HomeMy WebLinkAboutPermit Mechanical 1993-11-9
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~OOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Job Location: I 00 r:.,vc?~nlro. fe, t9Y'-
Assessors Map 1I: /7 f) 3 2.. ;)., '2., ~
Ollner: :5fflAI'(;&I'I'7 Rr"'C\ld-Q.v
Address: /00' c,....,p ", , I" I p
Ci ty: c"n.r .:" <-..t,:" fA State: 0 t<'
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Value of ~ood Stove/Pellet Stove~ ItnCV--
(please circle appropriate a~~:l~nce)
Office:
INSPECTION LINE:
726-375.9
726-3769
Tax Lot 1I:
:ib4oo
Phone 1I: 7'f~ -2!S'~
Zip:
Preliminary ,Inspection is~5.GO (prior to installation of insert)
~ood Stove/Pellet/Insert Permit is $15.00 + $10.00 Issuance + $.75 state surcharge.
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Phone 1I: 4GS; 3Cfoo
Zip: 97tJ-g 7
Expires: 7 -1<1
Type of Inspection Requested:
Contractor: (' a\/p~,/'l
{.,i15: Li ne
(l""/flS.+""I<'_[,;"'"
Address: 'Do ~ ~lJ/')
t!fV1 <2-r-......
Construction Contractors Registration
/)R..
1I: 9ZR24
City:
State:
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 lias provided with the ~ood Stove Safety information for IIood 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
may be required to be removed.
'~'7/S_.Y~
FOR OFFICE USE
REQUIRED INSPECTION(S): ~OODSTOVE/PELLET/INSERT~
Date of Application: II - 7' - 7 ,)
Total Amount Collec ted: ?c::;: 7 J
Job 1I:
//~ 09 -Cf?
Date
PRELIMINARY
9J/7/ /
Receipt 1I:
//J9?4-'l
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Checked for Historical Status: ~
Issued By:
Checked for Delinquencies:
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