HomeMy WebLinkAboutPermit Mechanical 1990-12-14
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SPRINGFIELD
VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477.
Offi~e: 726~3759
INSPECTION LINE: 726-3769
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Job Location:
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. Tax Lot I: () 2- 7 d'D
Assessors Hap ,I:
Owner: . . (\~\\
Address: '-\ S Lo..r'<<...
City: ~ 0./__. ( "'-_ \.,. State: OJ.
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Value of Vood Stove~t Sto0rnsert: L 000 b"
(please circle~:~.la.~ appliance)
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170 ?2-L l../ I
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Phone
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Zip: ex ,"\Q\
Preliminary Inspection is $15.00 (prior to installation of .insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $1.25 state surcharge.
Type of Inspection Requested: ~/~ ,
Address:~ \. ~
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Phone I: \.\ <6 '\. - '\. ~ c;l \
Contractor:
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Ci ty: l:? __. ~ . State: ("")...i<-
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Construction Contractors Registration II: h '\"\ 1 ~
Zip: "\'I.'-\l:l<"
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 also unders.tand that if I am
requesting a pr i - pection, the wall covering may be required to be removed.
Signature I / j~
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Date
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FOR,OFFICE USE
REQUIRED INSPECTION(S): VOODSTOV~ ,X
Date of Application: 12-- I LJ ~/J Job 1I:
Total Amount Collected: 1;/, 7J;
PRELIH~ARY
001470
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Receipt I:~t/l)
Issued By:
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Checked for Delinquencies:
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Checked for lIistDrical Status:
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pelletstove, woodstove. and insert installations - chimney
cleaning - brick and mortar repairs - custom metal work
- dampers - spark arrestors and caps - chimney liners,
tile and stainless - water proofing
CLAXTON'!it
Professional Chimney Service
NAME:
INSTALL DATE:
A. M. IP. M.
ADDRESS:
INVOICE #:
DATE:
AMOUNT DUE:
AMOUNT COLLECTED:
PHONE HOME:
WORK:
DATE COMPLETED:
DIRECTIONS:
TYPE OF JOB (STOVE, INSERT, Z/C, ETC.)
SPECIAL ORDERS(COLORS, TRIMS, ETC.)
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DISCRIPTJON OF WORK TO BE DONE AS DISCUSSED WITH CUST. (SALES I
PERSON)_~~,\~'\\......\,"._ o.c \..J.._J":)n~ ~,\.\,~ ,~<..,....-,
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SUPERVISOR'S
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NOTES:
OTHER MATERIAL NEEDED, NOT ON INVOICE:
INSTALLER'S COMMENTS AND JOB STATUS:
CUSTOMER HAS RECEIVED:
OWNERS MANUAL
BASICS
PERMIT [J YES [J NO
CUSTOMER SIGNATURE
DATE
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CUSTOMER COMMENTS:
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JEFFREY L. CLAXTON
Owner
Lie. #67728
wk.ord
215 E. 38th Avenue
Eugene, OR 97405
(503) 484-9583
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