HomeMy WebLinkAboutPermit Mechanical 1993-12-28
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VOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
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Assessors Hap II: /?"'l!!73~... ~ .c:.
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~#~ ~ Phone II: -;?I,/C-<::.?~
4"':P~.p State:_~~ Zip: ~/V:;:>)
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Value of Vood Stove/Pellet Stove/Insert: ~-<.. J"'-R ~ "ii"'....... ,##~_~~
(please circle appropriate appliance) ~ M' ~-;t' L7 /
r:W-/ /77/7 .
Preliminary ,Inspection is $15.00 (prior to installation of insert)
Vood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcharge.
Job Location:
Tax Lot II: ~~~
Owner:
Address:
City:
Type of Inspection Requested: ~-'S ?~~ l~~?;f~ ~~ ;~7/.--../J!'~~ef:!?
Contractor: ~#~~"p~:" /~q~,.-....._~,~ -::?~..::>.
Address: T~, 3-:-''''- ~6~ .Phone II: ~ _~~ -; 7~2>
City: V~A::;/_~ State: ~'1 ~ Zip: ??y~ ~
Construction Contractors Registration II: "92~ :2 ~ Expires: 7""'"'5'-sr
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 a'ld preliminary inspection standards. I further state that the appliance
I am install ng meets smoke emission standards as set by the Oregon Department of
Environmenta.l 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
may be required to be removed.
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Date
FOR OFFICE USE
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REQUIRED INSPECTION( S): VQoo031ovt.tf'fil.."t!:T/INSERT
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Date of Application: /2. '-:<"'3-9- ~
Total Amount Collected: ;;!'5:.':>S-
'. Job II:
Receipt II:
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Issued By:
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Cheeked for Historical Status:
-
Checked for Delinquencies: