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 -
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Value of Yood Stove/Pellet Stove/Insert:
(please circle appropriate appliance)
Tax Lot #: ~
Address:
City:
State:
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Phone #: '"'J6/,/-.&q4"/.<;--
Zip: ,d:?"~;/ ';Y)
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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
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Address: p...&'~,6I1iY 2~/
< =--L! ee:-?A!"-;-y ~5
,7 - - .
,Phone #: 6~-~?/c>
Ci ty: Ec..e:;,;t!!:...-./a:= _ Sta tel
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Construction Contractors Registration #:
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41h~5
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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.
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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:
.......----
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Checked for Historical Status:
.'---.
Checked for Delinquencies: