HomeMy WebLinkAboutPermit Mechanical 1998-7-29
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225 Fifth SU"eet
Springfield, Oregon 97677
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\/000 ~T(lVE/INSERT INSPECTIONintalllB~0010throughOAR9
CITY OF SPRINGFEILD 0090. You may obtain copies of the r
BUILDING SAFETY DIVISION calling the center. (Note: the telephone
number for the Oregon Utility Notification .
CenterJs 1-800-332-2344). Offlce:.
. . INSPECTION LINE;-
., ATrENTtON:Oregon law requires y~'Nc;FIE'-O
"'I . liIit
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.726.-3759
726-3769
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Job Location: S"qi rkwJ\+oV' S+.
Assessors Map ~: /7 II )'\ 4/7" . .
. Ta>: La t ~: 0 '(2.60
Ovner: . ~y-va : CO()K
Address: ,5qlH~~\+oV\ <;:;t j
CitY:~0x-\Y\Q--r.e\d ,
Value of \load Stove/Peliet.~tove/lnsert:
Phone: ~:
'71.-\(;- 3~qS
S ta te:
or<.
Zip Code: .
nso~
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__._..,_"_~.Preliniinal.y.Inspection.is S15.00 ,(pd6r .to installation 0,(;. insert) __ _._ _. ".
\load ,Stove/Pellet/I(lsen Permit is SI5.00... S.75 state surcharge.. '.$.6S administrative
fee.. S10.00 lssuan~e ~ S26.20 total
Type of Inspection Requested: New ~1J0c)J. .INSe;rt lLo{); AY\s~vy\oJ.e\\
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Contractor: C~\"\S\N\I'\'5\ow De,f\, Ye O\C:\ TowV\ <-,~,. .,.,..
Address: >-31 <10 S (:)o..J\'5S0Vl ~D.. Phone~: '/ ~c;, - 738 Z
City: ~V"-e")w-e{ [ State: of? Zip"C;ode:
Const.ruction Contractors 'Regi'stration 0: 52..,38 I Expires:
,II";'?
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,By signing .this pel-mi (/application, I agree' to . call for inspection(s) as reqllired
(726-3769). I state that all the information .em this permi t/application is correc.t
and .tha t I vas provided \Ii th the \lood Stove Safety' informa tion for \lood burning
appliances arid preliminary inspection standards. I ~urther.state"that_the appliance
I am installing. meets smoke .emission standards as set by the Oregon Department. of.
. Environmental' QuaH ty. or the. .Federal Environn.ental 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 pL-climinary inspection, the \lall covering
may be L"equiL"ed to, be removed. ' NOTICE: .
, THIS PERMIT SHAL
. ~.---~~..,s;? , - ~ ~ AUTHORIZED UNO .~EXPIRE/F:CMW@fji98
Slgna ture , GOMME Ei9a~:i PERMIt IS NdT
NGED .oR IS ABANDONE
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Date of Application:
-z/Jdf'r
U.2A
Job 0:
qf/O 1'1C.
fiy: ~ ?iJfl
Total Amount Collected:
l\e~'eiptll:03411.r
Issued
"Checked, for Oeliquencies:
l
Checked for Historical Status: