HomeMy WebLinkAboutPermit Mechanical 1995-9-6
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SPRINGFIELD
ijOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFEILD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: QY5 ~7,-"';rf~ ]J;-,
Assessors Map ~: /&.?z.. -",~-/y
Owner: 3o{; ,/ZN /21/"d('~
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Address:_95"C;. ,tJ/~;~-
City: ~(/M71 II State: (Qt-
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Value of I/ood Stove/Pellet Stove/Insert: ~ t//I()
Office:
I~SPECTION LINE:
726-3759
726-3769
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Tax Lot ~:
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Phone: ~:
7</6'- 5?'35
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Zip Code:
Preliminary Inspection is $15.00 (prior to installation of insert)
I/ood Stove/Pellet/Insert Permit is $15.00 + $,75 state surcharge +
fee + $10.00 issuance = $26.20 total
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Type of Inspection Requested:
Contractor: Pp/k / S-loye
Address: gfJ9c/~ :DNafP
City: j;JVIJ1/'; ~'tI State:
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Construction Contractors Registration ~:~;2()~~
$.45 administrative
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Phone ~:
??f'6~3505
97Y7 ?
7- '7 ~
Zip Cpde:
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 I/ood 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 <rf
Environmen tal Quali ty or the Federal Environnll~n tal Protec tion Agency and I agree to
provide the testing approval number to the inspector at the time of inspection. I
also underst nd that if I am requesting a preliminary inspection, the wall. covering
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FOR OFFICE USE
REQUIRED INSPECTION(S): I/OODSTOV~LCET/INSERI) .'------ PRELIMINARY
Date of Application: ~J?-;;-
Total Amount Collected: ~~- ~
. Receipt ~:_ /~'7:?9
Checked for Deliquencies:
...----
Checked
Job~: ~ ;;--;;~
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Issued By: ~~
for Historical'~atus:
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