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HomeMy WebLinkAboutPermit Mechanical 1993-8-13 YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: '7 ~/? /b~# .Jlq. Assessors Hap #: /?-c?3--~~,/':> owner:~~-~,A/E.:';r-+.;(;7 ~#~~~.A:2 - 2~' ~/ -D. - r Value of Yood Stove/Pellet Stove/Insert: (please circle appropriate appliance) Tax Lot #: ~ Address: City: State: #.4'. \ f:CO lei) Phone #: '"'J6/,/-.&q4"/.<;-- Zip: ,d:?"~;/ ';Y) ,; 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: Contractor: C~ ";~y~ - /l/AI-7Y . -'" -, - Address: p...&'~,6I1iY 2~/ < =--L! ee:-?A!"-;-y ~5 ,7 - - . ,Phone #: 6~-~?/c> Ci ty: Ec..e:;,;t!!:...-./a:= _ Sta tel I' Construction Contractors Registration #: ~. 41h~5 . Zip: q>Yb~ /~, '2e~5 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 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 Qualit,y or the Federal Environmental Protection Agency and I agree to provide the testini!,-: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 be removed. hkn_~o ~~: ~ t?/I~/r3' Date FOR OFFICE USE REQUIRED INSPECTION(S): VOODSTOVE~LLET/INSERT)' ~ PRELIMINARY ........ Date of Application: .,J;!-n-'93 Total Amount Collected: Y&'.26----- Job #: '9 -;? /"2/?:> Receipt #: ~~ Issued By: .......---- -4----~- Checked for Historical Status: .'---. Checked for Delinquencies: