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HomeMy WebLinkAboutPermit Mechanical 1993-10-19 \/000 STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LIN~/26-3/~ Job Location: .c;r;;; 05 (7 (fJ.-.t.-I'fY J;:rV, Assessors Hap #: \"" C(na~ \ .D lit: D Owner:I)06ser R lj) i.y~1l Address: 043 b,(,4{UE,0 j)i{, Cit,^,,-.Sfe/lUfS ?/Ef,J) State: oE. Value of \lood Stove/tllet StovdInsert:~YK c2.:!5 C;Z J.7 0 (please cirCle appropria te a'i>Pi~"u,,") Tax Lot #: ()~(~rD m. ./P4A--/ I Phone #: W7.i1/- ";;'767 Zip: 77 Lf 77 state surcharge. (615 B~ Construction Contractors State: ~ Phone #: J9j - ()~-33 , Zip: q / L./ I) 'I , ..... .. Expires: /0 - ,;;2.6 -93 Address: / a.-rb- City: '-'" ~ Registration #: Lf&,c:;()r;:- 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 \lood 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 Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the wall covering ma~~= to;;;~moZ)~ If) J /9/93 ~ure U Date I FOR OFFICE USE REQUIRED INSPECTION(S): \lOODSTO~T/INSE~ Date of Application: I D~ / ~...- '1 S Job Total Amount Collected: (j};'L/D, 15 ~PRELIHINARY #: t/:=s /5"'Q7 1/ Receipt #: / D~q Issued By: --------- j( j f) j} ;J!tU.-l- Checked for Delinquencies: Checked for Historical Stat~