HomeMy WebLinkAboutPermit Mechanical 1997-9-23
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Job Location:-1il? 2{) l.AW,J/llfJ6f;
Assessors Map #: /7 t:J..5 2..., 2- "2-
owner:~fo ot. J)f:;I('i'/t rL d>P1U
Address: 1Cn.20 L A-uJAlIt I" (, E'
City: c:: Oftlt.X,Flcd'l State: On....
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Value of Vood Stove~ Stove/In~ ~~---
Preliminary Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge +
fee + $10.00 issuance = $26.20 lal ,.-
Type of In6P:Jjtion Requested: ~ 1'4JAI
Contractor: ((ALf'H Wl6'cSLf)l2B(9( ~llAJ."t"IU.3c.TIlX 1
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Address: <;:'7S' Wl~u ~....
Ci ty: tCu~6JE. State: ~
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Tax Lot #:
A
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. Phone: #:
'14)~ I7ro
q74TJ
Zip Code:
$.45 administrative
Phone
#: lAil>, ~ 091]
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Il./q"')
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Zip Code:
Construction Contractors Registration #:~~~L--- Expires:
By signing this permit/application, I agree to call for inspection(s) as required
(726-3769). I state that all the information on this permit/application is correct
and that' I was provided wi th the Vood Stove Safety information for wood burning
appliances and preliminary inspection standards. I further sta~~\~~ the appliance
I am installing meets smoke emission stanQ~s as set lub,,~~~i~,It\' Department of
Environmental Quality or the Federal E~&~ht~~~i~~~o~~~~~Vand I agree to
provide the testing approval number to tb8l'i~l,1?~.~\\\I'_?,t{~F nm~~ inspection. I
also understand that if I am requesting~~\~pr~i~na~ln~~~~, the wall covering
may be requi red to be removed. p.\)~\-\O D O\'l'S II:
it~~e,__,..,,::~~,:~.~,~~_:.::~~_....,---_.
FOR OFFICE USE
~ PRELIMINARY
REQUIRED INSPECTION(S):
VOODSTOVE/~T/INSE~
#9~7
~,~o
Date of Application:
Total Amount Collected:
Receipt
#: 2-75'"1 J
Job #:
?J7/4'<.3
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Issued
BY:-//~
Checked for Deliquencies:
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Checked for Historical Status:
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