, the 'JaIl covering
~ay. be\~re uired to bel r/e~ )
\ ~ iD--2-/-q3.-
at~e ) ~ Date
) ./ FOR OFFICE USE
REQUIRED INSPECTION(S): \lOODSTOVE/~NSERT ') ~ PRELIMINARY
Date of Application: ;)-{ ()if t;3 . Job #:
Total Amount Collected: f!i L/ (), 7S-
Receipt #: .J-0 ~,_-:;'/D(P r;;l Issued 'BY: /IJ 1.1 Il~
~
Q3/G/,-C::
-
~
Checked'for Historical Status:
Checked for Delinquencies: